Tuesday, December 29, 2020

Sweet Dreams (Musings on the benefits of a well-rounded education)

Updated: 8 Jan. 2021 (Added addendum at the end)

No blog for a few months but wanted to write one for the end of 2020 and specifically the holiday season. December’s blog will discuss the benefits of a well-rounded medical laboratory science education. But I hope that the blog’s theme rings true for all transfusion medicine professionals.

The idea for the blog was stimulated by a message I wrote last year for an alumni reception of the MLS program I once taught in. As I couldn’t attend the Director asked me to send a greeting that she would read out. I’ve adapted it to a blog format and omitted some personal memories and the names of those MLS grads I mentioned.

The blog's title derives from a song co-written by Annie Lennox and originally released by the Eurythmics in 1983.

INTRODUCTION

Greeting to all Med Lab Science grads, no matter when you graduated. The oldster has two messages for all of you. First, I must tell you a bit about myself, but only so that you will appreciate - once you hear my messages - that I know what I'm talking about. In brief, I know the international scene in medical lab science well. Some examples (I excluded several others):

  • Founded a mailing list in 1994, MEDLAB-L, which became the world's largest English language mailing list for med lab professionals in all disciplines: 2400+ subscribers in 50 countries.
  • Still a list manager, albeit a silent one in the background, for CLSEDUC-L, the mailing list of U.S. clin lab science educators in all disciplines. All the leading educators are members, including textbook authors.
  • For decades I’ve been the webmaster for the TraQ website of the BC Provincial Blood Coordinating Office which distributes a monthly newsletter to 1000s of transfusion professionals all over the world. 

ANECDOTES 

1. In the 1990s medical laboratory technologist positions became scarce in Alberta due to severe government cutbacks. Many MLS grads went to work in the U.S. as they had written ASCP (MT) examinations when they graduated. I know from my extensive contacts there that MLS grads were highly valued and considered excellent. One reason of several was their long internship in clinical labs. The clinical rotation is shorter now, pretty much everywhere.

2. Several also worked in NZ for its national Blood Transfusion Service. To facilitate that adventure, I sent copies of the MLS curriculum to the NZ registration body. The NZBS runs blood centres and also pretransfusion testing laboratories.  

3. In the 1990s out-of-the-blue I was contacted by a company (Wyndgate Technologies, now part of Haemonetics) in Sacramento, California who made software for transfusion labs. The company had given a demonstration of their LIS software to staff in Hamilton, NZ for the New Zealand Blood Service. They were so impressed by the 5 MLS grads working there that they wanted to know if MLS had any more like that. 

Turns out two grads were game and worked for the company for many years, travelling all over the U.S. demonstrating the software for new clients. One was a NAIT graduate, who took MLS’s degree-completion program for technologists with general certification from CSMLS

WHERE LIFE TAKES US

In MLS you obtained 3 main skills:

  1. Extensive knowledge in all MLS disciplines; 
  2. Sound practical training in clinical labs;
  3. Priceless so-called 'soft skills' that are transferable to many occupations, especially communication skills and the ability to be a lifelong learner.

To me it's always been the third that's most valuable because we never know where life will take us. Most MLS grads went on to long careers in clinical labs, where many became supervisors and managers. Some rose to high positions in healthcare organizations.

Other MLS grads followed different paths. Some got post-secondary Masters or PhDs and became researchers, Deans in technical institutes and universities. Several became MDs and rose to high positions in healthcare. Others became lawyers, nurses, dentists, physical therapists, investment brokers, real estate agents, sales representatives, information system specialists.

I’ll highlight but one MLS grad: Susan was born in AB to immigrant parents and when she entered grade one she spoke only Chinese. She worked in her parents’ modest restaurant, as did her sisters. After working as a med lab technologist Susan became a lawyer and progressed to be a tax specialist who was the Regional Director at the Department of Justice Canada in Vancouver. Susan was appointed a judge of the Tax Court of Canada by Canada’s Governor General and now has the title Honorable as part of her name.

LEARNING POINTS

#1: As an MLS graduate be aware that your hard work has resulted in graduating from one of the world's top medical lab science programs. Not just top Canadian MLS program, but one of the world's finest MLS programs. As someone active on the international scene for decades, I can attest to this. 

Concrete Evidence: In 1998 MLS won a worldwide competition to put on a 5-day seminar in Saudi Arabia for the healthcare division of Saudi Aramco (Saudi Arabia's national oil company). 

#2: With an MLS degree you can become anything. You can work as a med lab technologist in Canada, the USA, and beyond or get further education in any field. 

Indeed, most of my 'kids' work as medical lab technologists in labs across Canada, not just in Alberta but literally from coast to coast to coast, including New Brunswick in the east, BC in the west, and Whitehorse, Yukon. As such they make important contributions to Canada's healthcare system. Yes, I'm incredibly proud of all my 'kids'. 

But if you want to, with an MLS BSc - and being skilled lifelong learners - you can take further education and enter any profession. The sky's the limit. You have the education to be FUTURE LEADERS in wherever life takes you. Never forget it.

SECRET TO SUCCESS

Regardless of the health profession it’s the so-called 'soft skills' that are transferable to many occupations, especially communication skills and the ability to be a lifelong learner. Not all the facts you have learned, though they are important to being a competent health practitioner.

