JALM Talk Podcast

Cardiac troponin is the supreme biomarker for the diagnosis of acute myocardial infarction.  The ability of the clinical laboratory to provide rapid and reliable troponin results is critical for patient management in the emergency room.  In clinics and environments far from a laboratory, point-of-care troponin testing may be necessary for timely results and patient triage.  However, questions rema...

Clinical laboratories play a crucial role in emergency medicine through toxicology and drug testing.  The type of testing provided is often a balance between laboratory resources and the patient population served.  Each approach to drug screening comes with advantages and disadvantages depending upon the specific drug exposure or illicit drug suspected. A "Case of Sudden Acute Coma Followed by Spo...

Measuring vancomycin levels has long been an important component of laboratory therapeutic drug monitoring.  Such measurements are important for obtaining optimal targets serum concentrations for drug dosing, while avoiding vancomycin induced nephrotoxicity.  "AUC-Based Monitoring of Vancomycin: Closing the Therapeutic Window" was published in the January 2019 issue of The Journal of Applied Labor...

"Clinical Effect of Expedited Pathogen Identification and Susceptibility Testing for Gram-Negative Bacteremia and Candidemia by Use of the Accelerate PhenoTM System" was published in the January 2019 issue of The Journal of Applied Laboratory Medicine .  This work evaluates the clinical impact on a new device for pathogen identification and antimicrobial susceptibility testing.

The gold standard for identification of fat malabsorption has conventionally been 72h fecal fat analysis.  Despite its long use, fecal fat analysis poses both preanalytical and analytical challenges for both the patient and the laboratory.  Implementing changes to well-established tests can be difficult in healthcare systems.  "Elimination of 72-Hour Quantitative Fecal Fat Testing by Restriction,...

Ovarian cancer is the fifth most common cause of cancer death among women in the U.S. The high rate of mortality for ovarian cancer is multifactorial, but it is estimated that more than 60% of cases have already metastasized at the time of diagnosis. Despite more invasive surgical treatments and targeted chemotherapies, ovarian cancer survival rates have remained similar over time. "Algorithms Use...

The potential benefits of maintaining sufficient vitamin D levels has led to a steady increase in testing of vitamin D status in the general population.  This increase has impacted laboratories in a variety of ways, as organizations adapt to growing demand while striving for accuracy and test standardization. The potential benefits of maintaining sufficient vitamin D levels has led to a steady inc...

The November 2018 issue of the Journal of Applied Laboratory Medicine published a Special Report by Drs. Ann Gronowski and Carey-Ann Burnham at the Washington University School of Medicine in St. Louis that discussed the formation of a professional development group for women in the pathology department of a major medical school. Dr. Gronowski, who is Professor in the departments of pathology and...

Diagnostic errors in medicine continue to be a large problem for effective healthcare delivery.  As a result, moderate and severe consequences from the errors, including death, account for 75% of diagnostic errors in the United States.  " Interventions That Can Help Reduce Diagnostic Errors " was published in the July 2018 issue of The Journal of Applied Laboratory Medicine .  The editorial discus...

Conventional approaches to drug testing rely on a primary screening step followed by a secondary confirmation.  Best practice dictates that the secondary confirmation step utilize a separate methodology than the initial screening step and have improved sensitivity and specificity.  This approach is widely utilized in clinical, pre-employment, and forensic settings.  Despite the standard adoption o...

The rapid rise in the prevalence of fentanyl and fentanyl analogs has contributed significantly to an increase in overdose death rates in North America.  Laboratories, healthcare providers, and government agencies struggle to effectively detect and reduce negative outcomes associated with fentanyl use in the absence of accurate data on prevalence and use.  "Keeping Up with Fentanyl: Failure to Do...

Laboratory automation holds the promise of enhanced workflows, improved efficiency, and decreased turnaround time while mitigating an environment of rising costs, constrained resources, and staffing shortages.  Many publications tout improved outcomes from laboratory automation but realizing these results may not come easily. Automated Laboratories: When Technology Needs a Human Touch was publishe...

"Thrombophilia: Women-Specific Reference Ranges Can Prevent Misdiagnosis in Women" was published in the March 2018 issue of The Journal of Applied Laboratory Medicine .  This work presents the establishment and impact of female-specific reference intervals for a variety of coagulation markers during pregnancy.

A high throughput LC-MS/MS method for the determination of phosphatidylethanol (PEth) in clinical samples using a simple automated extraction procedure was published in the May 2018 issue of The Journal of Applied Laboratory Medicine .  This work describes an improved automated approach to analysis of the alcohol marker phosphatidylethanol that uses liquid chromatography mass spectrometry instead...

"Genotype–Phenotype Correlations of Glucose-6-Phosphate–Deficient Variants Throughout an Activity Distribution" was published in the May 2018 issue of The Journal of Applied Laboratory Medicine .  This work examines G6PD mutations across a range of enzyme activities and seeks to establish enzyme activity cutoffs that could be implemented to rule out G6PD deficiency.

Recently, a method was described that combines the sensitivity of single-molecule counting with the convenience of dried spot collection.  The study evaluates three conventional protein analytes routinely measured in the clinical lab: Troponin I, Prostate Specific Antigen (PSA), and C-reaction protein.  The authors detailed the assay method that incorporates spot-scanning to account for dried bloo...

Cell-free DNA analysis, also called non-invasive prenatal screening and IPS, has emerged as an alternative to the conventional analysis of maternal serum markers.  Modern molecular techniques have now achieved sensitivity for the direct detection and analysis of placental DNA fragments that circulate in the maternal bloodstream and serve as a proxy for fetal aneuploidy. This technology is transfor...

The rise in opioid prescribing and subsequent growth of opioid abuse has led to increased oversight and challenges for clinicians who prescribe opioids to their patients.  Recommendations and guidance documents vary when recommending approaches to monitor patients receiving controlled substances. In this podcast, we will explore drug testing for pain management from the prescriber's perspective. ...

Opioids are frequently prescribed for pain management but there is large inter-individual variation in opioid-induced pain relief. These compounds are metabolized by enzymes leading to active and inactive metabolites, and there are differences in the quantity or presence of these metabolites between individuals. This complicates the interpretation by clinicians of urine drug tests that are often a...

Laboratory Medicine Practice Guidelines, published by the American Association for Clinical Chemistry, recommend best practices for clinical laboratories in a number of different areas of patient testing.   These guidelines are formed via a systematic review of published literature and the consensus of experts in the field with the goal of optimizing patient care.   Recently, a review of the pain...

Donor-derived cell-free DNA measurement in the circulating blood of transplant recipients is thought to have utility for clinical monitoring of tissue injury and therefore transplant rejection in heart, lung, liver, and kidney transplants, as increased levels of this biomarker are seen during acute rejection. However, the normal concentration of donor-derived cell-free DNA in successful kidney tra...

A Technical Tips article titled "The Importance of Verifying Reference Intervals for Calculated Results" published in the November 2017 issue of JALM, discusses the common ways in which laboratories establish reference intervals for calculated results. Further, it contains recommendations as to the best practice for verifying these reference intervals in the patient population that they serve. The...

Jane Dickerson and Mike Astion