2023-2024 Education Roundtable Series

Group Photo Of Professional Colleagues Working Together In Clinical Analysis Laboratory
Clinical Chemist Working
Clinical Chemist Group
Clinical Chemist in Lab
Clinical Chemist in Lab
Clinical Chemist Group
Clinical Chemist Working on Computer
Clinical Chemist in Lab
1Save today! Club members are entitled to join any or all of the Roundtables. Register once only and automatically receive an invitation for each Roundtable and access to the slides and recordings of past roundtables for the current year.

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2023-2024 SCHEDULE

Date Time (Eastern) Presenter(s) Topic
1. September 21,2023 14:00 Shirley Li Approaches to Ensure the Equivalence of Patient Results within One Healthcare System
2. October 5, 2023 14:00 Cody Lewis Using big data to derive thyroid hormone reference intervals and optimize a TSH testing algorithm
3. October 19, 2023 11:30 Jonathan Genzen Maximizing Efficiency in Processing and Specimen Distribution Through Laboratory Automation
4. November 2, 2023 11:30 Andre Mattman, Lawrence de Koning & Brian Lam Unusual and Unexpected Cases in Clinical Chemistry
5. November 16, 2023 14:00 Kelly Doyle Estimating Reference Intervals from Routine Laboratory Data – Application of the refineR and TMC R Packages
6. December 14, 2023 11:30 Jessica Boyd Gabapentinoids and Opioids: A Concerning Combination
7. January 18, 2024 11:30 Khosrow Adeli Reference Interval Harmonization in Canada: Harnessing the Power of Big Data Analytics to Harmonize Reference Intervals Across Populations and Analytical Platforms
8. February 1, 2024 14:00 Allison Venner & Vathany Kulasingam An “epic” implementation – Different Perspectives
9. February 22, 2024 11:30 Joe M. El-Khoury Hemolysis, Icterus and Lipemia: New approaches to dealing with old foes
10. February 29, 2024 11:30 Wes Schreiber Three Stories
11. March 7, 2024 14:00 Cristiana Stefan & Daniel Beriault Drug Checking as Public Health Response and the Role of the Clinical Laboratories
12. March 21, 2024 11:30 Michael Reid & Amy Pyle Eilola Stability of TCO2 Collected in Microcontainers: A stable relationship or a fizzled affair?

Recognizing Patterns of Results to Identify Pre-Analytical Errors in Pediatrics

13. April 4, 2024 14:00 Christopher McCudden Prediction of Kidney Failure Among Patients With Advanced Chronic Kidney Disease
14. April 18, 2024 11:30 Lei Fu Biomarkers in the risk assessment for preeclampsia: from laboratory to bedside
15. May 2, 2024 11:30 TBD Fellows in Training – Presentations/Journal Clubs
16. May 16, 2024 14:00
17. May 30, 2024 14:00 Rob Shorten & Katharine Hayden The laboratory’s role in achieving Net Zero healthcare

 

09-21-23: Approaches to Ensure the Equivalence of Patient Results within One Healthcare System

#1. September 21, 2023 Approaches to Ensure the Equivalence of Patient Results within One Healthcare System
Speaker: Jieli Shirley Li, Co-Director of Clinical Chemistry & Toxicology Laboratory/Assistant Professor of Pathology, The Ohio State University

Jieli Shirley Li, MD, PhD, holds the position of Assistant Professor-Clinical within the Department of Pathology and serves as Co-Director of the Clinical Chemistry & Toxicology Laboratory.  Dr. Li obtained her MD and PhD degrees from the Shanghai Jiao-Tong University School of Medicine and completed her fellowship training in clinical chemistry at the MD Anderson Cancer Center.  Her professional interests center around enhancing laboratory tests for the in vitro diagnosis, prognosis, and treatment planning of cancer, endocrine disorders, and cardiovascular diseases.  Dr. Li has authored over 40 scientific articles and contributions as an Ad Hoc reviewer for 20 different scientific journals.  She also plays a vital role in participating in guidelines writing for the Clinical & Laboratory Standards Institute (CLSI) and serving on the Expert Panel Committee of CLSI.  Furthermore, Dr. Li contributes to the field as an inspector for the College of American Pathologists (CAP) and is actively involved with CAP’s Chemistry Committee.