PHOTOS OF SOME OF MY MLS 'KIDS' (Most taken by me)

  • Wish I could include many more, but for now this is it.
  • Dr. Carol E, BSc (MLS), PhD (medical microbiology) & MD (anatomic pathologist), RAH at Edmonton Pride Parade 

  • Colleen Y, BSc (MLS),worked for CBS for years, & currently Macopharma marketing Manager in Lille, France 

  • Brenda M, BSc (MLS),longtime medical lab technologist, University of Alberta Hospital 
  • Francene S, BSc (MLS) longtime medical lab technologist (Dynalife)
  • Liz M, BSc (MLS), medical lab technologist,UAH, who became Director of Accreditation at College of Physicians and Surgeons of Alberta & more.
  • Sonja C, BSc (MLS), MEd (Post-secondary Studies), clinical instructor in MLS, now Dean, School of Health and Public Safety at SAIT
  • Chris W, BSc (MLS), MEd, now Associate Professor, Faculty of Medicine & Dentistry, Dept. Lab Med & Pathol, Division of MLS, who teaches multiple transfusion science and immunology courses, plus is involved in a multidisciplinary UAlberta course. Earlier he worked in multi-discipline 'core lab' then got my job and volunteered for CSMLS on exam panel when that was allowed.

  • Lisa D, BSc (MLS), ART(CSMLS), MT (ASCP) SBB, Learning management specialist at DynaLIFE Medical Labs 

  • Judy W, BSc (MLS), longtime medical technologist at CBS (photo of me & Judy)

  • Lisa P, BSc (MLS), MSc (medical microbiology & immunolgy)
    • First non-physician, non-PhD Director of MLS;
    • Assistant Dean, Graduate Student Affairs, Office of Advocacy & Wellbeing at University of Alberta

  • Anne H, BSc (MLS), MT (ASCP), MSc, Trinity College, Dublin, (Community Health/Public Health), PhD candidate UAlberta (transplant immunology);
  • Dr. Craig C, BSc (MLS), Bachelor of Commerce (Management Information Systems), PhD (Health Information Science); 
    • University Research Chair in Healthcare Innovation, UOttawa; 
  • Current position: Associate Vice-President, Research, MacEwan University
  • Dr. Susan N, BSc (MLS), MD +Hematopathology certification, University of Alberta; 
    • 2020 Physician of the Year for Edmonton Zone Medical Staff Association; 
    • Medical Director, Transfusion Medicine at Alberta Health Services;
    • Section Chief/ Divisional Director for the AHS Edmonton Zone Transfusion Medicine Service;
    • Deputy Clinical Department Head for Laboratory Medicine and Pathology
    • Member of the Alberta Blood Office Collaborative (ABOC)
    • Canada's National Advisory Committee on Blood and Blood Products (NAC) 
    • International Collaborative for Transfusion Medicine Guidelines (ICTMG).
  • Photo of me & Susan 

  • Jodi M, BSc (MLS); 
  • Quality Control Manager, Alberta Research Council
  • Quality Control Analyst, KS Avicenna Inc.
  • Founder & President of Keystone Labs Inc. (2005-present) 
  •                             


    • Shelly C, BSc (MLS), LL.B, admitted to the Alberta Bar;
    • Current position: Partner at Reynolds Mirth Richards & Farmer LLP
    • Volunteer and leadership experience:
      • Past President, Youth Empowerment and Support Services (YESS) Board of Directors (2003 - 2012);
      • Presenter, Edmonton Community Foundation;
      • Lecturer, Legal Education Society of Alberta;
      • Past Presenter, Metro Continuing Education, Edmonton Public Schools.
    • Prior work experience:
      • Regional Coordinator for Edmonton's then Capital Health Authority, Department of Laboratory Medicine;
      • Worked as a medical laboratory technologist in Saudi Arabia;
      • Worked with a humanitarian aid project (Osvita medical project) in Kyiv, Ukraine. 
    • Photo of me and group of Canadian medical technologists in Oslo, 1996 for a world congress. Shelly is third from the right, next to my spouse. 

    • Dr. Gordon C, BSc (MLS), PhD (medical biochemistry);
                                                  
    • Roberta M, BSc (MLS), MT(ASCP), MEd (Adult education) Work history:
      • Clinical Labs of Hawaii
      • University of Alberta, Faculty of Medicine & Dentistry, Dept. Lab Med & Pathol, Division of MLS - MLS instructor (Clinical Chemistry)
      • Current positions: Associate Professor and MLS Program Coordinator, University of Alberta, Division of MLS 
        • Instructing in Histology, Foundations of Instrumentation and Laboratory Management
                                               

  • Darcy F, BSc (MLS), MT (ASCP) Work history: 
  • Medical Technologist, Associated Pathologist Laboratories 
  • Implementation Specialist, Sunquest Information Systems
  • Implementation Specialist, Misys Healthcare Systems
  • Business Systems Advisor, Dell Services/NTT DATA Services 
  • Current position: Sr. Business Analyst - LIS at Verity Health System
  • Enterprise Application Administrator III, MultiCare Health System 
  •  


    Stay tuned
    ...more graduates to come.

    As always comments are most welcome and there are some.

    Addendum: Note: Most grads who worked outside of Canada were forced to do so by Alberta's conservative government, which cut clinical lab budgets by 49% and jobs dried up here.  Also, please see my latest blog, which is related to this one: I will remember you (Musings on a 1991 graduation speech)

    FOR FUN

    Monday, August 31, 2020

    Revolution (More musings on using artificial intelligence in transfusion medicine)

    Updated: 3 Sept. 2020 (Added to Learning Point)

    August's blog will discuss the issue of artificial intelligence (AI) & 'big data' in medicine and health.

    The idea for the blog was stimulated by a fascinating article in The Economist of June 13-19 as part of its Technology Quarterly: 'Driverless cars illustrate the limits of today's AI.' (Further Reading)

    The blog's title derives from a 1968 ditty by the Beatles written by John Lennon

    LIMITATIONS OF AI

    According to The Economist article, the following are some of AI's current limitations that I've chosen to highlight. Yes they relate to self-driving cars but most have broad applicability relevant to medicine:

    1. Self-driving cars work similar to other applications of machine learning. Computers crunch huge piles of data to extract general rules, and in theory the more data, the better the systems perform.  

    But deep-learning is statistical, linking inputs to outputs in ways specified by training data. That leaves them unable to cope with “edge cases” ­ unusual circumstances that are not common in those training data.

