Chair: Diponkar Banerjee, PHSA Laboratories, Vancouver, British Columbia

Errors in Cancer Diagnosis Involving Pathologists: Is It All About Slide Reading Skills?

Hardeep Singh, Chief, Health Policy and Quality Program, Houston VA HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Discuss the scope and types of errors in cancer diagnosis where pathologists can be potentially involved;
•  Explain how we can use a systems based approach to advance understanding of cancer-related errors that involve the pathologist;
•  Summarize contributory factors and potential preventive strategies to reduce errors related to cancer diagnosis in pathology.
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Organizational Culture for Patient Safety

Ron Westrum, Emeritus Professor of Sociology, Eastern Michigan University, Ypsilanti, Michigan

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Identify three typical patterns of information flow culture: pathological, bureaucratic, and generative;
•  Leverage the intellectual resources of their unit for better information flow and superior decision-making;
•  Avoid the factors that impede information flow and effective problem-solving.
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Reporting and Responding to Adverse Events Triggered by Errors in the Clinical Laboratory

E. Douglas Bell, Associate Executive Director, Managing Director, Risk Management Services, Canadian Medical Protective Association, Ottawa, Ontario

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Identify common causes of litigation in Clinical Laboratory Medicine;
•  Discuss how to choose between an "Accountability Review" and a "Quality Improvement Review";
•  Explain a process for learning from an adverse event.
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Question and Answer Session with all speakers

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1800-1900

1900-2000

Residents' Symposium at the Fairmont Hotel Vancouver

Residents' Dinner at the Shangri-La Hotel

Co-Chair: Anna Lee

Co-Chair: Ananta Gurung

Financial, Tax and Other Advice for Those Both In and Finishing a Pathology Residency and/or Fellowship

Brian E. Cummings, BBA, CA, MD

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•  Informatics SIG
•  Education SIG

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T501: CPAC: Reporting of Colorectal Polyps – A pan-Canadian Consensus Approach

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Tarek Bismar, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  1. Discuss updates on significant prostate cancer genetic aberrations;
•  2. List potential sub-classification of prostate cancer tumors relative to prognosis and response to therapy;
•  3. Summarize important updates related to novel biomarkers in prostate cancer.
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Victor Tron, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Explain the mechanism of RNA interference;
•  List methods available to measure miRNAs in human tumour samples;
•  Summarize an approach to experimentally and clinically validate a candidate miRNA.
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•  Guillermo Quinonez Seminar on the Medical Humanities
•  International Health – Assisting the Development of Pathology in Low Resource Nations

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T601: GE Healthcare Canada Presents

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Chair: Michele Weir, London Health Science Centre, London, Ontario

Staying Out of Hot Water: Risk Management and Cytopathology

Susan Swiggum, Senior Physician Risk Manager, The Canadian Medical Protective Association, Ottawa, Ontario

Click here for Objectives of this session

As a result of attending this session, the participant will be able to:
•  Discuss how to respond to an adverse event in Cytopathology.
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Refreshment Break

Celebration of Cytology in Canada: From the Last 50 Years to the Next

Past, Current and Future CSC Chairs

1980s – Dr. Vicky Chen

1990s – Dr. Maire Duggan

2000s – Dr. Meg McLachlin

2010s – Dr. Michele Weir

Future – Dr. Karim Khetani

Click here for Objectives of this session

At the end of this session, the participant will be able to:
•  Discuss evolving role of cytology in Canada over the last 50 years;
•  Identify future trends in cytology practice in Canada.
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Chair: Marciano Reis, Sunnybrook Health Sciences Centre and University Health Network, Toronto, Ontario

Molecular Mechanisms of MDS Pathogenesis

Aly Karsan, BC Cancer Agency, Vancouver, British Columbia

Click here for Objectives of this session

At the end of the session, participants will be able to:
•  Describe the cellular phenotype of MDS;
•  Understand the Pathogenesis of 5q-syndrome;
•  Describe common mutations in MDS
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Refreshment Break

Diagnostic Difficulties in Myelodysplastic Syndromes

Alden Chesney, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  List the specific entities considered within the category of myelodysplastic syndromes and compare their general features;
•  Identify the challenges to proper classification: unclassifiable cases, provisional entities, mimics;
•  Discuss the importance of integration of morphology, cytogenetics, flow cytometry and molecular testing to facilitate early diagnosis, correct classification and further understanding of disease biology.
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Chair: Dan Holmes, Providence Health Care, Vancouver, British Columbia

Click here for Objectives of this symposium

Understand the basic process of proteomic biomarker discovery from an analytical perspective:
•  Problems of the dynamic range
•  Targeted versus non-targeted approaches
•  Sample fractionation and separation methods: high abundance protein depletion, 1DLC, 2DLC, 2D-DIGE
•  Understanding mass spectrometric approaches: iTRAQ and SILAC
•  Choosing an appropriate peptide to quantitate: hazards and pitfalls
Coping with too much data:
•  Statistical and machine learning approaches to sieving out useful biomarkers from all candidates
•  Developing computer algorithms to cope with a multimarker approach
Translation:
•  Why translation is difficult
•  Why proteomic assays may show poor correlation with ELISA or other immunoassay
•  Barriers to translating a multimarker proteomic assays to the clinical laboratory from the perspective of assay validation and regulatory approval
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Novel Methods for Clinical Proteomics

Christoph Borchers, Facility Director, UVic-Genome B.C. Proteomics Centre, Victoria, British Columbia

Click here for Objectives of this session

At the conclusion of this session, participants will understand:
•  1) Principles of Multiple Reaction Monitoring (MRM) and Matrix Assisted Desorption/Ionization (MALDI) mass spectrometry in proteomics;
•  2) immunoMALDI (iMALDI) for absolute quantitation of low abundance proteins in high-throughput;
•  3) Multiplex and robust MRM assays for biomarker validation and discovery.
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Click here: Dr. Christoph H. Borchers biography

Christoph H. Borchers, Ph.D.
Dr. Borchers received his B.S., M.S. and Ph.D. from the University of Konstanz, Germany. After his post-doctoral training and employment as a staff scientist at NIEHS/NIH/RTP, NC and he was the director of the Duke – UNC Proteomics Facility and held a faculty position at UNC Medical School in Chapel Hill, NC (2001-2006). Since then Dr. Borchers is employed at University of Victoria (UVic), Canada and with the current position of Professor in the Department of Biochemistry and Microbiology. He is also the Director of the UVic – Genome Proteomics Centre, which is one out of six Genome Canada funded Science & Technology Innovation Centre and the only one solely devoted to proteomics. His research is centred around the improvement, development and application of proteomics technologies with major focus on techniques for quantitative targeted proteomics for clinical diagnostics. For this research, multiplexed LC-MRM-MS approaches and the immuno-MALDI (iMALDI) technique are of particular interest. Another focus of Dr. Borchers’ research is centred on technology development and application of the combined approach of protein chemistry and mass spectrometry for structural proteomics. Dr. Borchers has published more than 100 peer-reviewed papers in scientific journals and is the founder and CSO of two companies, Creative Molecules. Inc. and MRM Proteomics Inc. He is also involved in promoting proteomic research and education through his function as HUPO International Council Member, co-leader of the British Columbia Proteomics Network and President of the Canadian National Proteomics Network.
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Genomics and Proteomics in the Assessment of Transplant Rejection