Overview: There are 8 clinical laboratories in multiple locations in the Ohio State University Wexner Medical Center.  The standardization in pre-analytical, analytical and post-analytical phases in all the 8 labs dramatically improve quality, lower cost, provide better efficiency and equivalence of patient results, as well as cross-training of staff members.  These gains carry over to improved quality of care and patient satisfaction.  The approaches/experience to bringing standardization will also be shared and discussed.
Objectives: At the conclusion of this session, participants will be able to:
1) Describe the advantages of standardization in clinical laboratory services, including but not limited to instrumentation, quality management and workflows.
2) Address common challenges encountered in the process of implementing laboratory standardization
3) Implement practical approaches to assess the comparability of patient results within one healthcare system.

10-05-23: Using big data to derive thyroid hormone reference intervals and optimize a TSH testing algorithm

#2 October 5, 2023 Using big data to derive thyroid hormone reference intervals and optimize a TSH testing algorithm
Speaker: Cody Lewis, Assistant Professor, Clinical Biochemist, University of Saskatchewan / Saskatchewan Health Authority

Cody Lewis is currently a Clinical Biochemist working for the Saskatchewan Health Authority with an academic appointment at the University of Saskatchewan. He oversees the general chemistry laboratory at St Paul’s Hospital and co-leads point of care testing in Saskatoon. Additionally, Cody has interests in testing associated with endocrine disorders. Prior to joining the team in Saskatoon, Cody completed his fellowship training 2021 in Calgary Alberta. Before that, he obtained a PhD in Cancer Sciences from the University of Alberta and an MSc from the University of Lethbridge.

Overview: Physicians use reference intervals (RIs) to interpret laboratory results. Laboratories and analytical platforms often have different RIs. Alberta laboratories are striving to standardize RIs across the province, which includes thyroid hormones. To estimate RIs and to develop a reflex TSH testing algorithm, indirect sampling of “big data” was utilized. Data was analyzed by three statistical models: Bhattacharya, refineR, and non-parametric. TSH upper limits were highly variable depending on the model, ranging from 4.70 to 6.50 mIU/L. To refine estimated limits, a panel of adult and pediatric endocrinologists was engaged. The final decision took into account the percentage of normal matched free-T4 results. The standardization of thyroid RIs and the development of a new testing algorithm were achieved by this approach.
Objectives: At the conclusion of this session, participants will be able to:
1) Discuss the impact of implementing a sub-optimal reference intervals (RIs)
2) Define big data and appreciate how it can be used to estimate RIs
3) Recognize the limitation of deriving RIs via indirect sampling methods and discuss options for refining estimated limits

10-19-23: Maximizing Efficiency in Processing and Specimen Distribution Through Laboratory Automation

#3. October 19, 2023 Maximizing Efficiency in Processing and Specimen Distribution Through Laboratory Automation
Speaker: Jonathan Genzen

Dr. Jonathan Genzen is a professor at the University of Utah Department of Pathology. He serves as Chief Medical Officer at ARUP Laboratories, a not-for-profit enterprise of the University of Utah. He previously served as ARUP’s Chief Operations Officer. Dr. Genzen completed his undergraduate education at Northwestern University, and then both his Ph.D. and M.D. training at the University of Chicago. He joined ARUP Laboratories in 2013.

Dr. Genzen is a medical director in ARUP’s chemistry division and is medical director of ARUP’s laboratory automation team. His clinical and research focus is on automated clinical chemistry, process improvement initiatives, and the impact of laboratory regulatory proposals on patient care.

Overview: This lecture will describe how pre-analytical and post-analytical automation can help to improve efficiency and quality across small, medium, and large size clinical laboratories.  It will also discuss emerging technologies in use across manufacturing settings that also can provide benefits to clinical laboratories, including software solutions called robotic process automation.  The benefits of standardization will be emphasized across solutions presented.
Objectives: At the conclusion of this session, participants will be able to:
1) Understand the importance of automation in pre-analytical processing to reduce the risk of pre-analytical error.
2) Describe the benefits of standardization for routine aliquots and in molecular infectious disease testing.
3) Explain how robotic process automation can lead to clinical laboratory efficiency and process improvement.

