Lab Medicine Rounds

Disclosure of relevant financial relationship: Dr. Mazepa received honoraria from Sanofi.Timestamps:00:00 Intro00:52 Why is it important for physicians to have some understanding about TTP?04:26 What’s new in this immune TTP area?08:57 If you have a new patient show up, you do caplacizumab and plasma exchange together or are there certain patient populations, like certain characteristics who would or would not get this medication? 11:29 I was wondering if you could elaborate a little bit more about these chronic complications?16:32 Do you think there is a role for repeat testing of ADAMTS13 on these patients in chronic phase, or is that an area that is unknown at this point?18:53 What do you see on the horizon, what do you think the future looks like for TTP?21:36 OutroResources:Stroke and TTP (Hopkins group led by Dr. Shruti Chaturvedi):  https://ashpublications.org/blood/article/134/13/1037/374919/Reduced-ADAMTS13-activity-during-TTP-remission-isCognitive impairment in TTP:(Ohio State and London TTP group c

Timestamps:00:00 Intro00:43 Why is it important for physicians to understand about the reversal of these direct oral anticoagulants?03:09 The complications or the bleed rate was a lot less, with these direct oral anticoagulants?03:57 Although there is less severe bleeding, there was a concern by patients and physicians about, if it is severe, what is the plan? 04:51 What have we learned new? Are we learning more about what patient population to use them in, as well as the plans to reverse them?06:10 Can you elaborate a little bit about the idea for weekly monitoring for INR, why is it a big deal? 7:44 Could you give us an example of where it wouldn’t be ideal to do home INR monitoring for a given patient?09:06 Are there updates to what the reversal plans are, and how have they changed recently?12:34 Are there still some challenges that remain for reversing these direct oral anticoagulants?19:54 What do you think the future looks like for anticoagulant reversal? 23:47 OutroResources:https://pubmed.ncbi.nlm.nih

Timestamps:00:00 Intro01:10 Why is reference laboratory testing important for physicians and laboratorians to understand?02:00 No lab does all the testing in their own laboratory. Labs can’t really have a whole panel of laboratory tests; it just doesn’t make sense, right?04:39 What have we learned in the last couple years about reference laboratories, how we can best support clinical practice?06:10 Do you have an insight for how that communication goes? 8:46 How might a hospital reach out and partner with their reference laboratory? 11:06 What does the future of reference laboratories look like? What might be in store for us?15:00 Outro Register for Leveraging the Laboratory:www.news.mayocliniclabs.com/2021levlab

Timestamps:00:00 Intro01:15 Why are external rotations in pathology important from the student perspective?03:51 Do you get to understand the particulars of a program or maybe what kind of questions you might be asking when you later interview because you do a rotation? 05:03 What is unique from an international perspective? 07:53 Can you compare and contrast the in-person pathology elective, with some of the virtual resources that are available at this point and time?11:02 Are there any additional resources that you want to point out that are available now in 2021?12:34 Can you kind of dive in and provide advice for people that are following in your shoes who might be doing later electives this year or in the near future who are looking at applying to pathology in the next cycle?  13:41 Can you dive in and elaborate on what are some of the helpful things when students get onsite for one of these rotations?17:26 Can you help us understand how you go about cultivating those relationships? 19:36 Are there any k

Timestamps:00:00 Intro00:44 With this latest outbreak of the Delta variant with COVID-19, are laboratorians still working on new innovations for COVID?02:23 Could you go into more detail, elaborate for us about this COVID-19 innovation around sequencing? 04:25 Could you help us understand a little bit on what work is being done in those areas? 07:47 Could you help our audience understand what have these conversation been like now that we’re into this pandemic this far, and the way that laboratory medicine testing is moving? I imagine you’re having more conversations with some of your Infectious Disease colleagues and you’re having more conversations with public health these days?09:35 How do you answer that question?11:18 Are there one or two COVID-related challenges that have really been running around in your mind the past week?13:25 How is the Delta variant impacting what we’re thinking about for starting school?14:38 Outro Resources:American Academy of Pediatrics

Timestamps:00:00 Intro01:05 From your perspective, why is the blood inventory important to a hospital?04:17 What have you learned about managing a hospital’s blood inventory these past 18 months or so?08:09 I was wondering if you could give us a specific example on how are they trying to bridge that gap? 08:55 Can you explain who the Dream Team is?12:34 How does PVM look different on the hospital side? How is that being worked?16:33 How might physicians, non-pathologists, help their hospital’s blood inventory? What are the practical things that is within their sphere of control that they can help?20:52 What do you hope that our learners take away from these blood shortage challenges that we’re navigating right now?23:20 Outro 

