Saturday, July 23, 2016

Don't worry, be happy (Musings on how TM leaders mimic politicians)

Updated: 23 July 2016

Do you know what government politicians and transfusion medicine TM) leaders have in common? No matter what the threat, both repeatedly assure their constituencies, 'Don't worry, be happy.' 

July's blog takes its theme from recent transfusion-transmissible disease news. The title is from a 1988 ditty by Bobby McFerrin.


The blog's aim is to encourage readers to be skeptical about how safe our blood supply is and to hold our TM leaders to the highest standard, one higher than we expect from politicians.

GOVT LEADERS

Examples of politicians assuring citizens all is okay:
  • Canada: PM Justin Trudeau reassures Canadians that economy is in a good position to weather the storm in the wake of Britain's Brexit vote. (June 2016)
  • UK: Home Secretary Theresa May assures Brits that the UK has taken steps to amend powers and increase capabilities to deal with developing terrorist threats. (Aug. 2014)
  • USA: Obama assures Americans the highest priority is their safety following a string of terror attacks (Dec. 2015)
TM LEADERS
Similarly, all involved at top echelons of the blood industry in the developed world constantly reassure us that our blood supply is the safest it ever has been.

Unstated is the blood supply is the safest it has ever been for the KNOWN OLD infectious disease risks, the ones that figured in the so-called 'tainted blood' scandals that plagued us in past decades. Experts assure us

  • *We are doing all we can to minimize risks. 
  • Donor screening, improved transmissible disease (TD) tests, and manufacturing processes for plasma-derived products pretty much eliminate the old TD risks like hepatitis B, hepatitis C, HIV. 
  • The blood supply is safe. Don't worry, be happy.  
Need a  touchstone of how TM leaders now see our blood supply as bulletproof?
  • Today western nations have pretty much all moved from a total ban on blood donation for MSM males to a 5 year deferral to a one-year deferral, providing no MSM in the past year. 
  • Blood suppliers did so influenced by nation-wide, indeed global, campaigns by gay activists and others who support their cause. They decried the ban against gay/bisexual men donating blood, including the latest one-year deferral, calling it discriminatory and unjustified based on the evidence. 
  • Some even say the ban on MSM was unjustified from the get-go:
    • 'The new policy isn't any more scientific than the old policy. It's based on the same bigotry and gay panic defence that the ban has been based on since the beginning.' 
NEWS (JUNE-JULY 2016)
Examples of news that triggered this blog:

HIV

ZIKA VIRUS
Several disconcerting anomalies exist about Zika virus transmission:

MUSINGS
TM leaders standard response (SOP?) to blood supply risks is analogous to politicians who ensure citizens that 'all is okay'. And TM leaders are more-or-less correct, just as politicians are about their claims of relative public safety from economic disasters and terrorism. Except when the next man-made disaster strikes, as it inevitably does.

For both groups, claiming safety makes sense and often is in the public interest. The last thing citizens need is to fear for their safety, fear to travel, fear that those who are different ('the other') are somehow dangerous. Politicians who fear-monger usually do so in their own self-interest and often are despicable in spinning tragedies to their crass political benefit.

TM leaders never-ever fear monger. It's not in their best interest or ours, whether as blood donors or transfusion recipients. For the best of reasons TM leaders correctly assure us that life-saving transfusions are the safest they have ever been. Such reassurances serve the public interest because we don't want folks to fear life-saving transfusions or stop donating blood.

Yet many in the TM community come across as complacent and overly confident. I'd love to be similar, live in a bubble, sing 'Don't worry, be happy.' But, having experienced Canada's 'tainted blood' scandals, I'm skeptical. Note, skeptical, not cynical.

Partly it's because TM leaders failed us in the HIV tragedy. Out of arrogance or being true-believers matters not:

  • And the Band Played On (full movie on Youtube - it's a beauty)
  • Canadian Red Cross denies link between AIDS and blood products
    • Two-minute video
    • In the 1980s a Canadian Red Cross (CRC) medical director uses 'cost-benefit ratio" to determine if hemophiliacs should be transfused with potentially infected products
    • Reality: FVIII concentrates from thousands of donors were all infected with HIV, including untreated FVIII conc., probably transfused to use up CRC's expensive stock pile.
    • Note: Over 1100 Canadians were infected with HIV from blood transfusions, of which 700 had hemophilia and were treated with FVIII concentrates.
The results of economic-based calculations around the globe:
Today CRC's successor CBS - with most of the same trench-workers (but not leaders forced out for being truthful to Krever) - are still into cost-benefit. Indeed, they've refined cost-benefit into a science. It's evidence-based, TM dudes/dudettes!

CBS and others now use data - based on prevalence and disease severity - that determine whether a blood supplier implements a blood safety test or not for a given transfusion-transmissible risk. Today's blood suppliers are all about metrics and cost-savings, and they're proud of it, even crow about it.
Just like the Canadian Red Cross was when it declined to implement surrogate tests for hepatitis non-A, non-B (now hepatitis C). Seems Canada's experts judged surrogate tests to lack sufficient sensitivity and specificity. That tens of 1000s of Canadian transfusion recipients were subsequently infected with HCV is a testament to 'expert' opinion. It ain't infallible, especially if driven by cost constraints.