Janet Wilson-McManus, Centre of Excellence for the Prevention of Organ Failure (PROOF Centre), Vancouver, British Columbia

Click here for the Overview of this session

This lecture will describe a new way of using the field of “-omics” (genomics and proteomics) for discovering and implementing blood tests to improve patient management. The example of discovering and validating genes and proteins to be used as a blood-based test for rejection in heart and kidney transplantation will be discussed. The challenges in implementing new blood tests for this purpose will be presented.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  1) Appreciate the challenges in bringing on new blood biomarker tests into clinical use;
•  2) Understand a new definition of blood biomarkers and how they can be used to improve patient management.
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Click here: Janet Wilson-McManus biography

Janet Wilson-McManus
Janet Wilson-McManus serves as Chief Operating Officer for the Centre of Excellence for the Prevention of Organ Failure (PROOF Centre). The PROOF Centre is a not-for-profit society with a mission to discover, develop, commercialize, and implement biological markers (biomarkers) to prevent, diagnose, and treat heart, lung and kidney failure. Janet brings more than 25 years of hands-on research and program management experience from the clinical laboratory and basic and translational health research environments. Over the last decade, Janet has been instrumental in bringing in large-scale funding of more than $60 million of infrastructure and operating funds to the UBC community. All programs involved partner engagement and funding from academia, health care, industry, and private foundations. Janet is a co-author on more than 80 full length publications and chapters. Janet obtained her Bachelor of Science degree in Biology and Chemistry from the University of Southern Colorado and a Bachelor of Science in Medical Technology as well as post-graduate courses in Statistics at the University of Nebraska Medical Center. Janet also has training as a facilitator and in the Legacy Leadership model. Janet is a member of the Society of Cardiovascular Pathology, the Society for Research Administrators, and the Project Management Institute.
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Roadmap to Biomarker Discovery Using Proteomics

Vathany Kulasingam, University Health Network, Toronto, Ontario

Click here for the Overview of this session

This lecture will describe the process of biomarker development using proteomics – from discovery to validation to commercialization. Specific examples from our laboratory will be given to highlight the various phases of biomarker development. The major hurdles to overcome to bring a marker into the clinic will be discussed.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Understand the various steps of biomarker development and the importance of novel technologies such as mass spectrometry to play a critical role in these phases;
•  Appreciate the lengthy and difficult task of bringing a biomarker to the market.
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Click here: Dr. Vathany Kulasingam biography

Vathany Kulasingam, Ph.D.
Dr. Vathany Kulasingam completed her PhD at the Department of Laboratory Medicine and Pathobiology, University of Toronto, under the leadership of Dr. Diamandis. Her doctoral thesis focused on discovery and validation of novel breast cancer biomarkers by use of tissue culture model systems, in association with quantitative mass spectrometry. Following her PhD, she completed a post-doctoral training diploma program in Clinical Chemistry at the University of Toronto. Dr. Kulasingam is currently an academic clinical biochemist at the University Health Network and an Assistant Professor at the Faculty of Medicine, University of Toronto. Her current interests include novel tumor biomarker discovery and application of proteomics to clinical practice.
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Chair: Diponkar Banerjee, PHSA Laboratories,Vancouver, British Columbia

Malcolm Hayes, BC Cancer Agency. Vancouver, British Columbia

Click here for Objectives of this session

At the end of this session, the participants will be able to:
•  Discuss the current thinking concerning the multifocal origin of breast cancer and the origin of Paget’s disease;
•  Diagnose microglandular adenosis, acinic cell carcinoma and adenosquamous carcinoma;
•  Have an approach to solve the problem of a small cell neoplasm of the breast.
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Refreshment Break

Controversial Concepts and Diagnostic Challenges in Breast Pathology

Maria-Pia Foschini, University of Bologna, Bologna, Italy

Click here for Objectives of this session

At the end of this session, the participants will:
•  Be familiar with current thinking concerning the multifocal origin of breast cancer, the different origins of Paget’s disease, the evolution of forms of low-grade breast cancer;
•  Recognize the overlap between myoepithelial and epithelial neoplasms of the breast, and the overlap between breast cancer and salivary gland neoplasms;
•  Approach some diagnostically challenging cases.
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Chair: Morris Pudek, Division of Clinical Chemistry, Vancouver General Hospital, Vancouver, British Columbia

Click here for Objectives of this symposium

•  To understand the impact of our aging population on the prevalence of chronic disease and organ system dysfunction and its consequent healthcare resource implications
•  To review the hypothesized biochemical mechanisms leading to Alzheimer’s disease and the use of biomarkers for early detection
•  To review the pathogenesis of chronic kidney disease in the elderly, the increased susceptibility of the aging kidney to acute injury and the use of laboratory testing to recognize this problem
•  To recognize the prevalence, causes, diagnostic, monitoring and screening strategies and therapeutic approaches to osteoporosis in the elderly
•  To understand the contribution of the failing endocrine system to the aging process and the part laboratory testing can play to recognize and manage this problem
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Toward biochemical prediction of Alzheimer's Disease

Cheryl Wellington, Department of Pathology and Laboratory Medicine, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia

Click here for the Overview of this session

Alzheimer’s Disease (AD) is the one of the leading unmet medical needs in the aging population with over 100 million cases anticipated within by 2025. AD pathogenesis is estimated to begin approximately 10-15 years prior to the onset of clinically detectable dementia. Because this pre-clinical stage represents a critical window where potential disease-modifiying therapies may block or slow further progression into clinical dementia, accurate and reliable tools to measure the molecular and cellular changes associated with the earliest stages of AD are highly desirable. As cerebrospinal fluid (CSF) is in direct contact with the brain, examination of the CSF proteome offers an opportunity to develop diagnostic and prognostic biomarkers for AD, particularly in conjunction with neuroimaging. CSF Aβ42, and tau levels are showing promise as a diagnostic marker for clinical AD and in predicting its neuropathological state and trajectory. Additional biomarkers are being sought using unbiased proteomic approaches to improve staging and prognostic accuracy. This presentation will review the status of current AD biomarkers, including how these may be modified by lifestyle practices such as exercise.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  To understand the natural history of AD along clinical, pathological, neuroimaging and CSF biomarker trajectories.;
•  To understand how CSF Aβ42 and tau levels change during the pathogenesis of AD;
•  To understand the impact of exercise on cognition, AD pathophysiology and biomarker levels.
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Click here: Dr. Cheryl Wellington biography

Cheryl L. Wellington
Dr. Wellington obtained her PhD in Microbiology at the University of British Columbia in 1991 and did postdoctoral training at Harvard Medical School, the University of Calgary, and the University of British Columbia. She joined the Department of Pathology and Laboratory Medicine at the University of British Columbia in 2000 and was promoted to Associate Professor in 2006. Dr. Wellington’s research interests encompass include lipid and lipoprotein metabolism in the brain and how this relates to chronic and acute neurological disorders. Dr. Wellington’s group has made key contributions to the understanding of the role of apolipoprotein E (apoE) in Alzheimer’s Disease. ApoE is the major cholesterol carrier in the brain and the best established genetic risk factor for late-onset Alzheimer’s Disease. However, the mechanisms by which apoE affects Alzheimer’s Disease pathogenesis is poorly understood. Dr. Wellington’s laboratory has shown that the amount of lipids carried on apoE affects the metabolism of Aβ peptides, which are toxic species that accumulate as amyloid plaques in the brains of patients with Alzheimer’s Disease and also accumulate in individuals who have suffered traumatic brain injury.
Specifically, Dr. Wellington has identified the cholesterol transporter ABCA1 as the physiological transporter of lipids onto brain apoE. Her group has shown that mice deficient in ABCA1 have poorly-lipidated apoE in the brain and develop more amyloid, whereas transgenic mice that overexpress ABCA1 have lipid-rich apoE and have virtually no amyloid deposits. Her current research projects are aimed at developing methods to increase apoE lipidation in the brain for application to both Alzheimer’s Disease and traumatic brain injury.
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Endocrinology and Aging