    • You can imagine if this applies to driving cars how much it can apply to the complexities of human beings, their health, symptoms, medical needs, etc. Humans can cope with oddities much better than AI, which in some ways works with only half a brain. 

    2. Google’s “Translate” often does a decent job at translating between languages. But in 2018 researchers noticed that, when asked to translate 18 repetitions of the word “dog” into a language spoken in parts of Nigeria and Benin and back into English, it came up with the following hilarious translations:

    • “Doomsday Clock is at three minutes to twelve. We are experiencing characters and dramatic developments in the world, which indicate that we are increasingly approaching the end times and Jesus’ return.” 
    • Fact: Google’s system doesn't understand language because concepts like verbs and nouns are alien. It's constructed using statistical rules linking strings of letters in one language with strings of letters in another and is baffled by questions a toddler would find trivial. 

    3. Richard Sutton, AI researcher at the University of Alberta and DeepMind, published “The Bitter Lesson” (Further Reading) arguing that AI history shows that attempts to build human understanding into computers rarely work. The “bitter lesson” is that “the actual contents of [human] minds are tremendously, irredeemably complex…They are not what should be built in [to machines].” 

    Christopher Manning of Stanford University’s AI Lab notes that biological brains learn from far richer data-sets than machines. 

    4. About Big Data, which makes AI possible, see 'Big Data in Healthcare' (Further Reading). The conclusion: 'While big data provides great potential for improving healthcare delivery, it is essential that we consider the individual, social and organizational contexts of data use when implementing big data solutions.'  Personal note: 

    * The lead author is one of my UAlberta Med Lab Science 'kids'. 

    LEARNING POINT

    AI has a long way to go before it can be safely used in self-driven cars. Despite the hype, AI has an even longer road to travel before it's as safe and reliable as human health care professionals. Feel free to disagree. 

    The entire Technical Quarterly in The Economist, June 13-19, 2020 deals with AI and its limits. As its many proponents hype AI and Big Data, it's prudent to show their limitations too. Included articles:

    1. Reality check: After yrs of hype,an understanding of AI's limitations is beginning to set in
    2. Data - Not So Big: Data can be scarcer than you think and full of traps
    3. Brain Scan | An AI for an eye: Pioneering ophthalmologist highlights the potential, and the pitfalls, of medical AI
    4. Computing Hardware | Machine Learning: The cost of training machines is becoming a problem
    5. Road Block: Driverless cars illustrate the limits of today's AI
    6. The Future | Autumn is coming: As AI's limits become apparent, humans will add more

    Note:  If you don't subscribe to The Economist, perhaps take a trial one? Or check if your hospital is affiliated with a university, college (or perhaps the public library) has it available.

    As always, comments are most welcome. And there are some.

    FOR FUN

    I chose this song because pretty much everyone has hopped on Big Data and AI bandwagons as if they're a revolution that's going to sweep traditional medicine aside. Maybe but I suspect not for years.

    FURTHER READING

    Driverless cars illustrate the limits of today's AI - They, and many other such systems, still struggle to handle the unexpected (The Economist, June 13-19, 2020) 

    Prior AI blog (30 Nov. 2019): I can see clearly now (Musings on using artificial intelligence in transfusion medicine)

    The Bitter Lesson by Rich Sutton (19 Mar. 2019)

    Rich Sutton, University of Alberta | Also see this bio

    Kuziemsky CE, Monkman H, Petersen C, et al. Big Data in Healthcare - Defining the digital persona through user contexts from the micro to the macro. Contribution of the IMIA Organizational and Social Issues WG. Yearb Med Inform. 2014;9(1):82-9. Published 2014 Aug 15. 

    Friday, July 31, 2020

    I heard it through the grapevine-2 (Musings on the value of Twitter)

    In 2019 I wrote a blog promoting Twitter for TM professionals and for July's blog, I'll do a second one.
    The blog's title derives from 1966 ditty recorded by Marvin Gaye and later Creedence Clearwater Revival.  

    INTRODUCTION
    To me far too few transfusion professionals are on Twitter, including medical laboratory technologists, nurses, and physicians. Many reasons, including Facebook preceded Twitter and Twitter tends to have a poor reputation in general. Today Facebook has an even worse reputation but if you're on it, you may value how it keeps you in touch with pals and family. 

    In my experience TM folks on Twitter are a different breed. They want to share resources and expertise and, if you want to engage in continuing professionals education, Twitter is a wonderful free resource. Questions can be asked and answered by experts. Also Twitter is international. Based on my Twitter account (Further Reading), experts from Australia, Canada, UK, USA, and professionals from many nations in Africa and Asia participate. Glad to report that some Canadian medical laboratory technologists are on Twitter.

    UNDERSTANDING TWITTER (from earlier blog)
    First, Signing up on Twitter is easy 
    Tidbits (Twitter 101):
    • Language: Twitter is the software platform. You are a tweep. When you post a message, it's called a tweet. 
    • If not on Twitter when accessing a tweet and asked to join, just click on another part of the screen and you can see direct tweets. 
    • Be aware you don't need to tweet. Just as on mailing lists, you can lurk.  
    • By being on Twitter you can see the replies given by tweeps to other tweeps. If not, you can see only their direct tweets (not replies). 
    • Twitter gives you quicker access to important professional events and issues, allows you to share resources with colleagues.  
    • As a citizen Twitter is the place to be because you get news about anything well before it appears on mainstream media, e.g., disasters, latest weather, political events. All media and reporters are on Twitter.
    • Twitter hashtags are key (Further Reading) For example, they can be used to identify who to follow. And you can also see who others follow for more suggestions.
    Learning Point: If you are a transfusion professional in any capacity, please consider joining Twitter. You won't be disappointed. Look at my account to see who I follow, many transfusion experts from all over the world, well known experts.