Yes, I've written variations on this theme before. But I hope readers see how true the analogy of TM leaders being the same as political leaders who constantly reassure us (as a knee-jerk reaction) that we're safe because they're doing all they can to combat the risks we face.

BOTTOM LINE
I don't want folks to become fearful of our blood supply. It's safer than ever, although not bulletproof. Rather I encourage readers to be skeptical, i.e., to have some degree of doubt regarding claims that are normally taken for granted just because they come from our leaders.

In this case to be skeptical about what our TM 'thought leaders' tell us about blood safety, especially given the ever-evolving transfusion-transmissible threats AND the fact that commercial vested interests (Big Pharma, the diagnostic test industry) are now - more so than ever - in bed with transfusion professionals.

SIDE BAR (Food for Thought)


Let's consider the small picture of vested interests. Many experts who present at company-funded continuing education events or any CE event have strong ties to industry.

Think about the issue on a personal scale. Have you ever attended a TM talk, workshop, seminar sponsored by Big Pharma or a diagnostic test firm? If yes, have you even once heard representatives discuss anything that casts any doubt whatsoever on their products and its benefits? Suspect not. 
When attending CE events do you assess what ties the speakers have to industry? Or mostly listen in awe to the acknowledged world-renowned experts who transitioned from their original health care careers and now more or less work for profit-driven private industry?
Let's say I've built a good career on specializing in DNA genotyping of red cell antigens. What are the odds I'd be for each and every use of molecular typing in TM and a strong proponent of so-called personalized medicine?
Suppose one of my roles is as an academic whose career and advancement depend on getting my research funded and published? How likely would I be to criticize industry partners who fund my research? Or try to publish negative studies that don't support the company's products? 
Now let's return to the big picture. I'm not suggesting TM leaders are consciously influenced by commercial interests - who often just happen to be their industry partners (although they clearly are influenced in many ways) - on matters of blood safety. Rather my point is that people invariably act in their own best interests. Human nature...

Those in charge of the safety of our blood supply cannot admit the supply is unsafe. Just as politicians responsible for public safety cannot say citizens are unsafe. It's impossible. This means that you and I must be skeptical and not meekly accept pronouncements from on high about anything, including decisions influenced by pressure groups.

FOR FUN
The blog's theme perfectly fits this 1988 Bobby McFerrin song:

As always, comments are most welcome. 

Wednesday, June 22, 2016

If you could read my mind (Musings on blogging to share TM experiences)

Updated: 23 June 2016
June's blog is a follow-up to an article I wrote for the April issue of the BBTS magazine, BloodLines. In the BBTS piece I speculated on why so few health professionals, working or retired, blog. I'll expand on some of these ideas in the hopes that more transfusion professionals will be encouraged to give it a go and blog for CSTM or BBTS or any professional association in any country.

Now before you rapidly exit ('Blog? Not me!'), please take a chance and at least skim the blog. It's you I'm hoping to reach by planting a seed that maybe, just maybe, you could make a real difference by sharing your experiences with colleagues.

You don't need to be a 'big wheel' to blog. We tiny cogs in the wheel also have much to share. Perhaps we haven't published or presented at conferences. But we've all had unique experiences in our transfusion lives and, in years to come, no one will know if we don't tell our stories.

The blog's title comes from a 1970 song by Canada's Gordon Lightfoot, one of the most covered songs in pop music history. 

OBSTACLES
So why don't more transfusion professionals blog? There are many reasons, but here are my top three. 

1. No time
Most obviously, and likely the biggest obstacle to blogging, is lack of time. Like many continuing education opportunities these days, folks would need to blog after-hours on their own time. 

With internet and cell phones, many employees may already resent being connected 24-7. When work-life balance is out-of-whack, leisure time with friends and family, as well as time for yourself, becomes even more precious. 

And if you feel devalued by your employer, you may lose the enthusiastic puppy persona you had at the start of your career. Instead of a career, you may see your professional work as just a 9-5 job to earn money, not to gain fulfillment.

2. No incentive

Another obstacle to blogging
 is folks tend to get no credit for blogging. Indeed, blogs may even be dissed by the 'old guard' as not evidence-based, just opinion. Well, yes! Blogs offer OPINIONS on events, issues, and challenges of the day.

But blogs can offer evidence and present logical arguments. In some ways blogs are akin to editorials. Opinions by experienced health professionals can summarize issues, pro and con, and offer food for thought. 

3. Fear of ridicule
Every time you 
  • Open your mouth
  • Give a presentation
  • Put pen to paper
  • Write an e-mail message 
  • Participate in social media of any kind
you may say something silly or indefensible and risk being thought a fool. Been there, done that. Indeed, you may even open yourself up to abuse by pompous academics or online trolls.

But to me the opposite is even worse:
  • To avoid criticism, say nothing, do nothing, be nothing. (Attributed to...) 
ADVANTAGES
So, why blog, given its risks? Here's where I'll need to self-edit for brevity because I'm definitely a true believer in the merits of blogging.

Given that blogging is an enterprise done on your own time, why do it? 

Why I blog
I blog for 6 key reasons. Blogging...