Dan Holmes, Department of Pathology and Laboratory Medicine, St. Paul’s Hospital and the University of British Columbia, Vancouver, British Columbia

Click here for the Overview of this session

This session will review the normal phusiological changes associated with the aging of the Endocrine systems and will focus on matters pertinent to the Clinical Chemist and Medical Biochemist – ie. How this would affect the setting of normal ranges and the interpretation of endocrine tests. Special attention will be paid to the thyroid, adrenal, and growth hormone/1GF-1.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Have an awareness of when age dependent reference values will be necessary and generically describe how one would approach this from a statistical perspective;
•  Give a focused differential diagnosis for derangements in routine endocrine tests that take into account the patient’s age.
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Click here: Dr. Daniel Holmes biography

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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Refreshment Break

The Aging Kidney

Adeera Levin, Providence Health Care, Vancouver, British Columbia

Click here for an Overview of this session

This presentation will review the pathogenesis of kidney disease in the elderly, the unique susceptibility of elderly to AKI and accelerated CKD progression and laboratory testing strategies that may be useful.
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Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Understand the pathogenesis and etiology of CKD in the elderly;
•  Understand the incidence and prevalence of AKI (Acute kidney injury) in the elderly and reasons for it;
•  Understand the utility of laboratory testing in diagnosis of CKD and AKI in the elderly population, with particular attention to the usefulness of uACR.
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Click here: Dr. Adeera Levin biography

Adeera Levin
Dr. Levin is Professor of Medicine at University of BC, and Executive director of the BC Provincial Renal Agency, charged with fiscal and organizational responsibilities for renal patient care.
She is the Chair of Curriculum Committee for the National KRESCENT (Kidney Research and Education SCientist EducatioN Training program). She is Secretary General of the International Society of Nephrology,and serves on KDIGO, an international guideline development group. Research and clinical activities are focused on CKD, co morbidities in CKD, mechanisms of disease and health outcomes research. She actively mentors young investigators in CKD related research.
She was awarded the Providence Health Care Senior Scientist Research Mission Award in 2008, and the Kidney Foundation of Canada John Dossetor Research Mission award in 2009 for her contributions to Canadian nephrology research.
She has over 200 peer reviewed publications, numerous book chapters, and is on the editorial boards of NDT, CJASN and AJKD. She is subject editor for CKD in NDT. She reviews papers for numerous nephrology journals as well.
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Bone Disease and the Elderly

David Kendler, Director, Clinical Research Centre, The Osteoporosis Centre of British Columbia, ProHealth Clinical Research, Vancouver, British Columbia

Click here for an Overview of this session

After an introduction to bone biology and pathophysiology of osteoporosis, the presentation will cover fracture risk assessment and new paradigms of determining need for pharmacoltherapy. These include the FRAX 10-year absolute fracture risk calculator as well as the WHO diagnostic criteria for osteoporosis. The effects of medications on measured parameters (Bone Density, Bone Turnover Markers) will be discussed.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Appreciate the clinical tools to assess fracture risk and determine the need for medications in elderly persons at risk of fragility fracture;
•  Understand the effects of medications on Bone density and Bone Turnover Markers.
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Click here: Dr. David Kendler biography

David L. Kendler MD
Dr. Kendler graduated from the MD program at the University of Toronto in 1977. After completing a rotating internship in Toronto, he practiced for several years in Canada, Botswana, and New Zealand. He returned to Internal Medicine training in 1983 in Christchurch, New Zealand and in 1984 joined the Internal Medicine program in Halifax, Canada. In 1985 he moved to Vancouver to complete Internal Medicine and Endocrinology training at the University of British Columbia. After a 2-year thyroid immunology Fellowship in New York, he returned to the University of British Columbia Faculty of Medicine where he is now an Associate Professor of Endocrinology. He has led osteoporosis clinics at Children and Women’s Hospital; St. Paul’s Hospital and currently directs the Osteoporosis Program at Providence Health Care. He is the director of Prohealth Clinical Research, a major North American centre for clinical trials in the area of osteoporosis. He serves on the Scientific Advisory Council of Osteoporosis Canada, is Medical Advisor to the Thyroid Foundation of Canada, and Chairs the Western Osteoporosis Alliance. He is the Past-President of the International Society for Clinical Densitometry and the British Columbia representative to the Canadian Society of Endocrinology and Metabolism. He is a member of the Committee of Scientific Advisors of the International Osteoporosis Foundation. He has published over 60 peer-reviewed manuscripts on osteoporosis therapies, osteoporosis risk assessment technologies, and autoimmune thyroid disease.
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T701: Eli Lilly Canada: Practical Application of Histology and Biomarkers in NSCLC

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Chair: Anne O’Brien, St. John Regional Hospital, St. John, New Brunswick

Peritoneal Implants From Serous Borderline Tumor of Ovary

Stanley J. Robboy, Professor and Vice-Chairman of Pathology, Duke University Medical School and President-Elect, College of American Pathologists, Durham, North Carolina

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Define and characterize borderline serous tumors of ovary, including variants;
•  Differentiate the various type of peritoneal implants, including benign from malignant/invasive;
•  Recognize müllerian inclusion cysts in lymph nodes are metastases, but with little clinical import.
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Mucinous Tumors of the Ovary: Mucinous Borderline Tumor and Its Mimics

Blake Gilks, Vancouver General Hospital, Vancouver, British Columbia

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  List criteria for distinguishing between mucinous borderline tumor of intestinal type (MBTIT) MBTIT with intraepithelial carcinoma, MBTIT with microinvasion mucinous carcinoma with expansile pattern of invasion and mucinous carcinoma with destructive invasion;
•  Summarize the treatment implications of a diagnosis of MBTIT or mucinous carcinoma;
•  List features that support a diagnosis of metastatic mucinous carcinoma versus primary ovarian mucinous tumor;
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Interactive Session (Drs. Robboy and Gilks)

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Co-Chairs:
Benjamin Jung, Pathology and Laboratory Medicine, Children’s and Women’s Hospital Centre of BC, Vancouver, British Columbia
Andre Mattman, Department of Pathology & Laboratory Medicine, St. Paul’s Hospital, Vancouver, British Columbia

Click here for Objectives of this symposium

After attending this Symposium, participants will:
•  Understand current state of practice in laboratory medicine with regard to newborn screening and maternal fetal medicine
•  Be aware of evolving standards of care in clinical and laboratory practice with regard to maternal fetal medicine
•  Be updated on recent progress in defining appropriate reference intervals in the neonatal and pediatric populations
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Laboratory Needs in the Labour and Delivery Room