    As always, comments are most welcome.

    FOR FUN
    Chose this ditty because Twitter is a good grapevine to keep up with the latest transfusion medicine news.
    FURTHER READING

    Tuesday, June 30, 2020

    You never give me your money (Musings on paying to develop COVID-19 vaccine)

    Updated: 1 July 2020
    What to blog about when COVID-19 dominates the news, whether it's research funding, impact on blood supplies, paid plasma proponents, testing, treatments, vaccines? Plus, of course, government guidelines and measures to prevent the spread of coronavirus while opening up the economy.

    Finally decided that June's blog should discuss the question of who pays to develop COVID-19 vaccine and who gets priority once it exists, including which countries worldwide and, within countries like the USA without universal healthcare, will all be able to afford it.

    The blog's title derives from a 1969 ditty by the Beatles.

    INTRODUCTION
    Governments worldwide have invested billions into developing a coronavirus vaccine, some given to university researchers, some to Big Pharma. There are reports that if a vaccine is developed inside a nation, that country will have priority access to the vaccine.

    If COVID-19 has taught us anything it's that supply chains for crucial medical equipment like food, PPE and drugs must be secured and the best way is to produce them in the country, if possible. There are even reports of France and Germany accusing USA of diverting medical supplies like masks and that president Trump asked mask maker 3M not to supply masks and more to Canada and Latin America. Trump also bought up almost all stocks of Remdesivir, a drug used to treat coronavirus. (Further Reading)

    Plus the world is experiencing infighting and global politics at its worst:
    At G20 meeting of health ministers the intent was to strengthen WHO's mandate to coordinate fight against COVID-19 with a major focus on the process of crafting international agreements on any drugs or vaccines that successfully treat COVID-19. U.S. was the only country opposed to a statement that offered a framework for a united approach to fighting the pandemic and stopped funding WHO. (Further Reading)

    HISTORY
    The past has shown that poor developing nations don't have access to drugs that we in the industrialized world take for granted. Examples:

    For the vast majority of the 325 million people living with hepatitis B or C, accessing testing and treatment remains beyond reach (Further Reading).
    Without charitable donations by Big Pharma, for ages more than 75% of folks in developing world with hemophilia had little or no access to diagnosis and treatment. Those with severe hemophilia often did not survive to adulthood or, if they did, faced a life of severe disability and chronic pain (Further Reading).
    Learning Points: If history repeats itself, COVID-19 will follow similar path. Folks in poor nations will be last to get the vaccine and treatments. And nations like USA whose POTUS puts America first, will try to gobble up most, leading to worldwide inequality in life-saving treatments. All at a time when the world needs to come together to fight a pandemic. 

    As always, comments are most welcome and there are some.

    FOR FUN
    First song I chose for the blog:

    Back-up song you may enjoy is 'Money' from 1972's Cabaret film.
    • Money (by Lisa Minneli & Joel Grey)
    FURTHER READING
    Listed by date of news report

    Trump buys up almost all stocks of Remdesivir, a drug used to treat coronavirus (1 July 2020)


    Big pharma is taking big money from U.S. taxpayers to find a coronavirus vaccine  and charge whatever they want for it (24 June 2020)

    Will coronavirus pandemic change Big Pharma's long-term focus? (15 June 2020)

    Sanofi and Sobi donate up to 500 million additional IUs of clotting factor to WFH Humanitarian Aid Program (14 June 2020)

    U.S. must stop blocking global effort to fight COVID-19 (23 Apr. 2020)

    Big Pharma wants billions more for COVID-19 funding pot (21 Apr. 2020)

    German, French officials accuse U.S. of diverting supplies (4 Apr. 2020)

    WHO urges countries to invest in eliminating hepatitis (26 July 2019)

    Sunday, May 31, 2020

    For the times they are a-changing (Musings on COVID-19 global news)

    Stay tuned: Revisions are sure to come
    What to write about during COVID-19? It initially stumped me. Possibilities I considered include how coronavirus has impacted the blood supply worldwide and increased pressure from paid plasma advocates to promote paying for all plasma and other body tissues. 

    Finally settled on a mini-survey of coronavirus news featured in May's TraQ's newsletter to see what, if anything, that might reveal..

    The blog's title is based on a 1965 ditty by Bob Dylan, and yes, it can be read many ways given the news.

    INTRODUCTION
    The mini-survey is based on news items I selectively collated for TraQ's newsletter during March, April, and May 2020. As past blogs will show, the blogs are mine alone and reflect my personal biases. 

    For May's blog I arbitrarily organized COVID-19 news items into four topics, which have some overlap:
    • General (Information, industry news, search for treatments and vaccines)
    • Blood supply (Risk of shortages)
    • Convalescent plasma
    • Journal articles
    SUMMARY 
    Results of TraQ's March to May survey:
    TOPIC 
    MAR.
    APR.
    APR.
    TOTAL
    General 
    0
    13
    8
    21
    Blood supply
    6 3 4 13
    Convalescent plasma
    6 14 7 27
    Journal articles
    0 23 1538

    Limitations
    I could have calculated results incorrectly. My search alerts may not have identified all possible news items in each category. Also, in May the number of convalescent plasma news items soared and I decided not to include  many in the newsletter, as they often involved only a few people and were repetitive of earlier news. It's possible I haven't yet been alerted to the existence of more COVID-19 research articles published in May. 