1. Is a priceless opportunity to comment on issues of the day and try to shape opinion. One example from "Musings on Transfusion Medicine' - my likely futile attempt to shape opinion on paid plasma:
2. Allows us to celebrate colleagues who have made a difference and to record transfusion medicine history through the eyes of those who lived it, the good, bad, and ugly. See, for example, the Canadian Society for Transfusion Medicine (CSTM) blog series, 'I will remember you' (scroll down to see the 6 blogs to date).

About history, Australia and new Zealand offer a great example of how to preserve our past:
3. Makes you a better thinker and writer. It's simply a case of practice improves performance. As noted in my first BBTS blog, 'Born to be Wild', key points to any writing, even e-mail, include
  • Don't bury the lead - reveal blog's aim up front;
  • Make it easy to read by using bullets and short paragraphs;
  • Be as brief as possible;
  • Include a 'so what' statement.
I confess that my blogs are too long. Please don't take them as a model of suitable length. A blog can be short and deal with a single issue or experience. 

4. Creates a record of important experiences and allows others to learn from them. 
EXAMPLE:
I could write a blog about a student I once taught who, during her clinical rotation, missed adding patient plasma to an antibody screen test, causing it to be falsely negative, with the patient receiving incompatible blood by electronic crossmatch. The elderly patient suffered a severe hemolytic transfusion reaction and subsequently died.  
This true episode makes an interesting story of what happened, including the involvement of the hospital's lawyers, the reaction of the supervising technologist and transfusion service medical director. Much to be learned from a single experience, a story worth writing that would be lost forever if not recorded. 
5. Gets your name out there and furthers your career. Of course, blogging requires taking a risk, the risk of opening your mouth and being thought a fool. No big deal. I have a T-shirt from LSOFT:
  • "He Who Dares, Wins" (motto of the British Special Air Service)
6. Is great fun. Fact is, I enjoy poking the powers-that-be and sending up the absurdities in our professional lives. Someone has to do it.

SUMMARY
Expressing opinions on current issues and examining the past are valuable ways to spend one's time. So seldom today do we get the opportunity to reflect. And blogging invariably serves as informal continuing education because bloggers need to check they're not spouting total B.S.

Some claim that in today's milieu, folks no longer have the time, no longer care to spend free time on their careers. Please, let's prove this judgement wrong.

My take on blogging: It's a blast! I maintain three blogs, two professional and one personal where I pretty much rant about whatever bugs me at the time. The personal blog is therapy that keeps me sane. 

The professional blogs are my way to try to influence opinion, to motivate colleagues to think differently and challenge orthodoxies. You can too! We're here for such a short time. Why not try to make a difference?

Plus we need to create a historical record of our stories or they will be lost forever. See, for example,
Making colleagues smile also serves a valuable purpose. What struck you as silly recently? Why not blog about it? If you want to try blogging for CSTM, I'd be glad to help by offering my 2¢ worth (make that 'nickel's worth', as cent coins/pennies don't exist in Canada any more).

To inquire about blogging, please e-mail
Finally, I encourage bloggers to write their passions and will end with this quote by Canada's Margaret Laurence (click to enlarge):

Margaret Laurence quote

FOR FUN
Lightfoot's 'If You Could Read my Mind' seems right for this blog. Fact is, no one can read our minds. If we don't spill the beans and blog about our experiences, no one will ever know. 
If you could read my mind, love,
What a tale my thoughts could tell.
Just like an old time movie,
'Bout a ghost from a wishing well.
In a castle dark or a fortress strong,
With chains upon my feet.
You know that ghost is me.
And I will never be set free
As long as I'm a ghost that you can't see. 
                                        
If I could read your mind, love,
What a tale your thoughts could tell.
Just like a paperback novel,
The kind the drugstores sell...

As always, comments are most welcome.

Monday, May 23, 2016

The In Crowd (Musings on the relevance of transfusion journals)

Stay tuned because updates will occur
May's blog was stimulated a long time ago but returned to me recently when I was cleaning house and tossed out (recycled) several thick issues of the AABB journal Transfusion, which were piled on my computer desk, largely unread after scanning content indices.

The blog's title derives from a 1965 jazz instrumental by the Ramsey Lewis Trio.

Musings focus on the articles I read in Transfusion's May 2016 issue and what this says about the journal's relevance to someone with a medical laboratory technology/science background (me). For context, traditional measures of a journal's relative importance and Transfusion's top 10 cited articles are also discussed. 

The questions I hope to answer: 
  1. What value is the AABB journal to practicing transfusion professionals (as opposed to its value to authors/researchers)?
  2. Why am I (and presumably everyone) getting a paper version of the journal and not being given an option for an e-journal only?
  3. What would my AABB membership fee be if all the costs associated with a paper version of Transfusion were eliminated?
  4. What factors should affect a journal's overall relevance and importance?
The blog is written from a medical laboratory technology perspective, as that's my background, but the issues also relate to nursing and physicians. Regardless of where you live, please ask similar questions of your professional association's journal. For example, 
  • How many papers do you typically read in your transfusion-related professional journal and where - at work on breaks, at home? 
  • Do you scan titles only or a combination titles, authors and abstracts? 
  • Which criteria determine whether you will read a given article?
  • In deciding what to read, how important is an article's direct relevance to your daily work?
  • How many articles, if any, do you read just for curiosity or fun?
Sometimes I wonder of journals even matter anymore but of course they do. And I miss the days when transfusion services regularly held journal clubs during lunch hours, often based on journal articles or conferences, in which all staff participated.