11-02-23: Unusual and Unexpected Cases in Clinical Chemistry

#4. November 2, 2023 Unusual and Unexpected Cases in Clinical Chemistry
Speakers: Andre Mattman, MD, FRCPC, Medical Biochemist, St. Paul’s Hospital Chemistry Laboratory / Vancouver General Hospital Adult Metabolic Diseases Clinic

  • Division Head Chemistry Lab St Paul’s Hospital, Vancouver, BC since 2019
  • Physician consultant Adult Metabolic Diseases Clinic, Vancouver General Hospital since 2006.
  • Member of the multiple physicians and the environmental groups including Doctors for Planetary Health and the Royal College of Canada working group on CanMeds 2025 Planetary Health competencies.
    • Past Chair, Royal College of Canada National subspecialty committee in medical biochemistry.

Lawrence de Koning, Associate Professor and Clinical Biochemist, University of Clagary, Alberta Precision Laboratories and Alberta Children’s Hospital

Dr. Lawrence de Koning completed a PhD in Health Research Methodology from McMaster University in 2009, and concurrent postdoctoral fellowships in nutritional epidemiology and clinical chemistry at Harvard University from 2009-2012. He became board certified by the American Board of Clinical Chemistry in 2013 and a fellow of the Canadian Academy of Clinical Biochemistry in 2015. Dr. de Koning works as a pediatric clinical biochemist at Alberta Children’s Hospital, a consultant clinical biochemist for Rockyview General Hospital and has numerous clinical and research interests including biomarkers and epidemiology of pediatric and perinatal conditions, laboratory quality improvement, cardiovascular disease, and nutrition.

Ka Hang Brian Lam, University of California, Los Angeles

Overview: Three cases of oxalate nephropathy will be reviewed.

CASE 1:  Presented by Dr. Mattman:  Investigation of oxalate nephropathy

Oxalate nephropathy may be caused by primary and secondary etiologies. The investigation of oxalate nephropathy is complicated by the impact of nephropathy on oxalate concentrations in blood and urine. Nonetheless, oxalate nephropathy is responsive to etiology specific therapy – in some cases readily responsive – and so the laboratory’s role in documenting the etiology is an important piece of patient recovery.

At the conclusion of this session, participants will be able to:
1) Identify the common causes of acquired oxalate nephropathy.
2) Recognize that there are primary hyperoxaluria conditions which have distinct gene specific treatments (that area also distinct as compared to the acquired causes).
3) Identify the laboratory tests of utility in diagnosing primary and secondary hyperoxaluria

CASE 2: Presented by Dr. de Koning: Critically high ammonia in an adolescent girl

This session will review a case of repeatedly elevated plasma ammonia levels in an adolescent girl which were caused by specimen platelet contamination. Topics covered will include ammonia metabolism, urea cycle disorders, ammonia analysis, and the many preanalytical causes of elevated ammonia and how to minimize them.

At the conclusion of this sessions, participants will be able to
1) Describe the metabolism of ammonia
2) Understand the clinical manifestations of urea cycle disorders and appropriate treatments
3) Cite a number of common preanalytical causes for elevated ammonia, and identify ways to prevent them.

CASE 3: Presented by Dr. Lam: A suspected case of carbon monoxide poisoning consistent with fentanyl toxicity

This lecture sill describe a case of fentanyl poisoning that was consistent with carbon monoxide poisoning.
At the conclusion of this session, participants will be able to:
1) Understand the clinical presentation of fentanyl toxicity
2) Understand the difference between a traditional opiate immunoassay method and a synthetic fentanyl opioid immunoassay method.

11-16-23: Estimating Reference Intervals from Routine Laboratory Data – Application of the refineR and TMC R Packages

#5. November 16, 2023 Estimating Reference Intervals from Routine Laboratory Data – Application of the refineR and TMC R Packages
Speaker: Kelly Doyle, PhD, D(ABCC), FAACC. University of Utah School of Medicine, Department of Pathology and ARUP Laboratories, Salt Lake City, UT

Dr Doyle is a board‐certified clinical chemist and is an Associate Professor of pathology at the University of Utah. He is associate Director of the Clinical Chemistry Fellowship program and serves as the Medical Director of Special Chemistry and Endocrinology at ARUP Laboratories. He has a special interest in laboratory science education, the application of mass spectroscopy, and quality management.