Alain Gagnon, Children’s and Women’s Hospital Centre of BC, Vancouver, British Columbia

Click here for the Overview of this session

This lecture will review techniques helpful to the obstetrician-gynecologist and maternal fetal medicine specialist in the diagnosis of common obstetrical problems.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Understand the clinical implications of GBS carriage in labour;
•  Describe the data available around GBS rapid testing in labour;
•  List clinical and laboratory tools used in the prediction and diagnosis of preterm labour and preterm premature rupture of membranes.
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Click here: Dr. Alain Gagnon biography

Alain Gagnon
Education:
1985-89: Medical school, University of Sherbrooke, Quebec
1989-94: Residency training in Obstetrics and Gynecology, University of Sherbrooke, Quebec
1994-96: Fellowship in Maternal-Fetal Medicine, University of British Columbia, Vancouver, British Columbia
1996-97: Research fellowship, St-George’s Medical School, London, United Kingdom
Current affiliations:
• Clinical Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, BC Women’s Hospital, University of British Columbia
• Senior Medical Director, Ambulatory Programs, BC Women’s Hospital
• Chair, Meeting Planning Committee and Board Member, International Society on Ultrasound in Obstetrics and Gynecology
• Chair, Subspecialty Committee, Association of Professor in Obstetrics and Gynecology of Canada
• Vice-Chair, Maternal-Fetal Medicine Specialty Committee, Royal College of Physicians and Surgeons of Canada
Dr Gagnon has been with the Division of Maternal-Fetal Medicine at UBC since 1997.
Clinical and research interests:
Multiple pregnancies; Twin-to-Twin transfusion syndrome; Prenatal invasive diagnostic and therapeutic procedures; Obstetrical ultrasound.
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Preeclampsia: Do we have the tools to implement screening early in pregnancy?

Jean-Claude Forest, MD, PhD, FRCPC, FCACB, Service de biochimie, CHUQ-Hôpital Saint-François d’Assise, Québec, Québec

Click here for the Overview of this session

Preeclampsia (PE) and other hypertensive disorders of pregnancy remain a leading cause of adverse outcomes. Their pathophysiology remains elusive, hampering the development of efficient preventive interventions. Moreover, PE appears quite heterogeneous with regard to onset and severity of clinical manifestations. Delivery is still the only definitive treatment, reducing maternal complications but increasing morbidity in the newborn. The advent of early preventive measures, such as low-dose aspirin targeting high-risk women, emphasizes the need of better detection. Until recently, only environmental information and maternal risk factors were used, with equivocal predictive value. There were no validated screening procedures to identify at-risk women despite the emergence of promising ultrasonographic parameters and newly discovered potential biochemical markers. Parameters obtained through Doppler ultrasonography of the uterine artery such as the pulsatility index and bilateral notching and newly-assessed putative biochemical markers linked to the pathophysiological processes (angiogenesis, inflammation, endothelial dysfunction) represent encouraging new avenues. Due to its heterogeneity and the lack of specificity and/or sensitivity of existing markers (> 200 studied so far), it is unlikely that PE could be detected early by a single parameter. Indeed, systematic reviews have concluded that there were no single test capable to fulfill the criteria set by WHO for selecting biomarkers to diagnose/predict a disease. However, recent research reveals that by combining various data (antenatal risk factors, clinical parameters, biophysical and biochemical markers) into multivariate algorithms, it is possible to estimate the risk of PE with performance levels that would reach clinical utility and cost-effectiveness. Performance characteristics of various algorithms including markers such as sFlt-1, PlGF, PAPP-A, inhibin and ultrasonographic parameters will be presented and discussed with regard to transferability in different geographic and health care environments.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to appreciate:
•  The most recent hypothesis on the pathophysiology of preeclampsia;
•  The choice of putative predictive biomarkers and their performance;
•  The strengths and weaknesses of different screening strategies.
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Click here: Dr. Jean-Claude Forest biography

Jean-Claude Forest, MD, PhD, FRCPC
Jean-Claude Forest, MD, PhD, FRCPC, is Professor of Medical Biochemistry at the Faculty of Medicine of Laval University, member of the Service of Medical Biochemistry, acting Director of the Research Center and assistant director general for medical and university affairs and of the Centre de recherche du Centre Hospitalier Universitaire de Québec, Québec, Canada. He has directed numerous longitudinal studies related to the development and the evaluation of the performance of candidate biological markers for screening and diagnosis of disorders affecting pregnancy and child development, such as Down syndrome and preeclampsia. He is particularly interested by the long-term impact of preeclampsia on the mother and the child. He is currently the leading investigator of “Healthy Pregnancy Team”, a research program sponsored by the Canadian Institutes for Health Research studying prospectively a cohort of 8 000 women and children from pregnancy to early childhood with regards to various adverse outcomes. Over the years, he has become an expert in Clinical Laboratory Standardization and Metrological Traceability. This expertise has brought him to leading international positions such as Chair of the Executive Committee of the Joint Committee on Traceability in Laboratory Medicine (JCTLM), Chair of the Scientific Division of the International Federation of Clinical Chemistry in Laboratory Medicine (IFCC) and IFCC representative on the Expert Committee on Biological Standardization of the World Health Organization (WHO).
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Refreshment Break

New Approaches to Neonatal Screening

Graham B. Sinclair, Biochemical Geneticist, Newborn Screening Lab, BC Children’s Hospital, Vancouver, British Columbia

Click here for the Overview of this session

The application of tandem mass spectrometry to routine newborn screening has greatly increased the number of disorders that can be screened, but has also led to an increase in overall false positive rates. This lecture will discuss multi-tiered testing as an approach to improve screening test performance and will present the British Columbia experience with implementing such an approach for a number of disorders, Emerging technological advancements that may allow further expansion of the panel of disorders amenable to population-based screening will also be discussed.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Understand the impact that expanded newborn screening has had on overall test performance;
•  Appreciate the multi-tiered approaches that are being implemented to improve test performance;
•  Appreciate some of the emerging technologies that will facilitate a further expansion of newborn screening test panels in the near future.
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Click here: Dr. Graham B. Sinclair biography

Graham B. Sinclair, PhD, FCCMG
I completed a PhD in molecular biology at the University of Victoria in 2001 with work on mutation analysis and heterologous protein expression in Gaucher Disease, an inherited lysosomal storage disorder. This work was followed-up with a postdoctoral fellowship at UBC where I developed a conditional knockout mouse model of Gaucher Disease and utilized proteomic approaches to identify a novel biomarker for the mucopolysaccharidoses (MPS). In 2004, I started a clinical fellowship in Biochemical Genetics at BC Children’s Hospital and was certified by the Canadian College of Medical Geneticists in 2008. Since 2007 I have functioned as the clinical laboratory scientist for the BC Newborn Screening Laboratory where I have overseen the expansion of the program from 4 to 22 screened disorders as of 2010, including the introduction of a number of tandem MS-based second-tier screening tests. In addition to newborn screening, I also oversee all tandem MS-based clinical testing including method development, validation, and sign-out of clinical testing results. My research interests focus on the application of tandem mass spectrometry to diagnosis of inborn errors of metabolism and a fatty acid oxidation variant common to coastal BC First Nations and associated with an increased risk of sudden death in infancy.
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CALIPER: a Canada-Wide Initiative to Close the Critical Gaps in Pediatric Reference Intervals