To promote continuity of the blog's ideas, consider reading the blog in its entirety and then return to access linked resources. Bet you can't.

1. AABB JOURNAL 'TRANSFUSION' - BRAGGING RIGHTS

So to begin, here's how most journals measure their worth. On its homepage, Transfusion gives its ISI journal citation ranking under the medical specialty, hematology, as well as its Impact Factor. Both are intended to show the relative importance of individual journals. 

In 2014 Transfusion's ISI Journal Citation Reports© Ranking was 23/68 and its Impact Factor was 3.225. 

So what do ISI Journal Citation Reports© (JCR) Ranking and Impact Factor (IF) mean?
  • JCR Ranking claims to objectively critically evaluate the world's leading journals using statistics. Uh-oh! That's a red flag if there ever was one. Just kidding because, as with any statistical data, users need to use their noggins to assess validity. 
    • With a JCR rank of 23/68, my guess is that Transfusion ranks no. 23 of 68 journals and is in the top third of most hematology journal citations (two-thirds of similar journals have fewer overall citations, whatever complicated statistics are used).
  • Impact Factor is the average number of annual citations recent journal articles have and obviously the higher, the better. As such, it's a proxy for the relative importance of a journal in its field. 
    • With an IF of 3.225, recent Transfusion articles were cited an average of just over 3 times in a year.
But similar to surrogate tests such as elevated ALT and anti-HBc used to screen blood donors for non-A, non-B hepatitis before HCV was identified, issues exist for how well Impact Factors measure relative importance.

For interest, The Impact Factor was devised by Eugene Garfield, who explains its history in a 2006 JAMA article.
As an aside,  I love Garfield, because in my early pre-Internet years in Medical Laboratory Science, MLS subscribed to Current Contents, which I always enjoyed and looked forward to reading. If my memory is correct, each issue began with a fascinating Garfield comments/editorial. [See Further Reading]
2. TRANSFUSION'S TOP 10 CITED ARTICLES
Since 1975 I've been an AABB member and once read 90%+ of Transfusion's articles, but mostly for interest, not because they directly related to my work. 

Most reading was done because I'm curious and love transfusion medicine. After becoming an educator, motivation included the potential to discover 'juicy' tidbits that would interest or amuse students, and Transfusion's articles often did. 

In today's hectic and understaffed work environment, I wonder which of Transfusion's top 10 articles would be read during leisure time, on breaks or after hours, by 
  • Clin lab technologists/scientists in a blood supplier or transfusion service laboratory? 
  • Transfusion and blood conservation RNs?
  • Hematologists/hematopathologists?
I suspect that not many in these three professions would read 3, 7 and 9 below, which is good because only 30% un-read is excellent. As an experiment, please assess which of the following you would read. I've linked the PubMed abstract for each article. 

Please think about which criteria helped decide whether you would read an article or not.

Transfusion's Top Ten Cited Articles: [Author's work location/country]

1. Activity-based costs of blood transfusions in surgical patients at four hospitals. (Shander A, et al) 2010;50:753-65. [USA]

2. Transfusion of older stored blood and risk of death: A meta-analysis. (Wang D, et al) 2012;52:1184-95. [USA]

3. Pathogen inactivation and removal methods for plasma-derived clotting factor concentrates. (Klamroth R, et al) 2014; 54:1406-17. [Germany]

4. Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. (Yang L, et al) 2012;52:1673-86. [UK]

5. Fibrinogen as a therapeutic target for bleeding: A review of critical levels and replacement therapy. (Levy JH, et al) 2014; 54:1389-1405. [USA]

6. Duration of red blood cell storage and survival of transfused patients. (Edgren G, et al) 2010;50:1185-95. [Sweden]

7. Storage lesion: Role of red blood cell breakdown (Kim-Shapiro DB et al) 2011;51:844-51. [USA]

8. The use of fresh frozen plasma in England: High levels of inappropriate use in adults and children. (Stanworth S et al) 2011;51:62-70. [UK]

9. Adoptive transfer and selective reconstitution of streptamer-selected cytomegalovirus-specific CD8+ T cells leads to virus clearance in patients after allogeneic peripheral blood stem cell transplantation. (Schmitt M et al) 2011;51:591-9. [Germany]

10. Transfusion-associated circulatory overload after plasma transfusion. (Narick C, et al) 2012;52:160-5. [USA]

So, what's your health profession and  how many of these top cited papers would you have read? Be honest. As both a lab technologist in the trenches and an educator, I'd have read all but #9.  

3. TRANSFUSION'S MAY 2016 ISSUE
Below are three papers I read in the May issue of Transfusion (Volume 56, Issue 5,pp. 1001–1249) that directly relate to my prior career as a med lab tech/scientist and educator. Yes, only three and I read them out of interest. These days,although retired from real work, my time is even more precious. 

The journal sections each paper is under are included. I've summarized each with a 'So What?' conclusion.