Overview: The aim of this presentation is to describe the application of modernized indirect reference interval approaches, based on ready to use R packages refineR and TMC. Reference intervals are an integral component for result interpretation and are a regulatory requirement of laboratory medicine practice. Establishing RIs using the traditional approach by direct sampling is complicated by insufficient access to patients within varying interval partitions (e.g., pediatrics), and adoption or transferring of RIs is hindered by lack of assay standardization and unique population demographics. However, indirect sampling techniques using laboratory database results have significant practical advantages compared to direct sampling methods. The use of stored patient data can offer a faster and less costly means to developing RIs.
Objectives: At the conclusion of this session, participants will be able to:
1) Summarize the establishment and use of reference intervals in clinical laboratory practice.
2) Discuss the application of direct and indirect methods to determine population/sex/age-based reference intervals.
3) Describe the use of indirect methods refineR and TMC in estimating reference intervals from stored results.

12:-14-23: Gabapentinoids and Opioids: A Concerning Combination

#6. December 14, 2023 Gabapentinoids and Opioids: A Concerning Combination
Speaker: Jessica Boyd PhD FCACB DABCC(TC)
Associate Professor (Clinical), Department of Pathology, University of Utah School of Medicine; Clinical Toxicology Medical Director, ARUP Laboratories. Dr. Jessica Boyd is a Clinical Associate Professor at the Department of Pathology at the University of Utah School of Medicine. She is also medical director of urine toxicology and trace elements at ARUP Laboratories. She completed her PhD at the University of Alberta followed by Clinical Biochemistry Fellowship training at the University of Calgary/Calgary Laboratory Services. She is board certified by the Canadian Academy of Clinical Biochemistry and the American Board of Clinical Chemistry in Toxicological Chemistry.
Overview: The gabapentinoids, gabapentin and pregabalin, have been approved for use as anticonvulsants and in limited pain applications. However, there is increasing evidence that they are used extensively off-label for pain management and in combination with opioids. This presentation will review the history and use of gabapentin and pregabalin and outline the concerns of taking them with opioids. Analytical options for urine drug testing of gabapentin and pregabalin will also be discussed.
Objectives: At the conclusion of this session, participants will be able to:
1) Describe the current use of gabapentin and pregabalin
2) Discuss the concerns and prevalence of concurrent gabapentinoid and opioid use
3) Discuss analytical detection of gabapentin and pregabalin in urine

2-1-24: An “epic” implementation – Different Perspectives

#8. February 1, 2024 An “epic” implementation – Different Perspectives
Speaker: Vathany Kulasingam, University Health Network

Dr. Vathany Kulasingam is Division Head of Clinical Biochemistry at University Health Network and is an Associate Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. She is the Co-Director of the Postdoctoral Training Program in Clinical Chemistry.

Allison Venner, PhD, FCACB, Clinical Biochemist, Alberta Precision Laboratories, POCT Provincial Medical Lead, Alberta Precision Laboratories, Clinical Biochemistry Associate Section Chief, Alberta Precision Laboratories, Clinical Associate Professor, Dept. of Pathology & Lab Medicine, University of Calgary.

Dr. Allison Venner is a Clinical Biochemist with Alberta Precision Laboratories (APL). She is the Clinical Biochemistry Associate Section Chief and the Provincial POCT Medical Lead at APL. Dr. Venner is a Clinical Associate Professor with the Department of Pathology & Lab Medicine at the University of Calgary, and is certified as a Clinical Biochemist by the Canadian Academy of Clinical Biochemistry (CACB). She is past president of the Alberta Society of Clinical Chemists and the Canadian Society of Clinical Chemists. She is the current Secretary of the Alberta Association of Clinical Laboratory Doctoral Scientists (AACLDS).

Dr. Venner has a particular interest in Quality, Informatics, and Point of Care Testing (POCT), and she is involved in many related local, provincial, national and international initiatives. She is focused on education, and in bringing increased awareness of quality within and outside of the clinical laboratory to improve patient care. She has multiple publications, with a recent focus on test utilization, harmonization of reference intervals, and innovation and quality assurance in POCT. She has been an active member of the Epic and Connect Care implementation within Alberta.

Overview: This lecture will describe the experience from a laboratory perspective of an integrated electronic health record implementation at a large academic healthcare institution and across a provincial system implementation. The sequence of steps completed, challenges encountered, and benefits realized will be discussed.
Objectives: At the end of this session, participants will be able to:
1) Discuss the opportunities with implementation of an integrated EHR system
2) Identify the challenges associated with a successful implementation.