    LEARNING POINTS
    So, as I recall from the 1966 film Alfie, it's time to ask, 'What's it all about Alfie?' Or as I once told my Med Lab Sci students, you should try to identify the 'so what' message of research papers. So too should blogs have a point. My biased musings on the results:
    • So much money is being poured into research for a vaccine and improved COVID-19 testing. It's a race to get there first among nations, including to have the vaccine manufactured in a country, as presumably that would give priority access to its citizens. 
    • Seems a rush to strike gold first. Potential for industrialized nation to get priority access and developing nations to be left out as often is the case. Think of recombinant FVIII being unavailable for ages in developing nations. Also countries like India where blood banks still use ELISA to test for HIV, Hepatitis B and C, rather than NAT.
    • Convalescent plasma is the flavour of the year of COVID-19. Results look promising but final results not in yet. More troubling is the notion that having antibodies allows you to return to work as you are protected. But scientists don't know yet whether people who've been exposed will be immune for life, as for measles, or if COVID-19 can return again and again, like the common cold. 
    • Big Pharma wants mega-money up front to fund COVID-19 research (Further Reading). Quote from article:
      • Particular concern over poorer countries’ access to medical supplies was highlighted by G20 health ministers’ failure at the weekend to issue a declaration of solidarity after this was blocked by the US
    FOR FUN
    I chose this Bob Dylan song as it reflects what's called the 'new normal' during COVID-19 and also reflects the current protests happening in the USA over the killing of a black man by a police officer. Somehow I suspect, with zero evidence, that the protests may be stronger and more widespread because of the coronavirus lockdown. Or perhaps because murder of black people by police has become all too common in America?

    Chose Joan Baez to sing it for several reasons, the most important being she has a much better voice than Dylan. Also this version has the song's lyrics. Tidbit: Joan and Bob were once an item (Further Reading).
    As always comments are most welcome.

    FURTHER READING
    TraQ's newsletters
    Big Pharma calls for ‘billions’ in upfront coronavirus funding (20 Apr. 2020)

    Joan Baez finally gets her public apology from Dylan (21 Sept. 2009)

    Thursday, April 30, 2020

    Could I have this dance (Musings on a love affair with transfusion medicine for NMLW)

    Updated: 3 May 2020 (Fixed typos)  

    INTRODUCTION
    Because it's National  Medical Laboratory Week, for April's blog I'll share brief anecdotes from the labs of the blood suppliers and transfusion services I've worked for, including when an educator. These are the personal anecdotes of an oldster and I hope that some of them give a chuckle, albeit a wry one.

    Keep in mind that I last had a real job working in a clinical laboratory 20 years ago. But I taught many students who still work and we keep in touch. Plus I manage a transfusion mailing list for the Canadian Society for Transfusion Medicine and an educational transfusion website, so keep up-to-date in the field.

    The blog's title is based on a 1980 ditty by Canada's Anne Murray, and yes, it's an allegory for what I want to convey in this blog.

    1. CRC-BTS [Canadian Red Cross Blood Transfusion Service] 
    CRC-BTS in Winnipeg, MB, Canada is where I began my career in 1964. It was a combined blood donor centre and central transfusion service for the city and outlying areas of Manitoba and northwest Ontario. In those days Winnipeg hospitals did not have blood banks per se but functioned merely as distribution centres of blood, whose 'blood banks' were managed by hospital RNs. 

    As I've written before, today I would never be hired as I had a general BSc (not when hired, though), and no med lab training. My knowledge of blood was close to nil. Nonetheless, CRC-BTS became my family for 13 years and I thrived. Fact is, I loved coming to work each day as I never knew what it would entail and what else I'd learn.

    I decided to read the current immunohematology bibles (textbooks and journals) and eventually wrote the CSMLS (then CSLT) subject exam in immunohematology (now transfusion science), which no longer exists as a subject exam. 

    Tidbit: As a subject blood banker, I'm a dinosaur who no longer exists in Canada. At one point I took offense when the then CSLT President said those with subject certification were only good for chopping liver. Think I wrote a letter to the Society's newsletter in rebuttal. 

    Then I became the clinical instructor for med lab students from Red River Community College (now Red River College), new CRC-BTS lab staff, and any trainee physicians who wanted to learn about the transfusion service. 

    Teaching was a natural as after the science faculty, I took a short session in the Faculty of Education and taught high school in rural Manitoba for a year. Yes, the school I taught in was so desperate for teachers they took someone without a BSc and 3 months education training. Main subjects taught were chemistry and maths but many more as it was a 4-room high school. 

    Same with CRC-BTS, they hired me without a BSc (I'd goofed off and failed physics in my first year). Eventually after 3 years, management pressed me to get the BSc and I obliged with a night course in what I recall as the 'new algebra'.   

    Anecdote #1 
    There were no SOPs at CRC-BTS, and before I became the clinical instructor, what students and new hires learned depended on which technologist trained them on-the-job. You can imagine what fun that was for trainees. Today, med lab training is based on competencies and students are evaluated daily, but not then. 

    Finally, I decided to write SOPs for the transfusion service (TS) part of the operation on my holidays at a local lakeside cabin. Whatever possessed me? This was before I became the clinical instructor. So why did I do it? Lo and behold, the crossmatch lab used the SOPs I'd written. The SOPs weren't validated, we were in a wild west world where anything goes. 

    Anecdote #2
    At one point a new hire with a general BSc had a disability that included having deformed hands. She could do all laboratory tasks well (TS wasn't automated and everything was done by manually pipetting) but when it came to her compulsory medical done a few months into the job, the physician said she could not do the job and should be let go. 

    After I spoke to other medical lab technologists, we unanimously agreed that we should all sign a letter to management saying she could do the job and we did. So why did we do it? Bottom line: She was kept on and stayed in the job for decades, eventually becoming a supervisor/manager. 

    2. MLS [Medical Laboratory Science, University of Alberta]
    In late 1977 I was hired as an MLS instructor to teach introductory transfusion science, with a joint appointment as the clinical instructor for the University of Alberta Hospital transfusion service (UAH-TS). I was sad to leave my pals and family in Winnipeg but excited to move to Edmonton and meet the challenge of teaching at a university. Yes, in MLS I loved coming to work each day as you never knew what it would entail, students being students, and what else I'd learn.