Khosrow Adeli, The Hospital for Sick Children, University of Toronto, Toronto, Ontario

Click here for the Overview of this session

This lecture will review the critical gaps that currently exist in pediatric reference intervals and discuss the activities of the recently established CALIPER program to address these major gaps. Canada-wide collaborative efforts among 7 pediatric centres will be reviewed and new reference interval data from recent CALIPER studies will be presented.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  1) Appreciate the major gaps that currently exist in pediatric reference intervals;
•  2) Learn the goals and study design of the CALIPER (Canadian Laboratory Initiative in Pediatric Reference Intervals) program;
•  3) Understand the influence of age, gender, BMI, and ethnic origin on biochemical tests in children, adolescents, and teens.
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Click here: Dr. Khosrow Adeli biography

Khosrow Adeli, Ph.D., FCACB, NACB, DABCC
Dr. Adeli is currently head and full professor of Clinical Biochemistry at the Hospital for Sick Children and the Departments of Biochemistry, and Laboratory Medicine & Pathobiology at the University of Toronto in Toronto, Canada. He is also the Director of Point of Care Testing program at the Hospital for Sick Children in Toronto. Dr. Adeli is a fellow of the Canadian Academy of Clinical Biochemistry and a diplomate of the American Board of Clinical Biochemistry. Dr. Adeli served as the Editor-in-Chief of the Clinical Biochemistry journal for 7 years (1999-2006). He is an editorial board member of the Clinical Biochemist Reviews. He is currently the President of COMACC, the Commission on Accreditation in Clinical Chemistry, a North American organization responsible for accreditation of clinical chemistry training programs in the USA and Canada. He serves as the Vice-Chair of Publications and Communications Division of the International Federation of Clinical Chemistry (IFCC), as well as the Public Relations Coordinator for the IFCC organization.
He has been actively involved in both basic and clinical laboratory research since 1988 and has published over 200 articles and abstracts to date. He has received several national and international awards for research excellence including the Merck Senior Investigator Award of the Canadian Lipoprotein Conference (2008), the Canadian Society of Clinical Chemistry National Award for outstanding contributions to clinical chemistry (2006), Canadian Academy of Clinical Biochemistry National Award (2004), the Canadian Society of Clinical Chemistry Research Excellence Award (1999), Bristol-Meyers Squib Young Investigator (1995), the Merck Senior Investigator Award (1997), and the Simon-Pierre Noel Award (2001) from the Canadian Lipoprotein Conference.
His basic research program is focused on the link between insulin resistant diabetes and dysregulation of lipoprotein metabolism. His group has particularly focused on elucidating the molecular mechanisms linking diet-induced insulin resistance and metabolic dyslipidemia. His laboratory is employing animal models of insulin resistance to investigate the molecular mechanisms mediating the diabetogenic effect of fructose-rich diets, mechanisms of fructose-induced hepatic insulin resistance, and pathways leading to hepatic and intestinal lipogenesis and lipoprotein dysregulation. Dr. Adeli holds research operating grants from the Canadian Institutes of Health Research (CIHR), Natural Sciences and Engineering Research Council of Canada (NSERC), the Heart and Stroke Foundation of Ontario, Merck, AstraZeneca, Pfizer, Abbott Diagnostics, Roche Diagnostics, Resverlogix, and Amgen.
Dr. Adeli is also active in clinical chemistry research and has been involved in a number of projects on diagnostic test development projects. He is the principal investigator of the CALIPER (Canadian Laboratory Initiative on Pediatric Reference Interval Database) project aimed at the establishment of a laboratory reference interval database for biomarkers of pediatric disease. This is a national initiative involving a network of several clinical laboratory investigators from pediatric health care centers from across Canada. Standardized age- and gender-specific reference intervals are being established involving pediatric health care centers across Canada. This valuable database will also be useful to pediatric health care centers worldwide as significant gaps exist in the available database in both developed and developing countries.
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Chair: Michael Pollanen, University of Toronto and Office of the Chief Coroner of Ontario, Toronto, Ontario

Introduction to the Autopsy as it Relates to Drug Relatd Deaths

Christopher Milroy, University of Ottawa, The Ottawa Hospital, and Ontario Forensic Pathology Service, Ottawa, Ontario

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Approach the autopsy in a potential drug related death in a systematic manner and understand patterns of drug use on external examination;
•  Understand the microscopic appearances that drugs may produce on the body;
•  Explain the difficulties of interpreting post-mortem toxicology.
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Amphetamines, Ecstasy and New Drugs

Christopher Milroy, University of Ottawa, The Ottawa Hospital, and Ontario Forensic Pathology Service, Ottawa, Ontario

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Understand the different types of amphetamine like drugs in use;
•  Understand the macroscopic and microscopic appearances that ecstasy and related drugs cause and discuss difficulties in interpreting toxicology;
•  Summarize the changing patterns of drug use and evolving ecstasy mimics.
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Refreshment Break

Cocaine, Excited Delirium and Deaths Following Tasers

Steven Karch, Consultant Cardiac Pathologist and Toxicologist, Berkeley, California

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Understand the process of myocardial remodelling and indentify the associated histo-anatomic changes associated with the process; Understand the principle mechanisms by which stimulant drugs cause remodelling and the effect that remodelling has on cardiac electrical conduction;
•  Understand the toxicology of cocaine, and of dopamine receptors, and how interactions between the two lead to the syndrome known as delirium; discuss alternate theories of causation for the death of restrained prisoners and learn the detailed components of ED;
•  Understand the interaction that occur when TAZER currents are applied to humans; discuss what is, and what is not, an appropriate experimental model for researching TAZER action. Discuss which substrates, if any, must be present before a TAZER may cause harm; review the autopsy findings and lessons to be drawn from the Death of Robert Dziekansi.
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Chair: David Lebrun, Queen’s University, Kingston, Ontario

Co-Chair: David Huntsman, University of British Columbia, Vancouver, British Columbia

Click here for the Overview of this symposium

The recent development of a suite of novel genomic sequencing technologies has for the first time made it possible to account for all abnormalities in cancer and other diseased tissue. We now can move beyond descriptive analysis of what cancers look like and how they behave to an understanding of what they are. This has profound implications for pathology practice as it will eventually lead to stratification of disease into treatment groups that transcend site based pathology classification, the development of laboratory tools to predict and monitor the emergence of drug resistance and the use of whole genome sequencing both for disease prevention and as tool to assist in treatment decisions. This is arguably the most exciting opportunity for pathologists to engage in research and reshape laboratory medicine since the introduction of microscopy to anatomic pathology over 150 years ago. We hope that the session will be equally challenging and exciting to all participants.
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Next Generation Sequencing Why this is a Ground Breaking Technical Advance: An Introduction

Stephen Yip, BC Cancer Agency, Vancouver, British Columbia

Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  List recent developments in sequencing technology and how these have revolutionized and accelerated the discoveries of novel genetic changes in human diseases;
•  Summarize how the next generation sequencing has altered the practice of medicine – from the discovery of novel cancer genes identifying the genetic underpinnings of hereditary diseases;
•  List the potentials and some of the practical challenge of adopting next generation sequencing and translating novel next generation sequencing gene discoveries in the clinical laboratory.
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Approaches to Identification of Genomic Aberrations from Next Generation Sequencing Data: Mutations, Copy Number Variations and Rearrangements