02-18-24: Interval Harmonization in Canada: Harnessing the Power of Big Data Analytics to Harmonize Reference Intervals Across Population and Analytical Platforms

#9. February 18, 2024 Reference Interval Harmonization in Canada: Harnessing the Power of Big Data Analytics to Harmonize Reference Intervals Across Population and Analytical Platforms
Speaker: Dr. Khosrow Adeli, Clinical Biochemistry, Laboratory Medicine & Pathobiology, University of Toronto
Dr Adeli is a senior scientist and academic clinical biochemist with over 35 years of experience in clinical chemistry service, education, and research. He has held numerous leadership positions in the field of clinical biochemistry and laboratory medicine over the past three decades. Has an established track record in both basic and clinically oriented research in the fields of metabolic health & disease as well as clinical biochemistry and pediatric laboratory medicine. Published over 700 articles and abstracts with an h-index of 82 with >36,000 citations. Academic achievements have been recognized nationally and internationally through several prestigious research awards. Elected as president of IFCC in 2019 and served for three years (2020-2023). Currently serving on the IFCC Executive Board as IFCC past president. Since 2015, he has served as a co-chair of the CSCC Working Group on Reference Interval Harmonization, working with laboratory directors across Canada to achieve harmonization of clinical laboratory test result interpretation and clinical decision making in hospitals and medical centres country wide.
Overview: Several national surveys have reported wide variation in reference intervals across healthcare centres in certain regions, even those using the same analytical platform and reagents for the same assay. There is a high risk of inappropriate test result interpretation when reference intervals are not appropriately harmonized. The Canadian Society for Clinical Chemistry (CSCC) Working Group on Reference Interval Harmonization was established in 2015 to develop evidence-based harmonized/common reference intervals and support their implementation in laboratories across Canada. Harnessing the power of big data, laboratory results were collected across populations and testing platforms to derive common adult RIs for 16 biochemical markers. A novel comprehensive approach was established, including: (1) analysis of big data from community laboratories across Canada; (2) statistical evaluation of age, sex, and analytical differences; (3) derivation of hRIs using the refineR method; and (4) verification of proposed harmonized reference intervals across nine laboratories with different instrumentation using serum and plasma samples collected from healthy Canadian adults. Harmonized RIs were calculated for all assays using the refineR method, except free thyroxine. Derived harmonized reference intervals met proposed verification criterion across nine laboratories and five manufacturers for alkaline phosphatase, albumin (BCG), chloride, LDH, magnesium, phosphate, potassium (serum), total protein (serum). Further investigation is needed for select analytes due to lower verification in one or more laboratory (albumin (BCP), calcium, total CO2, total bilirubin, sodium) or concern regarding harmonized reference intervals that were considered too wide (alanine aminotransferase, creatinine, TSH). In this presentation, we will discuss the work completed by the Working Group on Reference Interval Harmonization in Canada, challenges encountered, and future plans to support implementation.
Objectives: At the conclusion of this session, participants will be able to:
1)  Gain an understanding of the challenges associated with wide variations in reference intervals across healthcare centers in certain regions, especially when using the same analytical platform and reagents for a specific assay.
2)  Explore the establishment and objectives of the Canadian Society for Clinical Chemistry (CSCC) Working Group on Reference Interval Harmonization, and its role in developing evidence-based, harmonized/common reference intervals for biochemical markers across laboratories in Canada.
3)  Learn the innovative comprehensive approach employed by the CSCC Working Group, utilizing big data from community laboratories across Canada, statistical evaluation of age, sex, and analytical differences, and the refineR method for deriving harmonized reference intervals for 16 biochemical markers.
4)  Assess the successful verification of proposed harmonized reference intervals across diverse laboratories and manufacturers, while identifying specific analytes that require further investigation or adjustment due to concerns about wide intervals or lower verification in specific laboratories.

02-22-24: Hemolysis, Icterus and Lipemia: New approaches to dealing with old foes

#9. February 22, 2024 Hemolysis, Icterus and Lipemia: New approaches to dealing with old foes
Speaker: Joe M. El-Khoury, Yale University,

Dr. Joe El-Khoury is Associate Professor of Laboratory Medicine at Yale School of Medicine and Director of the Clinical Chemistry Laboratory and fellowship program at Yale-New Haven Health. He is board certified by the American Board of Clinical Chemistry and a fellow of the Association for Diagnostics and Laboratory Medicine Academy. He currently serves on the Editorial Boards of Clinical Chemistry and Clinical Biochemistry, as Chair of the IFCC Committee on Kidney Diseases and on the Board of Directors for ADLM. He recently launched his own Youtube channel, entitled “Clinical Chemistry with Joe El-Khoury”, that infuses science with comedy and is focused on improving laboratory medicine practice. His interests including reducing preanalytical errors, biomarkers of kidney disease and injury, toxicology, mass spectrometry and science communication.