Timestamps:00:00 Intro02:15 Why is it not enough for learners just to focus on the curriculum of their program?04:30 What are two or three things that learners should pay attention to during their training?07:19 Paying attention to the habits of our mentors and understanding that those habits are what is reassuring them, that is a key source for their confidence in their clinical practice. What’s another thing?09:50 Do you have a third one that we should pay attention to?12:45 How could learners take ownership for their education and get that knowledge that’s inside their mentor’s heads, into their heads? Any strategies that you recommend?19:56 What are you thinking about explicitly incorporating into your training program with residents and fellows?25:05 Outro 

Timestamps:00:00 Intro01:19 Could you help us understand, why should I consider getting an ethics consult? What value could this bring to my clinical practice?07:49 What should our audience understand in order to really work better with our local med ethics team?13:58 Could you help us understand about organizational ethics? How does that compare and contrast with that hospital ethics committee that you said everybody has and are most used to turning to?22:24 What would be your recommendation for how to reach out to who is doing organizational ethics at our institution?  25:00 I was wondering if you would be willing to share one or two predictions for the future of medical ethics to open our mind up to what are the main issues and questions, and how is your field evolving? 30:35 Outro 

Timestamps:00:00 Intro00:45 Why is it important to perform molecular testing on solid tumors?02:47 What is the significance of this testing for the patients and physicians?07:18 Can you share with us, what are some recent examples that have blown this door open about hereditary oncology?10:28 Can you talk a little bit about the challenge on how do we get the rapid rise in molecular knowledge and testing? What is your perspective?15:25 Can you elaborate a little bit on how you interact with your clinical colleagues on how to keep people up to date, or how to explore what’s the right thing to bring on to that test menu? 18:11 What’s your secret to leveraging those relationships?20:00 What does the future of molecular tumor testing look like?21:48 Outro 

Timestamps:00:00 Intro01:11 What are frozen sections, and why are they an important part of patient care?04:50 What are some of the challenges of actually performing a frozen section diagnosis?07:03 How has frozen section changed in recent years, or over the course of practice? Has it been practiced similarly over the years, and are there differences in frozen section practice in different hospitals?14:37 Given this uptick in the complexity of cases, how do you mentor people who are trying to find their way, i.e., the students and trainees?19:14 As a practicing Pathologist, where do you solicit your feedback from, and maybe an example of how you use that feedback to get better? 24:32 Looking at the future in pathology and surgical pathology, there’s so much interest in artificial intelligence and informatics; is that thought to play a role in the future of the frozen section practice?27:51 Outro 

Timestamps:00:00 Intro01:00 How does the cardiovascular laboratory support patient care?01:47 Can you tell us a bit about ceramides? What are they?04:14 When should ceramides be tested? 06:04 Can you modify someone’s ceramides such that the test can be repeated and monitored, or is it once in a lifetime because ceramides or more static?08:05 What is the controversary around ceramides? 09:52 Could you give our listeners an introduction to Lipoprotein(a)?11:45 Who should be tested for Lipoprotein(a)?13:59 How do we treat elevated Lipoprotein(a)? 17:20 How did your interests in laboratory medicine develop? How has this brought meaning for you in your career professionally? 19:23 Outro Resources:1.  Ceramides and Ceramide Scores: Clinical Applications for Cardiometabolic Risk Stratification. Hilvo M, Vasile VC, Donato LJ, Hurme R, Laaksonen R. Front Endocrinol (Lausanne). 2020 Sep 29;11:570628. doi: 10.3389/fendo.2020.570628. eCollection 2020. PMID: 33133018 Free PMC article. Review. 2.  Measuring the contributi

Timestamps:00:00 Intro01:00 Can you give us the lay of the land and explain how does the cardiovascular laboratory provide patient care?03:24 Can you elaborate for us what it looks like when you have clinical chemists, cardiologists, and other professionals with different backgrounds working together?05:56 Can you talk about bringing these people into the laboratory and developing a test that provides a lot of value to patients? How is that blended and what’s the output?07:31 Talking about meetings that you guys do -- how is this meeting not some hierarchy of people who come together? How do these meetings work as an interprofessional utopia?   11:21 How do you keep your clinical colleagues educated about laboratory science?14:25 Are other laboratories adopting this leadership model?15:42 What have you learned about establishing the culture and getting them to understand what the plan is?17:59 Turning to medical laboratory scientists, what’s your pitch for why they should go into clinical chemistry? 20:12 Out

00:00 Intro01:15 What’s your origin story? How did you become a forensic pathologist?03:53 What are some of the misconceptions about forensic pathology?06:15 Is there a big public health component to forensic pathology?07:29 Covid is a nice example on how you have partnered with public health, can you elaborate more on that?  10:15 What other types of physicians are you interacting with periodically and what are those conversations about?13:10 Do you approach autopsies differently depending on the case at hand?17:30 In what ways is the field of forensic pathology continuing to evolve and grow?20:50 Outro 