Sohrab Shah, University of British Columbia and BC Cancer Agency, Vancouver, British Columbia

Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Understand the evolving role of computational biology in the discovery and development of novel pathology tools;
•  Summarize the steps involved in extracting knowledge from whole genome derived and other next generation sequence derived data;
•  Understand how pathway based analysis can identify defining features of cancers not apparent through the analysis of single genes.
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Refreshment Break and interactions with faculty

Genomic Landscape of Breast Cancer

Samuel Aparicio, BC Cancer Agency, Vancouver, British Columbia

Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Understand the degree of intertumoral heterogeneity of breast cancer and its likely impact on the practice of pathology;
•  Explain the concept of intratumoral heterogeneity and its role in the emergence of drug resistance;
•  Understand how integration of multiple genomic data sets can lead to discoveries that would not be apparent through the analysis of a single genomic perspective.
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A Pathogenetic Approach to Using Next Generation Sequencing: From Discovery to Clinical Application

David Huntsman, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia

Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Explain the great potential of next generation sequencing as a source of both novel biomarkers and therapeutic targets for serious diseases;
•  To discuss how pathologists are in a unique position to effectively apply these technologies to cancer and other serious diseases;
•  Discuss some of the opportunities and challenges involved in using next generation sequencing technologies in the clinical domain.
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Chair: John Maguire, Vancouver General Hospital, Vancouver, British Columbia

HIV and Less Common Inflammatory Disorder of the Human CNS

Harry Vinters, Chief of Neuropathology, UCLA, Los Angeles, California

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  List the neuropathologic consequences of HIV-1 infection of the nervous system;
•  Understand the cellular events that contribute to neurologic complications of direct HIV-1 infection of the CNS; appreciate the consequences of various opportunistic infections and neoplasms that occur with significant frequency in HIV-infected individuals;
•  Understand and recognize the significance of the clinicopathologic features of Rasmussen encephalitis, a rare unihemispheral cause of intractable epilepsy in infants and children.
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Refreshment Break

The Neuropathology of Fatal Cerebral Malaria in Children

Katerina Zis, University of British Columbia, Vancouver. British Columbia

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  List the principal Neuropathological findings in fatal cerebral malaria in children;
•  Correlate sequestration and blood-brain barrier pathology with central nervous system lesions;
•  Discuss possible pathogenetic mechanisms of CNS damage.
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Pathology and Pathogenesis of Multiple Sclerosis: Current Concepts

Wayne Moore, University of British Columbia, Vancouver, British Columbia

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Discuss the classic neuropathology of multiple sclerosis;
•  Summarize the current concepts of the pathogenesis of multiple sclerosis;
•  Discuss the current controversies in the pathology and pathogenesis of multiple sclerosis.
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Chair: Laurette Geldenhuys, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia

Pathologists as the Models of the Highest Quality and Standards in Medicine

Jared N. Schwartz, Chief Medical Officer, Aperio Technologies Inc.

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Understand that pathologists are the most quality-conscious professionals in medicine;
•  Learn how pathologists can influence other medical practitioners in improving quality and safety in healthcare;
•  Know how to ensure their own practice is compliant with high quality and standards required for optimal patient care.
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Using Lean to Create and Maintain a Quality System

Diponkar Banerjee, PHSA Laboratories, Vancouver, British Columbia

Click here for Objectives of this session

At the end of the session, the participants will be able to:
•  Understand the origins of Lean and the impact of Lean Management principles in the clinical laboratory;
•  Become familiar with quality assurance concepts within Lean Management;
•  Learn how redesigning workflow through Lean management is a continual, incremental, and perpetual process of improvement, not a one time Herculean effort.
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Chair: Patrick St. Louis, Laboratory Director, Clearstone Central Laboratories, Mississauga, Ontario

Click here for Objectives of this symposium

After attending this Symposium, participants will:
•  Understand the clinical breadth and various causes of critical illness related to Toxicology, Infectious Disease and Endocrinology
•  Know what are the diagnostic dilemmas related to some of these illnesses
•  Understand the role that the laboratory can have in supporting the diagnosis and management of patients in these situations
•  Be able to consult with clinical staff and make informed decisions on the selection and implementation of useful laboratory tests
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Acute Endocrinology

Adam S. White, MD, FRCPC, Clinical Assistant Professor, St. Paul’s Hospital, Division of Endocrinology, UBC Division of Endocrinology, The University of British Columbia, Vancouver, British Columbia

Click here for the Overview of this session

This session will review the acute management, recognition and pathophysiology of acute endocrine-related illness.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Recognize the common acute emergency situations in endocrine illness;
•  Describe common clinical presentation of endocrine emergencies;
•  Understand the acute management of endocrine emergency including appropriate investigations.
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Click here: Dr. Adam S. White biography

Adam S. White, MD, FRCPC
Dr. White completed training in Endocrinology and Metabolism at the University of British Columbia in 2008 where he also completed Undergraduate and Internal Medicine training. He is currently practicing within the St. Paul’s Hospital Division of Endocrinology and is the Director of the St Paul’s Hospital Thyroid Clinic.
Special interest includes Medical Education, in which he has completed a 2-year Clinical Educator Fellowship with the UBC Undergraduate Medical Program/Center for Health Education and Scholarship and the University of Dundee Center for Medical Education in Scotland, UK. Specific areas of interest in the field are related to Evaluation and Assessment challenges related to the Royal College CanMeds competencies. Currently, he is involved with the Undergraduate Medical program at UBC, in particular management of the Endocrinology and Metabolism curriculum, as well as postgraduate training in the UBC Division of Endocrinology.
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Sepsis as a Model for the Immune Response to Critical Illness

James Faix, Associate Professor, Stanford University School of Medicine, Palo Alto California

Click here for the Overview of this session

In some patients with infection, a systemic response occurs which worsens their clinical course. This phenomenon, called sepsis, may progress to “severe” sepsis, with significant widespread organ dysfunction which, despite a variety of supportive measures, often leads to death. Sepsis is itself a critical illness, but the immune paralysis now recognized as an important component of severe sepsis may offer a model for the anti-inflammatory state that arises after trauma, tissue injury, and organ dysfunction in the absence of infection. Although still poorly understood, the pathogenesis of this response will be explored using evidence from recent clinical and experimental studies.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  List key features of immunosuppression of the adaptive immune system seen in severe sepsis;
•  Define evidence for up-regulation of anti-inflammatory mechanisms in sever sepsis and other types of critical illness;
•  Discuss potential approaches to treatment of severe sepsis (and other types of critical illness) involving immunostimulation.
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Click here: Dr. James Faix biography

James Faix
Dr. Faix was born in New Jersey, currently resides in California and hopes to retire to Maine. He obtained his MD at Hahnemann Medical School (now part of Drexel University) in Philadelphia, PA and performed his residency in Anatomic and Clinical Pathology at Massachusetts General Hospital in Boston, MA. He also completed a fellowship in Clinical Immunology there. He served as Director of Clinical Immunology and Associate Director of Clinical Chemistry at Beth Israel Hospital in Boston and as Director of the Clinical Laboratory at Joslin Diabetes Center in Boston before moving to Stanford University in 2001 where he is Director of Clinical Chemistry and Immunology and Associate Professor of Pathology. Research interests include markers of sepsis and autoimmune disease. He is active in the American Association for Clinical Chemistry, where he is currently a member of the Division Management Group and the Program Coordinating Committee, as well as the College of American Pathologists, where he currently serves on the Council for Scientific Affairs, the Chemistry Resource Committee and the Standards Committee.
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Refreshment Break