    Anecdote #3
    As the prior transfusion instructor had unexpectedly left after attending an AABB conference and meeting a young man 😂, the position was temporarily filled by an experienced med lab technologist from the UAH-TS. Indeed, she had applied for the job but did not get it as she lacked a BSc.

    This technologist became a dear, close friend, showed me the ropes, how to navigate the hospital, and introduced me to the local blood bank community, which became my new family. She also got me involved in the CSMLS in several ways, including recommending me for the Certification Board, a 3-year appointment. So why did she do it?  

    Anecdote #4
    As mentioned earlier, I lacked education and training in medical laboratory science and managed to learn transfusion in-depth through reading and broad practical experience in a busy joint blood centre and transfusion service. In MLS most colleagues were graduates of MLS and they too befriended me, put up with my many deficiencies, became my family, and generously taught me the key things I needed to know in other clinical lab disciplines. I'm forever grateful. So why did they do it? 

    3. CBS (Canadian Blood Services, Edmonton)
    After MLS, I was lured to take a job at CBS as an assistant lab manager, where I was in charge of the patient services laboratory (PS lab): pretransfusion testing, prenatal testing. Not quite the job I expected, as it was promoted as having a significant teaching component. I refer to it as my 'assman' job as that's how the QA dept. addressed my correspondence. Again, I loved coming to work each day as I never knew what it would entail, more specifically what new knowledge and skills I'd learn. 

    Anecdote #5
    The person who had been running the lab on a temporary basis was in the first MLS class I taught all the way through, one of my 'kids' as I call them. She was an assistant to the person in the manager job prior to me. She should have gotten the job I now had, but nonetheless, she kindly showed me the CBS ropes and performed any function I asked her to do. So why did she do it? 

    Anecdote #6
    All of the PS lab staff (supervisors, technologists, lab assistants, clerical) generously welcomed me, a rank outsider. One of the big projects we had was being the Canadian pilot site for a new CBS computer system (Mak Progesa). In conjunction with the new lab information system, I decided to change most of the PS lab's serological and policy SOPs to update them, including instituting the electronic crossmatch. 

    Despite what must have been stressful, all staff pitched in, performed above and beyond, and did so as a team with great camaraderie. In retrospect, I suspect we had a lot of fun meeting the training challenges. So why did they do it?

    4. PLC [Consulting career]
    I won't go into the many adventures I had in a consulting career as that's another blog. 

    SUMMARY
    So the questions above ask why did I, she, they do it? The answer is the same for all. 

    My experience is that medical lab technologists (biomedical scientists) who work in transfusion, and I suspect all clinical laboratories, are a close-knit family dedicated to protecting patient safety. Why do I say family? Because just like a biological family, the medical laboratory family has little to nil to do with ancestors and genes and everything to do with love, compassion, and support for members of the team.  

    Perhaps transfusion is even more so a family, because we are a comparatively  small group. For example, when I was active in the profession I knew many med lab technologists in blood centres and transfusion services across Canada. When the Internet made international mailing lists possible, the family grew to include lab professionals from around the world. 

    For all the positions I held throughout a long career, members of the family became lifelong pals. I think of my career and those of my colleagues as a long love affair with transfusion medicine and laboratory medicine that's never ended. I hope that those who work as med lab professionals in any discipline are lucky enough to feel the same, indeed, workers in any field. That I lucked out with my career is an understatement and I'm sure many of my transfusion colleagues over the years feel the same way.

    Happy National Medical Laboratory Week (April 26 to May 2, 2020 in Canada). Though largely hidden from the public and working behind the scenes, we in clinical laboratories play a crucial role in diagnosing and treating diseases. 

    FOR FUN
    I chose this song as a allegory for how so many medical laboratory technologists (biomedical scientists) feel about transfusion, myself included. 
    Could I have this dance for the rest of my life?
    Would you be my partner every night?
    When we're together it feels so right
    Could I have this dance for the rest of my life? 

    As always, comments are most welcome and appreciated. See some below.

    Tuesday, March 31, 2020

    We are the world (Musings on COVID-19's impact on the world's blood supply)

    Stay tuned: Revisions are sure to occur
    March's blog derives from the ongoing worldwide shortage of blood due to the coronavirus (COVID-19). Of course, because this is a transfusion medicine blog, I'm preaching to the converted. But I hope it gets wider distribution among all healthcare colleagues and the public beyond. 

    Specifically, I ask all transfusion heath professionals to speak to colleagues, family, friends, neighbours about the ongoing need for blood donation, made even more crucial because of the COVID-19 pandemic. 

    The blog's title is based on a 1985 song written by Michael Jackson and Lionel Richie for  'USA for Africa.' 

    BLOOD SHORTAGES
    For TraQ's newsletter, I've collated some of the ongoing blood shortages across the globe (Further Reading). Fact is, the need for blood transfusion is ongoing despite the COVID-19 pandemic. Yet blood donation has dropped off significantly in many nations for numerous reasons explained in the news items in Further Reading. 

    TRANSFUSION NEEDS
    Despite the ongoing efforts of the Transfusing Wisely initiative (Further Reading), implemented in many nations, regular need for transfusions still exits for many patients. Transfusing Wisely's general goals: Reduce the rate of unnecessary blood transfusions with the goals of lowering the risk of complications for patients and supporting the judicious use of valuable resources. 