Timestamps:00:00 Intro01:29 Why is it really important for leaders in our practice to really understand quality for clinical practice?03:13 What are the latest developments in your area of clinical laboratory medicine?06:01 In recent years, what have we learned about quality and how we do quality in the hospital?11:19 How do we actually implement this in clinical practice for success, for sustainability? You talked about putting together an interdisciplinary team. What’s the secret sauce for putting that together?  15:36 You talk about recognition for these project successes. How do we do that when maybe the project is a failure, but still keep that motivation high in our community, make sure it’s normalized as sometimes it doesn’t work out, but not something we don’t talk about anymore?18:12 What have you kind of learned from your experiences for what are ways to make projects successful and sustainable?20:28 Can we kind of closeout with thoughts on where the future of quality improvement in medicine is head

00:00 Intro00:40 Can you tell us how your roles in these different laboratories support testing for patient care?03:13 What are the latest developments in your area of clinical laboratory medicine?07:22 Can you elaborate a little bit about this new approach that you have developed is able to bring both sensitivity and specificity along?10:55 Putting the interpretation on the form, you are probably experiencing quite a few phone calls with our clinical colleges. Can you talk to us about how those interactions go between the laboratory and clinical professionals?  15:10 How have your clinical consultations changed, based on feedback you’ve gotten from previous conversations?18:15 You also serve as Vice Chair for Supply Chain Management in the Department of Laboratory Medicine and Pathology. This has been talked about a lot related to the Sars-Cov-2 pandemic. Do you have any reflections about key lessons you have learned as you try to stay ahead of supply chair issues?22:06 Can you tell us more about resiliency

Timestamps:00:00 Intro01:07 Why is transfusion support an especially important component of patient care for patients that are on ECMO support?03:24 Are there some principles that we can think about that will help us better understand transfusion decisions in these patients?05:52 Can you take us through some specific situations that might help our listeners get our hands around (DO2 and VO2) from a practical standpoint? 10:31 How can laboratory professionals add value to the clinical care of these patients?12:35 How can we improve that interaction (between the clinical side and the laboratory side)? 16:41 What are the different devices we need to keep in mind?17:11 Outro

Timestamps:00:00 Intro01:11 As a critical care physician, why is laboratory testing important for your practice?04:09 What do you wish lab medicine folks understood better about critical care medicine?08:19 What would be your advice to a laboratory medical professional that’s interested in developing a better understanding of critical care medicine?14:51 What do you see for the future collaboration between laboratory medicine and critical care practice?16:44 Outro

00:00 Intro01:15 From your perspective, why is cellular therapy an important topic for our listeners?02:55 What is your origin story into this world of cellular therapy? 06:20 Working in such a fast-paced area, what has been a unique challenge you have had to navigate and how have you done that?  08:05 Keeping up with the literature can be a challenge, and once you are out of training you don’t have those deadlines of “have you read your recent articles for the month.” How have you approached keeping up with the literature?11:53 There is so much potential with cellular therapy. What is one direction you see this field moving towards over the next 5 years? 15:34 Outro

Timestamps: 00:00 Intro00:58 How is cellular therapy contributing to the COVID effort?04:42 Can you give us a little bit of an introduction about what’s so important about the cell (mesenchymal stem cell) or where it comes from?08:19 What sort of work are you and your lab doing for patient care?11:14 Once you figure out a successful cellular therapy, is there then opportunity for that to get brought to scale for a given patient population, or does cellular therapy need to exist as a very individualized treatment?13:48 For our listeners who might be students or other clinicians or laboratory medicine folks, how can they get involved in cellular therapy or how do you recommend those first steps to learn more about this field and how they might intersect with it?15:50 OutroResources:https://stemcellsjournals.onlinelibrary.wiley.com/doi/10.1002/sctm.20-0472 https://www.medrxiv.org/content/10.1101/2020.10.15.20122523v2 

00:00 Intro00:45 Can you let our listeners know what we know about the vaccines at this point (December 2020)?02:00 With using the mRNA approach, do these vaccines have similar performance characteristics?03:00 What does this mean for people after they get vaccinated? Hearing this high numbers of efficacy that is protecting me from the virus, what does this mean for how I should be behaving after I get vaccinated?04:25 What are your thoughts on if there should be post-vaccination serology testing?07:10 From your standpoint in the laboratory, has the laboratory developed all the tests that are needed? With the vaccines coming out, is laboratory medicine’s job done regarding COVID-19? Or do the folks in research and development still have some things they need to get done in lab medicine?10:15 Is the fact that we have a couple of variations out there a testament that this was testing that needed to be brought up in the moment, which is why there are a couple of different strategies, and maybe over time we will