Point of Care Testing in Critical Illness

James Nichols, Ph.D., DABCC, FACB, Professor of Pathology, Tufts University School of Medicine, Medical Director, Clinical Chemistry, Baystate Health, Springfield, Massachusetts

Click here for the Overview of this session

This presentation will define point-of-care testing (POCT) and its role in critical care. Limitations of POCT will be discussed along with strategies for managing the quality of test results.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Define point-of-care testing (POCT) as laboratory testing conducted close to the site of patient care;
•  Describe the variety of POCT available to support critical care;
•  Discuss the limitations of POCT and complexities involved in managing the quality of test results.
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Click here: Dr. James Nichols biography

James H. Nichols, Ph.D., DABCC, FACB
Dr. Nichols is a Professor of Pathology at Tufts University School of Medicine and Medical Director, Clinical Chemistry for Baystate Health in Springfield, MA. Jim received his B.A. in General Biology/Premedicine from Revelle College, University of California at San Diego. He went on to complete a Masters and Doctorate in Biochemistry from the University of Illinois, Urbana-Champaign. Dr. Nichols was a fellow in the Postdoctoral Training Program in Clinical Chemistry at the Mayo Clinic, Rochester, MN. He is board certified in both Clinical Chemistry and Toxicological Chemistry by the American Board of Clinical Chemistry. Dr. Nichols spent several years as Associate Director of Clinical Chemistry, Director of Point-of-Care Testing, and an Associate Professor of Pathology at Johns Hopkins Medical Institutions prior to moving to Massachusetts. Baystate Health includes Franklin Medical Center, Mary Lane Hospital and Baystate Medical Center, a leading acute care center in New England. Jim is responsible for Clinical Chemistry including core automated chemistry, immunoassay, endocrinology, toxicology/therapeutic drug analysis, estoteric and point of care testing conducted through Baystate Reference Laboratories, one of America’s largest hospital-based outreach programs. Dr. Nichols’ research interests span evidence-based medicine, information management, laboratory automation, point-of-care testing and toxicology.
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Diagnosis and Management of the Poisoned Patient

Christopher DeWitt, Consulting Medical Toxicologist British Columbia and Alberta Poison Centres, Vancouver, British Columbia

Click here for the Overview of this session

This lecture will review some common and uncommon poisonings, their clinical presentations/findings, and the importance of the laboratory in aiding diagnosis.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Better understand utility of both clinical and laboratory information in caring for poisoned patients;
•  Understand the limitations of clinical and laboratory information in the setting of poisoning;
•  Appreciate the importance of communication between lab and clinical staff.
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Click here: Dr. Christopher DeWitt biography

Christopher DeWitt
Dr DeWitt graduated from University of Colorado School of medicine. He completed a residency in Emergency Medicine at Denver Health Medical Centre and Fellowship Training in Medical Toxicology at the Rocky Mountain Poison and Drug Centre in Denver, CO. He holds certifications in Emergency Medicine in Canada and the US and is a Fellow of the American College of Medical Toxicology.
Currently he is a Clinical Associate Professor in the Department of Emergency Medicine at the University of British Columbia, an attending physician at St Paul’s Hospital Emergency Department in Vancouver, BC and a consulting Medical Toxicologist for the BC and AB Poison Centres.
He has special interests in the areas of Drug Stuffers, Cardiovascular Toxicology, and Amanita Mushroom poisoning. He has lectured extensively to Emergency Medicine Physicians at local and national meetings and at international Toxicology symposiums.
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Chairs:
Loralie Langman, Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry/Immunology, Mayo Clinic, Rochester, Minnesota

Bhushan Kapur, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto Ontario

Click here for Objectives of this symposium

After attending this Symposium, participants will:
•  Identify the mechanism and causes of pain
•  Demonstrate the use of new strategies in the medical treatment of patients with chronic pain
•  Identify novel approaches to the management and treatment of chronic pain
•  Describe the laboratory's role in the support of Pain Management clinics
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Pathophysiology of Pain

Brian C. Cairns, The University of British Columbia, Vancouver, British Columbia

Click here for the Overview of this session

This lecture is intended as an overview of the peripheral and central nervous system mechanisms thought to contribute to the development and maintenance of different types of pain. The pathological changes associated nociceptive, inflammatory, neuropathic and functional pain will be outlined. The concepts of peripheral and central sensitization as well as descending inhibitory controls and the contributions to chronic pain conditions will be explored.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Better understand utility of both clinical and laboratory information in caring for poisoned patients;
•  Understand the limitations of clinical and laboratory information in the setting of poisoning;
•  Appreciate the importance of communication between lab and clinical staff.
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Click here: Dr. Brian E. Cairns biography

Brian E. Cairns, BSc, BSc(Pharm), ACPR, PhD
Brian Cairns is an Associate Professor and Canada Research Chair in Neuropharmacology at the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, B.C. He is a hospital residency trained pharmacist who has developed an interest in experimental pain research. His main research focus is the identification of novel receptor targets for the development of analgesics that would act on muscles and joints directly to inhibit pain, and thus be less likely to cause centrally mediated side effects such as drowsiness. He is also exploring the role biology plays in the increased prevalence of certain chronic muscle and joint pain conditions, such as fibromyalgia and temporomandibular disorders, in women. In particular, he is investigating whether sex-related differences in the sensitivity of nerve fibres that innervate muscles and joints contribute to the increased prevalence of these pain conditions in women. He is the author of numerous articles, book chapters and scientific communications in the field of pain research and regularly presents this work at international meetings.
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Clinical Management of Chronic Pain

Pam Squire, The University of British Columbia, Vancouver, British Columbia

Click here for Objectives of this session

This lecture will review common pharmacological approaches to the management of chronic pain.
At the conclusion of this session, participants will be able to:
•  Identify guidelines to treating neuropathic pain for using opioid analgesics;
•  List usual analgesics and common adjuvant medications used in chronic pain;
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Click here: Dr. Pam Squire biography

Pam Squire
Dr Squire currently practices in Vancouver B.C. where she has a consultative practice in complex pain. She is an Assistant Clinical Professor in the department of Family Practice at the University of British Columbia and is involved in medical education and curriculum development for both under-graduate and post-graduate physicians. In 2010 she was given the Academic Pain Educator of the Year award by the American Society of Pain Educators.
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Refreshment Break

Neuropathic Pain: Is it a Disease?