Overview: This lecture will describe the three most common types of interferences with clinical chemistry testing: hemolysis, icterus and lipemia. We will discuss the mechanism of interference for each, and more importantly, how clinical laboratories can implement new solutions to reduce or eliminate their effect.
Objectives: At the end of this session, participants will be able to:
1) Describe the mechanisms of interference for hemolysis, icterus and lipemia (HIL).
2) Identify new tools to reduce or eliminate the effects of HIL.

02-29-24: Three Stories

#10. February 29, 2024 Three Stories
Speaker: William E. Schreiber, MD, Professor, Dept. of Pathology & Laboratory Medicine, The University of British Columbia

Dr. William E. (Wes) Schreiber earned an MD degree from Baylor College of Medicine and completed a residency in clinical pathology at the University of Washington. He was a consultant pathologist at Vancouver General Hospital for more than 30 years, with service responsibilities in the broad area of clinical chemistry. He was also medical director of the Provincial Toxicology Center for 10 years, which provides both forensic and clinical toxicology services for the province of British Columbia. He recently retired from LifeLabs after spending 6 years as the Clinical Director of Chemistry.

At UBC, Dr. Schreiber committed a large part of his career to the education of medical students, residents and colleagues. He directed the medical biochemistry residency program for 10 years and served as associate dean for undergraduate education at UBC from 1999-2002. He has received a number of teaching awards from students and peers, as well as recognition from professional organizations for contributions to continuing medical education.

Dr. Schreiber served as president of the American Society for Clinical Pathology (ASCP), the largest pathology organization in North America, in 2016-17.

Overview: This presentation will review three phases of my career in laboratory medicine:

1) discovery of mutations causing acute intermittent porphyria and their translation into diagnostic tests
2) leadership of a forensic toxicology laboratory
3) role as a clinical consultant for a large outpatient laboratory

Objectives: At the end of this session, participants will be able to:
1)  Explain how mutation analysis is used to identify carriers for single gene disorders
2)  List key differences between clinical and post-mortem toxicology
3)  Describe the type of consultations needed in academic hospitals vs. community practice

03-07-24: Drug Checking as Public Health Response and the Role of the Clinical Laboratories

#11. March 7, 2024 Drug Checking as Public Health Response and the Role of the Clinical Laboratories
Speakers: Dr. Daniel Beriault, MSc, PhD, FCACB, Head of Biochemistry and Specimen Management, Unity Health Toronto, Associate Professor, University of Toronto, Investigator, Li Ka Shing Knowledge Institute

Dr. Beriault is the Head of the Biochemistry division and the Specimen management division at Unity Health Toronto, and an Associate Professor at University of Toronto. Along with Dr. Stefan, he is one of the founding members of Toronto’s Drug Checking service.

Dr. Cristiana Stefan, PhD, DABCC (CC,TC), FADLM, Director, Clinical Laboratory and Diagnostic Services, Clinical Biochemist/Toxicologist, Centre for Addiction and Mental Health

Dr. Cristiana Stefan is the Director of the Clinical Laboratory and Diagnostic Services at the Centre for Addiction and Mental Health (CAMH) in Toronto, where she also practices as Clinical Biochemist/Toxicologist. In addition to her directorship and clinical responsibilities for Biochemistry and Point of Care Testing, Dr. Stefan oversees research and R&D services; participates in the education of clinical and medical fellows; is actively involved with professional associations. Along with Dr. Beriault, she is one of the founding members of Toronto’s Drug Checking service.