1. TRANSFUSION MEDICINE ILLUSTRATED (pp.1006–7)
Delayed hemolytic transfusion reaction captured by a cell phone camera.Margaret E. Gatti-Mays, S. Gerald Sandler [USA]
So what? The delayed hemolytic reaction was due to anti-Jka and shows a photo of the peripheral blood smear with multiple microspherocytes. Authors encourage physicians to use cell phone cameras to photograph peripheral blood smears and use them in clinical presentations. 
2. IMMUNOHEMATOLOGY (pp. 1182–4)
Anti-Mur as the most likely cause of mild hemolytic disease of the newborn. Sara Bakhtary, Anastasia Gikas, Bertil Glader, Jennifer Andrews [USA
So what? Full term infant had jaundice presumed to be due to anti-Mur, an antibody more commonly found in Asian patients in the USA, and one important to recognize since the Mur+ phenotype has a higher prevalence in this population.
3. LETTER TO EDITOR (pp.1247–8)
Sustained and significant increase in reporting of transfusion reactions with the implementation of an electronic reporting system. Rosanne St Bernard, Matthew Yan, Shuoyan Ning, Alioska Escorcia, Jacob M. Pendergrast, Christine Cserti-Gazdewich [Canada]
So what? In 2009 the authors transitioned from a paper-based to an electronic reporting system (ERS) for suspected transfusion reactions. The user-friendly process did not result in “junk inflations”. Instead reporter suspicions generally concurred with specialist conclusions. Accordingly, they endorse using an ERS for transfusion reaction reporting to improve hemovigilance.
ANSWERING THE QUESTIONS
Here are my answers  - conditioned by my professional experience and biases - to the questions posed about Transfusion. Your answers may differ and likely will.

Q1What value is the AABB journal to practicing transfusion professionals (as opposed to its value to authors/researchers)?
A: Transfusion has value as a good read for anyone who's curious on current 'hot' clinical issues and to educators who must keep up-to-date with the latest and greatest, including esoteric research, which may or may not ultimately translate into something useful to practitioners.
The journal's relevance to the day-to-day working lives of medical laboratory technologists/scientists in laboratories is minimal. Most papers relate to clinical practice (MDs, RNs) or research (PhDs).
Q2Why am I (and presumably everyone) getting a paper version of the journal and not being given an option for an e-journal only?
A: Transfusion is a glossy journal that costs many trees to produce, plus mailing costs, which are not insignificant. I don't need or want a paper copy.  
It's published monthly, plus has supplements of Annual Meeting abstracts and others such as conference proceedings. That's a lot of paper.
For May's issue I read only 7 of 248 pages, ~2.8%, which related directly to my work. And some issues have even fewer articles relevant to my needs and interests.
Q3What would my AABB membership fee be if all the costs associated with a paper version of Transfusion were eliminated?
A: My 2016 AABB membership cost $124 USD, which at the time I paid was $170.27 CDN. Sure, membership is a good deal, less than 50 cents/day.
But how much of this does AABB pay per member to Transfusion's publisher, Wiley? Darned if I or any member knows.
Academic publishers such as Wiley and its subsidiaries, e.g., Wiley-Blackwell,  surely make most money from advertisers and libraries. It's interesting that they've been under pressure recently for being an oligarchy that gouges cash-strapped university and college libraries. [See Further Reading]
Q4. What factors should affect a journal's overall relevance and importance?
A. To me, Transfusion's relevance should relate not only to its citation ranking or impact factor. Rather, a key factor is how many articles in each issue busy transfusion professionals will actually read because they relate to their day-to-day jobs.   
Yes, it's easy to dismiss my views because immunohematology (beloved to med lab techs/scientists) is a dying art and increasingly irrelevant. But how many papers in the 2016 May issue would time-strapped nurses and physicians read in their spare time? You decide.
Transfusion comes with AABB membership. Shouldn't its content reflect the needs of ALL members, at least according to their membership percentage?
SUMMARY
Just a few of the many issues I'd love AABB to address:

1. AABB, please allow members to opt out of receiving a paper copy of Transfusion and please decrease membership fees accordingly. 

2. AABB seems an association mainly for physicians. Is it? Why does its journal offer only continuing MEDICAL education credits for reading select articles and successfully completing a test on the content? I think I know why...

Cannot help but wonder what percentage of AABB's membership constitutes physicians vs PhD researchers vs medical lab scientists vs nurses vs administrators. Transparency please. We'd love to know.

3. Never mind med lab technologists/scientists, how about more Transfusion articles relevant to nurses? They increasingly play a key role in our profession. 

Of course, I know from experience that asking AABB or any large organization such questions is pretty much useless and akin to pissing in the wind. Would love to be proven wrong.

FOR FUN
I decided to use 'The In Crowd' in the blog's title for these reasons:

1. It's a laid-back, simple tune that's easy to listen to. Indeed, over the years I've listened to it for many hours because I bought the Ramsey Lewis album of the same name many moons ago. 
2. Although it's an instrumental version, the lyrics fit with the blog's theme of promoting a journal based on its relative ranking and impact. Hey dude, don't ya wanna publish in the 'In Crowd' journal Transfusion?
I'm in with the in crowd.
I go where the in crowd goes.
I'm in with the in crowd.
And I know what the in crowd knows.
Tidbit: I've got this album somewhere if I could only recall where I stashed the few 331⁄3 rpm vinyl records I've kept.  
  • The In Crowd (The Ramsey Lewis Trio vinyl album, recorded live at the Bohemian Caverns in Washington, D.C. in 1965)
As always, comments are most welcome. 