    For the general public, just some of the ongoing needs for blood transfusion include the following (not all inclusive):

    Patients who need blood transfusions
    • Mothers who incur significant bleeding during delivery, including those with placenta previa
    • Gastrointestinal bleeding (if massive can be life threatening) with many causes such as hemorrhoids, peptic ulcers, tears or inflammation in the esophagus, diverticulosis and diverticulitis, ulcerative colitis and Crohn's disease, colonic polyps, or cancer in the colon, stomach or esophagus  
    • Kidney disease, sometimes secondary to type 1 diabetes, that requires dialysis
    • Any surgery that involves significant blood loss
    • Trauma patients including those in car accidents who experience blood loss and victims of knife attacks or gun shot wounds
    • Blood disorders, including
      • Thalassemia major patients need regular red blood cell transfusions to raise their hemoglobin level and deliver oxygen to body tissues
      • Sickle cell disease patients need regular red blood cell transfusions to provide normal red blood cells, lessen anemia and reduce the blood's viscosity, allowing it to flow more freely and ease disease symptoms and prevent complications
      • Leukemia patients who develop thrombocytopenia need platelet transfusions to control bleeding 
    The need is real and ongoing. Please encourage colleagues, family, friends, and neighbours to donate blood and save a life. It's one thing folks can do during the pandemic. Further Reading includes questions about donating in Canada and blood systems in all nations have similar information. 

    FOR FUN Naturally, I chose We Are The World, originally written for 'USA for Africa' in 1985 by Michael Jackson and Lionel Richie, produced by Quincy Jones and Michael Omartian, and sung by many fabulous American  artists.  
    We are the world
    We are the children
    We are the ones who make a brighter day
    So let's start giving...

    As always, comments are most welcome and appreciated.
    FURTHER READING
    Australia: In the face of coronavirus pandemic, Australian Red Cross Lifeblood’s stocks are threatened (24 Mar. 2020)

    Canada: Top doc says Canada still needs people to give blood amidst social distancing (17 Mar. 2020)
          Canadian Blood Services: Message by CEO Dr. Graham Sher
          CBS answers COVID-19 blood donation questions

    Pakistan: Experts urge volunteers to donate blood as thalassaemia patients face shortage (22 Mar. 2020)

    Spain: In COVID-19 emergency blood bank stocks in Costa Del Sol hospitals are alarmingly low (18 Mar. 2020)

    UK: Blood donors needed after 15% drop, says NHS (23 Mar. 2020)

    USA: Coronavirus fears threaten America's blood supply (12 Mar. 2020)

    Transfusing Wisely Canada

    Saturday, February 29, 2020

    You don't own me (Musings on questioning Dr. orders)

     Updated: March 1, 2020
    February's blog derives from another TraQ case study from decades ago that discusses a topic not often included in online transfusion medicine cases but is still relevant. This case was based on a case study used to teach nurses at the McGill University Health Centre (MUHC) in Montréal, Québec. Because of this blog, I've revised the case to update all links. 
    • The blog's title derives from a 1963 ditty first recorded by Lesley Gore.
    Case Study O6: Transfusion Reaction Coincidental with Failure to Disobey Physician Orders
    This case was suggested by an RN and, because I'm not a nurse, several helped me with the case, also medical laboratory technologist pals from Hamilton and a physician (whom I taught when she was in Medical Laboratory Science at the University of Alberta). 

    CASE SUMMARY
    This case study presents a scenario in which a nurse did not follow several key transfusion protocols and procedures, including adhering to the time limit for transfusing blood, monitoring vital signs throughout a transfusion, and questioning orders that contradicted hospital policies and procedures.

    It began when the nurse called the attending physician to explain the situation and charted the conversation as follows:
    • The Dr. was made aware; he ordered to continue transfusion even if it takes all day.
    What happened to the patient? Based on laboratory results and a multidisciplinary discussion, staff concluded that a febrile non-hemolytic reaction had likely occurred after the second PRBC and had triggered subsequent events:
    • Increased temperature and chills increased intracranial pressure (the drain had been closed the previous day), leading to
    • Seizure and convulsions (treated by medication, induced coma, and intubation)
    Analysis of the incident revealed that the nurse in question required remedial training related to resolving slow running transfusions and critical thinking in general, and also required re-training for how to monitor and document transfusions.

    A more systemic problem was identified regarding the responsibilities and related skills of health professionals to provide checks for patient safety as part of the healthcare team. In other words, she should have questioned the physician's orders and taken it further, though that would be difficult.

    Further analysis resulted in individual re-training and a system-wide education program on responsibilities and skills for providing interdisciplinary checks to ensure patient safety.

    Key learning points include:
    1. Clinical staff who administer transfusions must be trained and assessed in blood administration.

    2. Monitoring and documenting vital signs must be done for each blood component transfused before, during, and after transfusion according to established policies and procedures.

    3. Scopes of practice ensure that health professionals have the required education, training, and professional qualifications to perform their duties competently and safely.

    4. Within their respective scopes of practice, members of the health care team collaborate in providing patient care.

    5. Perceived loss of autonomy is considered to be a major obstacle to collaboration and open questioning within health teams.

    6. Nurses and allied health care professionals such as medical laboratory technologists have a duty to question physician orders that are inappropriate or unclear.

    FOR FUN 
    Yes, I'm being facetious with the title and song, having some fun, but I couldn't resist. Decided to use the version with Bette Midler, Goldie Hawn & Diane Keaton as in the 1996 film, The First Wives Club. Yep, love these actors.
    As always, comments are most welcome.

    FURTHER READING
    Case Study O6: Transfusion Reaction Coincidental with Failure to Disobey Physician Orders (Links are fixed) 

    Davies C. Getting doctors and nurses to work together. BMJ 2000 Apr 15;320:1021-2. [Changed title]

    Mancini ME. Performance improvement in transfusion medicine. What do nurses need and want? Arch Pathol Lab Med 1999;123(6):496-502.

    Poerto G, Lauve R. Disruptive Clinician Behavior: A Persistent Threat to Patient Safety (July /August 2006, Patient Safety & Quality Healthcare)

    Salvage J, Smith R. Doctors and nurses: doing it differently. The time is ripe for a major reconstruction. BMJ. 2000 April 15; 320(7241): 1019-20.