Overview: The role of the clinical laboratory in drug checking as public health response to reduce the harms associated with substance use and prevent overdose has not been previously explored or recognized. This presentation is based on speakers’ direct involvement with the Toronto’s Drug Checking Project, launched in October 2019 as part of an interdisciplinary partnership focusing on opioid harm reduction. Speakers will discuss the concept of drug checking in the context of unregulated (street) drug use that expands beyond drug testing and will present the legislative requirements to operate drug-checking services. The speakers will also discuss the services goals for drug identification along with technological strategies used to detect novel psychoactive substances; as well as the project’s drug findings since implementation, focusing on fentanyl and fentanyl analogues, benzimidazole (nitazene) opioids, non-opioids and designer benzodiazepines.
Objectives: At the end of this session, participants will be able to:
1) Define drug checking and legislative requirements in Canada to operate drug checking services
2) Identify the service goals of the Toronto’s Drug Checking Project for drug detection
3) Discuss the main drug findings of drug checking in Toronto and impact on people who use drugs, public health and clinical practice

03-21-24: Recognizing Patterns of Results to Identify Pre-Analytical Errors in Pediatrics – and – Stability of TCO2 Collected in Mictrocontainers: A stable relationship or a fizzled affair?

#12. March 21, 2024 1. Recognizing Patterns of Results to Identify Pre-Analytical Errors in Pediatrics

2. Stability of TCO2 Collected in Microcontainers: A stable relationship or a fizzled affair?

Speaker1: Amy Pyle Eilola, PhD, Nationwide Children’s Hospital, Columbus OH

Dr. Amy Pyle-Eilola is currently an associate professor of Pathology at The Ohio State Wexner Medical Center and the Director of Clinical Chemistry at Nationwide Children’s Hospital. She’s active in the Association for Diagnostic and Laboratory Medicine. She is passionate about using lab data to generate evidence-based guidelines and educating clinicians about preanalytical errors.

Speaker 2: Michael Reid, Alberta Precision Laboratories

Michael Reid is a Clinical Chemist with Alberta Precision Laboratories in Calgary, Alberta. He received his BSc in Chemistry from Thompson Rivers University in 2012 and his PhD in Analytical Chemistry from the University of Alberta in 2018. He completed his Clinical Chemistry Fellowship at the University of Calgary in 2023 before starting his position at Alberta Precision Laboratories. His areas of interest include endocrinology, assay interferences, and teaching.

Overview1: Preanalytical errors are very common causes of error in the clinical lab. This is particularly unfortunately in a pediatric setting, in which a false result may require recollection from a child, or even cause inaccurate treatment. This session will use a case-based presentation to illustrate the lab findings that may indicate that an error occurred during collection.
Objectives 1: At the conclusion of this session, participants will be able to:
1)  define the most common sources of pre-analytical error encountered in pediatrics
2)  recognize specific patterns of results that are associated with particular errors.
Overview 2: Collecting blood from a heel puncture into microcontainers is a common practice in neonates. However, open collection methods expose blood to air, resulting in the loss of volatile analytes such as total carbon dioxide (TCO2). This presentation will review a recent study where we quantified the loss of TCO2 from simulated microcontainer collections. The effects of several steps in the testing process will be highlighted, specifically the effects of the collection procedure, sample transport and handling, and air exposure post-centrifugation. The presented data will aid in the determination of the suitability of microcontainers for TCO2 analysis. Additionally, several recommendations to reduce the loss of TCO2 in micro-collections will be discussed.
Objectives 2: At the end of this session, participants will be able to:
1)  Describe the steps in the testing process that affect the stability of TCO2 and what factors result in the greatest loss of TCO2
2)  Implement strategies to improve the stability of TCO2 in neonatal blood collections that are exposed to air.

04-04-24: Prediction of Kidney Failure Among Patients With Advanced Chronic Kidney Disease

#13. April 4, 2024 Prediction of Kidney Failure Among Patients With Advanced Chronic Kidney Disease
Speaker: Christopher McCudden

Dr. McCudden is a Clinical Biochemist at the Ottawa Hospital. He is a Professor and Vice Chair of the Department of Pathology & Laboratory Medicine at the University of Ottawa. He serves as the Deputy Chief Medical Scientific Officer and Medical Director of Informatics and Information Technology for the Eastern Ontario Regional Laboratory Association. His interests include automated chemistry, laboratory informatics & machine learning, quality improvement, plasma cell dyscrasias, and audit and feedback for laboratory stewardship.