FURTHER READING
Academic publishers reap huge profits as libraries go broke (CBC, June 15, 2015) 
Larivière V, Haustein S, Mongeon P. The oligopoly of academic publishers in the digital era. PLoS ONE 10(6): e0127502. E-pub: June 10, 2015 (Free full text)
Just for fun
Confession: I've included these just so I have a record and can read on some long winter nights.

The writing of Eugene Garfield, including
Essays of an Information Scientist:1962 - 1973 
Essays of an Information Scientist:1974 - 1976 
Essays of an Information Scientist:1977 - 1978 
Ex:  Humor in Scientific Journals and Journals of Humor

Friday, April 22, 2016

Heart of Gold (Musings on donating the gift of life)

Updated: 24 April 2016
April's blog was stimulated by a flurry of news about organ and tissue donation in North America due to 
  • Canada: National Organ and Tissue Donation Awareness Week, April 22-28;
  • USA: April is National Donate Life Month;
  • Other nations have similar days, weeks, months throughout the year.
Recently, many news items have appeared on selling a body tissue, namely the introduction of paid plasma collection centres in Canada. Be aware that this is NOT another blog on that contentious issue. Rather it's about awareness of 
  • What we can donate;
  • Why we should donate;
  • How we can donate;
  • Why we don't donate. 
The blog's title derives from a 1972 ditty by Canada's Neil Young.

STATISTICS ON  DONATING BLOOD VS TISSUES AND ORGANS
The blog will mainly present Canadian statistics, which are not that different from statistics elsewhere in the world, except where noted. The focus will be on tissue and organ donation, not blood donation. OMG, statistics! Not to worry about being flooded with numbers. Statistics are great fun. 

About blood donation, ~4% of Canadians voluntarily donate bloodAs to tissue and organ donation, 80-90% of Canadians support organ and tissue donation but less than 20% make plans to donate.

Donating tissue and organs is in many ways different than donating blood, especially if the former applies to the future once you're dead, something you put in a Will or indicate on your driver's license. 

Organ donation is a complex process, which involves identifying potential donors, getting consent from families and procuring organs around the time of death. Donating tissues and organs after death is something that won't affect you personally as you're dead. 

But donating will affect your family at an emotional time, so it's essential that you frankly discuss your wishes with them. If your family objects, regardless of your wishes, your donation will not happen. 

Canadian STATS - Organ Donation (2014)
  • Over 4,500 people waited for organ transplants (77% needed a kidney); 
  • 2,356 organs were transplanted;
  • 278 people died waiting for a transplant (one-third needed a kidney).
TIDBITS
You can register to donate your organs and tissues and even donate certain organs while you're still alive: a kidney, part of the liver, and a lobe of the lung. See, for example,
An estimated two-thirds of deceased patients who are eligible to donate organs in Canada do not make it through the complex organ donation process. 

Only 2% of people who die meet the strict criteria for organ donation. But 90% can donate tissues, including corneas, heart valves, tendons and skin. 

Each deceased donor provides 3.4 organs on average.

Quebec had the highest deceased organ donor conversion rate in Canada, at 21% of eligible deaths, nearly double that of all the Prairie provinces.  

Transplant BC has 988,740 registered organ donors but only 422 organs were transplanted in 2015 due to strict medical requirements that rule out 99% of donors. Most deceased donors are declared brain-dead in intensive care but their hearts are kept beating until surgeries can be performed. 

Donation after Cardiac Death (DCD) is an emerging phenomenon in Canada that has forced the health care system to confront ethical issues on what constitutes death. Canada has adopted neurological criteria (“brain arrest”) to define death but some provinces do accept DCD.  

MUSINGS
Why don't more people donate?
So why don't more people take steps to give the gift of life after death? It's complex but here's why I think many good folks don't think about donating tissues and organs and plan for it:
  • Simply because it doesn't enter their consciousness;
  • Unless they know someone whose life depends on a transplant, they're unaware;
  • If they think about it, cutting up their bodies, even if dead, to remove parts may seem creepy;
Legal trade in tissues and organs
In many nations voluntarily donation is honoured but, depending on the body part, you may be able to sell it legally. For example:
Some argue we should be able to sell organs, not just plasma, hair, etc. 
 'A recent survey of Americans by researchers from Argentina, Canada, and the US. ...found that while barely half of respondents initially favored a system that would pay organ donors, the number rose significantly—to 71 percent—once those surveyed were given information about how the system would actually work.'
And some use arguments similar to those used to justify paid plasma. Paying helps the economy (the poor have more disposable money to spend) and recipient lives are saved. 

Black market in tissues and organs
We volunteer to donate body tissues and organs, we sell some legally, then there's the dark side, and it's very dark indeed.
As well, there's another shady, hidden body organ market that seldom sees the light of day:
You can search the Internet and find MANY similar - and even more gruesome - real-life, true reports.

LEARNING POINTS 
To me paid plasma is the thin edge of the wedge, the slippery slope that leads to hell, a hell where the poor sell their body parts in the open market to the highest bidder. Paid plasma and 'kidneys for sale' are on the same continuum.