    Friday, January 31, 2020

    Stand by me (Musings on transfusion medicine errors)

    Updated: 1 Feb. 2020 (Learning pt. 5, Further Reading)
    To begin the new decade, I'll muse on a TraQ case study from decades ago that discusses a topic not often discussed by educators in class or included in online cases* but is still relevant and merits airing. 

    *Online transfusion cases often involve antibody identification or making a diagnosis using lab and other diagnostic tests, in other words, cases with clear evidence-based results: yes and no answers that require factual knowledge and experience but not much reflective thinking. You may disagree, that's okay too. 

    This blog's case study involves a student whose error resulted in a patient dying prematurely but, given another patient, could easily have been THE cause of death. Frankly, I shudder to think what the headlines may have been if local media had gotten hold of the story and were anything like the UK's tabloid press. 

    The blog's title derives from a 1961 ditty by Ben. E. King.

    CASE A8: Severe Hemolytic Transfusion Reaction Involving a Student
    This case involved me directly as I was the clinical instructor of the student and transfusion service (TS) involved. As the clinical instructor I taught the student in a 2-week student lab (involving wet laboratories and small group tutorials) followed by a 4-week internship in the clinical transfusion lab where students were supervised by medical laboratory technologists. All the details of the case are in Further Reading. 

    CASE SUMMARY
    The student was supervised by an experienced, respected technologist  who was also responsible for working on the bench and processing routine work. The TS laboratory performs antibody screens using gel technology followed by an electronic crossmatch for patients who lack clinically significant antibodies.

    The lab's policy is to initially supervise students very closely and then, depending on performance (which is documented daily),  to gradually allow students to perform with less supervision. Regardless of the intensity of supervision, the policy requires that supervising technologists always read the results of student tests.

    The student did gel antibody screens on a batch of 5 patients in the late afternoon.

    One of the 5 patients had a positive (3+) antibody screen ("Patient A") but, because blood was not ordered and unlikely to be required for the type of surgery, the patient specimen was set aside for antibody identification the next day.

    One of the 4 patients with a negative antibody screen ("Patient B" - an 70-year old male scheduled for liver resection for metastatic colorectal cancer) had an electronic crossmatch performed for 3 units of RBC.

    Early the next morning Patient "B" was transfused with 2 units of RBC.
    When the morning shift began in the laboratory, an antibody identification panel on Patient A was unexpectedly negative, as was the repeat antibody screen. Antibody screens were then repeated for all patients in the batch and one (Patient B) was positive. Patient B was later found to have an anti-Fya and anti-c.

    Immediately upon discovering the mix-up and positive antibody screen on patient B, the ward was contacted to stop any transfusion in progress, to inquire about Patient B's condition, and to monitor him for signs of a possible hemolytic transfusion reaction (HTR). Subsequently, Patient B was found to be experiencing a severe HTR and the TS medical director was consulted to help manage it. 

    The student and supervising technologist were questioned in private, both individually and together, by the medical director and laboratory supervisor. The student could not recall making an error and thought that patient plasma had been pipetted correctly for each patient. The supervising technologist recalled not seeing the student actually pipette patient plasma into the gel cards but did read the results of all indirect antiglobulin tests (IATS) in the batch.

    By chance, staff were able to retrieve gel cards from the biohazard garbage and identify that Patient B had less volume than usual in the antibody screen tests, consistent with no plasma having been added. The conclusion was that there was a pipetting error in which Patient B's plasma was not added to Patient B's gel antibody screen cards but rather to Patient A's tests.

    Patient B died the day following transfusion.

    The hospital's Risk Management Office was contacted and the chief counsel discussed the case with the TS medical director and Patient B's physician.

    A series of group meetings were held by the lawyer from Risk Management with the TS laboratory supervisor, student, supervising technologist, and TS clinical instructor (me) all being present.

    The Chief Medical Examiner was notified and investigated the death.

    The TS medical director openly disclosed and explained what had happened to the patient's family. We waited for 2 years suing limitation but the family never decided to sue. 

    The supervising medical technologist left the lab and began a career in a related field.

    My personal learning points from the case:
    1. When medical technologists in a busy lab supervise students, they can't watch every student move. Student errors may happen and supervising technologists are devastated, as in this case. Suspect this may be true for other health professionals supervising students who make serious errors too. 

    2. The group sessions with the hospital's Risk Management lawyer were enlightening to me. She stressed that anything said in our meetings couldn't be used in court because of attorney-client privilege.

    3. Our TS medical director was exemplary in her transparency to disclose the error to the patient's family. Perhaps ahead of her time?

    4. I suspect many lab errors are latent errors (aka systems errors as well documented by UK's SHOT) caused by flaws in the system, i.e., errors that lead to human (operator) errors and whose effects typically lie dormant in the system. (Further Reading) 

    5.The student in Case 8 thought she'd added drops to the antibody screens correctly. Many times in the student lab when students get incorrect results they'd almost always say, 'But I did it right. I know I did.' Then I'd gently remind them that it was, of course, normal to think that.If they knew they were adding the wrong drops, following the wrong procedure, they'd not have done it. 

    Being human we make all sometimes make mistakes.What's key is to learn from them and realize the clinical laboratory has a culture of no blame that enhances patient safety. The worst thing would be for them to be spooked and frightened of making mistakes in the clinical lab (self-fulfilling prophesy) where patient safety is at risk. 

    6. Reminds me of the reality that transfusion med lab technologists / scientists are often the last barrier between a patients and possible death. The transfusion service is different from many other med lab departments (not all) where unusual results are often repeated before reporting. 

    I knew this as early in my career I'd crossmatched group AB blood for a patient who died because she was group O and had a wrong group AB sample sent to the off-site transfusion service where I worked. 

    As always comments are most welcome. 
    FOR FUN
    Chose this song because I think all health professionals need to stand by colleagues and students when human or systematic errors occur because there, but for the grace of gawd, go I. 
    FURTHER READING