Overview: Development of a short timeframe (6-12 months) kidney failure risk prediction model may serve to improve transitions from advanced CKD to kidney failure and reduce rates of unplanned dialysis. This presentation will describe development of prediction models for urgent dialysis. In addition, it will describe the formation of the multi-disciplinary team who developed and validated the models as well as practical aspects of data acquisition, model development, and future implementation hurdles.
Objectives: At the end of this session, participants will be able to:
1) Define urgent dialysis and describe its impact on patients
2) Describe problems where machine learning algorithms may be useful
3) List enablers and barriers to implementing machine learning in the real world

04-18-24: Biomarkers in the risk assesssment for preeclampsia: from laboratory to bedside

#14. April 18, 2024 Biomarkers in the risk assessment for preeclampsia: from laboratory to bedside
Speaker: Lei Fu, PhD, DABCC (Chem, Tox, Mol), FADLM, FCACB, Clinical Biochemist, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Center, Toronto

Lei Fu is a clinical biochemist in the Precision Diagnostics and Therapeutics Program, at the Sunnybrook Health Sciences Centre. She completed her training at the McMaster University Clinical Chemistry Postdoctoral Fellowship Program. She was certified by the Canadian Academy of Clinical Biochemistry. She was also certified by the American Board of Clinical Chemistry in all three disciplines, Clinical Chemistry, Toxicological Chemistry, and Molecular Diagnostics. She is actively engaged in clinical service, teaching, and research. Her research interests are focused on biomarkers in maternal and fetal health, and clinical applications of pharmacogenetics.

Overviiew: Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality, affecting 3-5% of pregnancies. Biomarkers for timely and accurate identification of patients at risk of developing preeclampsia are extremely valuable to improve patient outcomes and safety. This lecture will describe the circulating biomarkers, various laboratory assays and their clinical applications in preeclampsia management throughout the pregnancy. The utility of multiple marker screening model for preeclampsia risk prediction in 1st trimester of pregnancy will be explained. The clinical implementation of sFlt-1: PlGF ratio testing for preeclampsia risk stratification and diagnosis in 2nd and 3rd trimester of pregnancy will be discussed.
Objectives: At the conclusion of this session, participants will be able to:
1)  Understand the needs of biomarkers in the risk assessment for preeclampsia
2)  Describe different analytical methods in the measurement of PIGF & sFlt-1 and their clinical applications in preeclampsia
3)  Explain the considerations in clinical implementation of preeclampsia biomarkers.

05-30-24: The laboratory’s role in achieving Net Zero healthcare

#17. May 30, 2024 The laboratory’s role in achieving Net Zero healthcare
Speakers: Dr. Rob Shorten, Consultant Clinical Scientist, Lancashire Teaching Hospitals &
Katharine Hayden, Consultant Clinical Scientist, Manchester Foundation Trust
Both representing the Association for Clinical Biochemistry and Laboratory MedicineDr Shorten is a Consultant Clinical Scientist at Lancashire Teaching Hospitals. He has broad experience in clinical microbiology and is the departmental lead for research, and the pathology lead for clinical audit. He is an honorary senior lecturer at the University of Manchester, and his research interests have included tuberculosis, laboratory diagnostics, and viral haemorrhagic fevers. His current interests include diagnostic stewardship and environmental sustainability. He is also the current Chair of the Microbiology Professional Committee of the ACB, and a member of the Advisory Committee on Dangerous Pathogens.Kath Hayden is a Consultant Clinical Biochemist at Manchester University NHS Foundation Trust. Following training in South Manchester, she has held posts in hospital laboratories in Manchester and Liverpool for over 35 years, overseeing advances in analytical technologies, point of care testing and harmonisation of laboratories, and her research interests include endocrinology and renal medicine. She is an honorary Senior Lecturer at the University of Manchester and her last role was as Clinical Head of
Division for Laboratory Medicine at Manchester University NHS Foundation Trust, before taking up her current role as President of the Association for Clinical Biochemistry and Laboratory Medicine, UK. Current interests include sustainability of laboratories and appropriate test utilization.
Overview: This lecture will outline the importance of the climate emergency and its consequences for the planet and health. It will detail the role that healthcare, and in particular diagnostic laboratories plays in contributing to the carbon footprint. Challenges, and opportunities of how laboratory services can contribute to making patient pathways more environmentally sustainable will be explored.
Objectives: At the conclusion of this session, participants will be able to:
1)  Understand how the climate crisis is also a health crisis
2)  Understand how laboratories contribute to the climate crisis
3)  Understand how laboratories can reduce their carbon footprints.