My view is that voluntary tissue and organ donations are an incredible opportunity to make a real difference in the lives of fellow humans, whether 
Please take the time to indicate you want to donate tissues and organs, put it in your Will, and and explain your reasons to your family. Donating tissues and organs is a wonderful way to live after you die. 
  • In Canada, How to donate
  • In your country, search for 'organ donation' plus your nation, e.g., 
    • Organ donation UK, organ donation Australia, etc.
FOR FUN
Neil Young's song fits this blog:
FURTHER READING
A selection of resources used to develop this blog and ones well worth reading.

Saturday, March 19, 2016

We can work it out (Musings on transfusion medicine succession planning)

Updated: 21 Mar. 2016 (See Further Reading)
This month's blog derives from a news item in TraQ's monthly newsletter that resulted in my thinking about a topic I've spoken and written about often, succession planning
  • Why clinical labs and anatomic pathology are at risk because of no formal succession plan to develop their next generation of management leaders (Dark Daily, 16 Mar. 2016)
The Dark Daily report focuses on succession planning in US clinical labs and anatomic pathology. To me it encompasses several related issues.

My musings focus on why succession planning is a challenge in today's clinical laboratories and what I see as the main way it can realistically happen.


The blog is written from a medical laboratory technology perspective, as that's my background, but the issues also relate to nursing and physicians.

For example, as someone involved with helping seniors in their 90s who often go to Emergency Departments in ambulances, and later become what are disparagingly called 'bed blockers' in acute care hospitals, I see how short-staffed and stressed nursing staff are in both acute care and long term care facilities. To think these nurses, or the health care system in general, could ever prepare for succession planning beggars belief. Yet many nurses no doubt mentor their colleagues.

As for physicians, and hematopathologists in particular, mentoring happens due to the efforts of exceptional physicians. These professionals give above and beyond. I often see them answering queries at 11 pm, well after their work day ends, indeed after they've tended to family responsibilities.

The blog's title derives from a 1965 Beatles ditty.

For links to news item and resources, see Further Reading at the blog's end. Please take time to read the sample quotes from those who lived through restructuring and centralization. They're enlightening.


MUSINGS
CHALLENGE #1: Decreased CPD / CE
Decreasing budgets mean less money to train managers. Indeed, often money for continuing professional development (CPD) / continuing education (CE) all but dried up post-
laboratory consolidation.

If money were available for regional and national conferences, it went to medical directors, and perhaps to a lab manager, if any was left over. Sometimes medical directors paid part or all of their own expenses, leaving CPD/CE budgeted funds for managers and supervisors.

Today in Canada, some 20-25 years post-regionalization of laboratory services, clinical lab staff are mostly unionized and have contracts giving some degree of support such as 3-5 days paid leave for CPD/CE. But transportation to and accommodation at conferences often run over $1000, making attendance all but impossible without support.

In many cases, attending conferences also requires a supportive spouse and family to tend to extra duties with children, and generous colleagues to take up the slack at work, because while you're away, adequate replacement staff (if any at all) are seldom brought in.

Although valuable, the main benefit of conferences is not so much in hearing the latest and greatest from speakers (researchers and 'thought leaders'), but rather in socializing with peers.

It's in the socializing that you learn the goodies and tidbits not found in journals and not presented at conferences.

CHALLENGE #2: Decreased Mentoring
Staffing cutbacks leave remaining managers and administrators little time to mentor those with promising management and leadership skills.

Today it takes staff all their skill and energy to produce reliable lab test results that physicians rely on to diagnose and treat patients.

For example, with centralization and regionalization of laboratory services in the 1990s in Alberta,Canada, the first to go were middle managers. In this case, career lab technologists in affected hospitals - all experienced managers and supervisors - were left competing for the few remaining positions.

  • To see the reality of what lab regionalization means to people, see CSTM's blog on Dianne Powell below.
Under such circumstances, successful candidates often find themselves stressed to the max, not only with an extra workload, but often in unfamiliar surroundings (e.g., a different hospital in the same city).

Other contributing factors to stressed and overworked staff following lab centralization include

  • After significant change, many staff are so stressed that they may become negative, opting to do the bare minimum required for the job and fostering 'bitch sessions' at coffee and lunch. Even 'keeners' can be brought down by a steady diet of negativity.
  • Some staff come to believe, sometimes with good reason, that the organization is not loyal to them and they reciprocate the perceived feeling. Work may then become a '9-5 job' (just to earn $) as opposed to a career (lifelong journey to fulfill personally rewarding goals).
  • With centralization, more automation invariably follows because volume makes the instruments more affordable, especially given that fewer higher paid technologists are needed. To some lab workers, once the thrill of something new and shiny subsides, automation is 'okay' but not particularly rewarding.
Frankly, working with their hands and problem solving were the magical magnets that drew many to working in transfusion labs (and also microbiology). Loading mega-specimen trays, pushing buttons, and watching the instrument's software spew out results is not the most rewarding to such folks.

At the same time as automation occurs, specialized staff are lost and more generalists, as well as laboratory assistants, are hired to be supervised by a shrinking number of specialists. All of which contribute to overwork and increased stress in managers. The priority is for labs to become huge factories churning out products (lab results).

Mentoring future leaders becomes tougher and requires incredible effort by truly dedicated lab managers.
 