Cory Toth, Department of Clinical Neurosciences at University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta

Click here for the Overview of this session

This lecture will describe the pathological changes seen in the nervous system in response to the presence of neuropathic pain. New techniques to identify these changes from skin to neuroinflammatory inflammation will be described. New therapies used in neuropathic pain management will be highlighted
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Click here for Objectives of this session

This lecture will review common pharmacological approaches to the management of chronic pain.
At the conclusion of this session, participants will be able to:
•  Appreciate the pathological changes related to neuropathic pain;
•  Understand the pathogeneses of neuropathic pain;
•  Appreciate the spectrum of therapies and future therapies that may manage neuropathic pain.
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Click here: Dr. Cory Toth biography

Cory Toth
Dr. Toth started as an Assistant Professor in Neurology at the University of Calgary as of July 2005, and he was promoted to Associate Professor in October 2010. Prior to this, he graduated from the University of Regina with Great Distinction in Physics and Mathematics, before entering and completing the MD program at the University of Saskatchewan in 1997. He completed residency training in Neurology at the University of Saskatchewan in 2002 with FRCPC certification. After completing a three year fellowship in basic science studying the complications of diabetes upon both the central and peripheral nervous systems, Dr. Toth developed a mouse model of the human diabetic brain. His main research interest is to understand the contributions of RAGE and insulin deficiency to the development of white matter changes, brain atrophy, and cognitive decline in the diabetic brain, both in type 1 and type 2 forms of diabetes. In addition, he also studies the development of diabetic peripheral neuropathy in the same mouse models. Dr. Toth also collaborates with local and international researchers regarding problems in nerve regeneration, neuropathic pain, and motor neuron diseases.
The clinical research of Dr. Toth is centered around diabetic complications of the nervous system, particularly upon the experimental diabetic brain, where diabetes leads to brain atrophy, white matter abnormalities, and cognitive decline. He also investigates experimental diabetic neuropathy and models of nerve regeneration, as well as etiologies of peripheral neuropathies and neuropathic pain. He is a member of the Canadian Society of Clinical Neurophysiologists in EEG and EMG, and a multiple time recipient of teaching awards at multiple levels. At present, Dr. Toth is funded by the Alberta Heritage Foundation for Medical Research as a Clinical Investigator and by the Juvenile Diabetes Research Foundation. He has recently secured funding from the Canadian Institutes for Health Research, and was awarded the 2010 Neuropathic Pain Research Award from Pfizer Canada. He also has received research funding support from the University of Calgary, the Calgary Health Region, the Action Committee for Neuropathic Pain, Pfizer Canada, Valeant Canada, Purdue Pharma Canada, and Talecris Canada.
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Laboratory Support of Pain Management Clinics – What Tests do they Need

Loralie Langman, Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry/Immunology, Mayo Clinic, Rochester, Minnesota

Bhushan Kapur, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto Ontario

Click here for the Overview of this session

This presentation will describe drug–drug interactions and their impact on half-life. Co-administered medications can change the half-life and thus the pharmacodynamic properties of the medication. Changes in drug half-life may influence changes in medication and dose.
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Click here for Objectives of this session

At the conclusion of this session, participants will be able to:
•  Appreciate the need of half life in deciding change in dose;
•  Calculate elimination half-life from two samples;
•  Appreciate the importance of drug interaction with in Clinical Staff.
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Click here: Dr. Bhushan M. Kapur biography

Bhushan M. Kapur, D.Phil, C.Chem, FRSC (UK), FACB (US) and FACBC (C)
Dr Bhushan M. Kapur graduated with D.Phil. from the University of Basel, Switzerland in 1967 under the guidance of Prof. Dr. T. Reichstein (Nobel Laureate 1956). After three years of post-doctoral work, he joined the Addiction Research Foundation (ARF) in 1971 where he was the Director of Laboratories (Clinical Chemistry, Toxicology and Hematology) to May 1995.
In May 1995, he joined the Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children in Toronto as a scientist and a consultant in toxicology. In June 2000 he was appointed as a consultant and scientific affiliate staff in the Department of Clinical Pathology, and Associate Scientist(2008), Sunnybrook Research Institute, Sunnybrook Health Science Centre. From August 2001 to November 2005 he was responsible for the direction of the toxicology laboratory at the St. Michael’s Hospital in Toronto.
As a scientist Dr Kapur’s research interests have been in the biochemical changes in the alcohol and drug (ab)using population and pharmacological approaches to interpreting laboratory results. He has over 90 peer reviewed publications and has over 150 scientific presentations to his credit. His other credits include coauthoring a book titled Alcohol and the Identification of Alcoholics, invention and patent of an alcohol dipstick, POCT finger prick devices for acetaminophen, salicylate and methanol; a computer software program CBAC: Computerized Blood Alcohol Calculator, and book chapters on drugs of abuse. As an expert in Workplace Drug Testing he has represented ILO (International Labor Organization, UN, Geneva) in ILO sponsored Tripartite (Governments, Employers and Labor) meetings in Geneva and Oslo.
Dr. Kapur currently has a number of grants to study: Fetal alcohol spectrum disorder: Perinatal mechanisms, treatment and diagnosis (Co-PI, CIHR-NET); Folic acid supplementation and red blood cell folate in an urban Quebec population: Are pregnant women reaching the recommended levels? (Co-PI, Alva Foundation) and Placental production and transfer of formic acid in the presence and absence of folic acid (PI, Can Found for Fetal Alcohol Research)
Dr. Kapur is an Assistant Professor in the Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto. He is a Fellow of The Royal Society of Chemistry (UK), Academy of Clinical Biochemistry (USA) and Canadian Academy of Clinical Biochemistry. He is the winner of various awards: CSCC’s International Visitors Traveling, June 2000; CSCC Award for Outstanding Contribution to Clinical Chemistry, June 2004; CSCC’s Award for Research Excellence 2010 and best CSCC poster awards in 2007, 2008 and 2010 respectively; Life Time Achievement Award from Ontario Society of Clinical Chemist in Nov 2008. In recognition of his contribution to Addiction Medicine, he was awarded Honorary Membership of the Canadian Society of Addiction Medicine in October 2006
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Click here: Dr. Loralie Langman biography

Loralie Langman
Loralie Langman got her BSc in Laboratory Medicine and Pathology, CSMLS, and ASCP certifications at the University of Alberta. She completed her Ph.D. Laboratory Medicine and Pathology at the University of Alberta. She completed her Clinical Chemistry training at the University of Toronto, specializing in Forensic Toxicology and Molecular Genetics. She worked in Vancouver, British Columbia, at the Provincial Toxicology Centre and BC Biomedical Laboratories as a Forensic Toxicologist/Clinical Chemist. She is currently the Director, Toxicology and Drug Monitoring Laboratory, Mayo Clinic Rochester, MN and Associate Professor of Laboratory Med/Pathology, Mayo Clinic College of Medicine.
Dr. Langman was certified with the Canadian Academy of Clinical Biochemistry (CACB) and is the first individual to have achieved Diplomat status with the American Board of Clinical Chemistry (ABCC) in all three disciplines (Clinical Chemistry, Molecular Diagnostics, and Toxicological Chemistry). She is also a Diplomat with the American Board of Forensic Toxicology.
Dr. Langman is a member of and serves on committees for several professional organizations including: The Society of Forensic Toxicologists; the American Academy of Forensic Sciences; the National Academy of Clinical Biochemistry; the Canadian Society of Clinical Chemists; The International Association of Forensic Toxicologists, The International Association of Therapeutic Drug Monitoring and Clinical Toxicology and the American Association for Clinical Chemistry.
Currently, Dr. Langman is Director of the Toxicology and Drug Monitoring Laboratory at Mayo Clinic Rochester. She has over 30 peer reviewed publications, 6 book chapters, and over 40 abstracts/presentations at National and International meetings. Her areas of expertise include: toxicology; drugs of abuse (particularly amphetamine-type stimulants and cocaine); post-mortem toxicology; therapeutic drug management; and pharmacogenetics.
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