LEARNING POINTS

1. Health professionals should give themselves every educational advantage.

Especially in the 1990s, many exceptional Canadian laboratory technologists (and those of many nationalities) were forced to leave the profession due to lack of jobs. Others with appropriate credentials found work internationally. A BSc in Med Lab Science helped. Suspect a BSc in Nursing helped too, at least for working in the USA under NAFTA.

2. After large-scale centralization, or massive change of any kind, managers must have emotional intelligence.

From my brief experience in the world of management, managing staff is more important than all the experience and knowledge in the world (which also counts on the respect metre).

3. Formal succession planning? Are you kidding? A formal plan is tough. Mentoring is where it's at.

I know several med lab technologist leaders who continue to mentor staff informally. Mentoring occurs in nursing and among transfusion physicians too. All by folks I call the 'special ones' - health professionals who love their careers and go the extra mile to share the nuggets they've learned over many years.

Personally, I've had many talented mentors over the years. The first was Catherine Anderson, the lab manager at Canadian Red Cross Blood Transfusion Service in Winnipeg, when I was a kid of 21 years. She had CRC-BTS fund my way to local, national, and international conferences and workshops, had me speak in her place at conferences (at first I was 'shaking in my boots'), and left me in charge of a few administrative tasks when she was away. 


Plus when I screwed up, and I did, it was a learning experience, not the blame game. 

I'll mention one other mentor, Dr. David Ferguson, Medical Director of the UAH transfusion service in my days in MLS, University of Alberta, where I was also a clinical instructor for the UAH blood bank.

What David did was treat me as an equal, although I definitely was not. We shared many a laugh over student oral exams (Delicious biflorus being an answer one student gave to 'What is the the anti-A1 lectin?'). We also co-authored an immunohematology paper published in Transfusion. His reaction to reviewer feedback still makes me chuckle  today.

Mentoring is what develops future leaders in any field. Mentors come in all shapes and sizes. Some fear and resist change, others are big-picture visionaries who welcome change. A m
entor's key characteristics? 
  • Encouraging staff to be all they can be.
  • Modelling how exemplary professionals think and act.
As always the views are mine alone and comments are most welcome.

FOR FUN
I chose the blog's title song for its lyrics about life being short and there's no time to fuss about. Mentor potential lab leaders NOW or the proverbial poop will hit the fan as experienced staff retire in increasing numbers.

Life is very short, and there's no time
For fussing and fighting, my friend
I have always thought that it's a crime
So I will ask you once again

Try to see it my way
Only time will tell if I am right or I am wrong....

FURTHER READING


CSTM 'I will remember you' blogs (in alphabetical order) 
Sample quotes related to this blog's theme
NOTE: These blogs are based on my interviews with health professionals, leaders in their field, to celebrate their outstanding careers, awards, and accomplishments. Refreshingly, besides all the things they loved about their transfusion medicine lives (read the blogs!), they also speak frankly about regrets and the realities of laboratory consolidation and cost constraints.
  • Kieran Biggins (17 Jan. 2016)
    • Also, I regret allowing myself to be consumed by change fatigue during the last few years of working for Alberta Health Services.
    • ...I became the first Transfusion Safety Officer (TSO) in Alberta. Unfortunately, as the healthcare system in Alberta was consolidated yet again and again, my employer felt it necessary to add additional responsibilities to my new position such that I soon had two full-time equivalent responsibilities: TSO and Laboratory Quality Assurance Supervisor!
    • In the last few years of my employment with AHS, there was an overwhelming culture of DON'T question any changes, keep your head down, don't make waves and don't rock the boat. Unfortunately,  this (as you know) is not me....
  • Kathy Chambers (8 Jan. 2016)
    • Accomplishments and fun: Managing a team of smart, empowered women who made the transfusion service as good when I was not there as when I was.
    • This happened at RCH in New Westminster. From designing a new lab, working in less than good circumstances... moving into the new space and doing great work in their day-to-day duties, I think we truly had a quality system before it was introduced into labs.
    • Others: Having good mentors to make me a better person...
    • Attending conferences all over the world, meeting and networking with fellow TM practitioners. Loads of memories and great friendships.
  • Kate Gagliardi (20 Mar. 2016)
    • 'Regionalization – most of us minions had no control over fundamental changes in the environment which led to multi-sited organizations – and yet I sincerely missed the glory days of a single-site academic institution and the world within it that we had created.  It would have been nice to retain some of the good things – tight, dedicated teams, which endured despite changes in the personnel and services.'
  • Dianne Powell (7 Feb. 2016)
  • As a cost cutting measure, the RAH and Charles Camsell Hospital laboratory services were to merge. The process involved much uncertainly and anxiety. Our laboratory manager at the Camsell was given a package and quietly disappeared and staff felt quite un-tethered. As supervisors, we tried to provide support for the lab staff as we were dealing with the uncertainty, but as supervisors we were also dealing with maintaining the daily routine in the lab and ensuring testing got done.

    And we were told almost immediately that
    • We would need to submit our resumes and compete with our counterparts at the RAH Laboratory for our positions.
    • If unsuccessful in the competition, there was no place in the organization for us.
    • We would be given a package and be asked to leave immediately so we should have our personal stuff packed up.
    • Sounds like the reality TV show 'Survivor', no?