Lab Medicine Rounds

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

Timestamps:00:00 Intro01:00 As Pathologists, we have a lot of competing priorities. Why is mentoring residents and fellows consistently a high priority for you?03:27 Often what we are trying to do as educators is not transparent to our learners, for a variety of reasons. What do you wish that all residents, fellows, and learners understood about the process of their training?05:00 How do you address someone who started out on the right food and then started a slip a little and stopped taking ownership of their cases? How do you readdress that with the learner?06:25 Lately, there has been a lot of discussion about deliberate practice as the pathway to developing expertise. How are you deliberately becoming a better pathologist?08:10 If you had one magic medical education wish, what would it be and why?08:50 Have there been some things that you have done that have helped you be more successful at having that dedicated time for education? 10:00 Last question, what has surprised you most about your professional j

Timestamps:00:00 Intro01:00 What is HIT and why is it important for clinicians to correctly diagnose HIT? 03:30 What do we know about how laboratory testing may help clinicians get the diagnosis right? 07:25 How could the process of diagnosing HIT be updated or made better?10:45 What does the future hold for HIT testing? In five years’ time what do you think HIT testing is going to look like in this country?12:45 How has your relationship with your clinical colleagues helped advance your practice of medicine? 15:30 OutroRelated Resources:Conference: A Case-Based Workshop: Clinical and Laboratory Aspects of Hemophilia and ThrombosisArticle: National Symposium Focuses on Bleeding and Thrombotic Disorders

Timestamps: 00:00 Intro01:00 Why is it important for medical students to prepare for their residency interviews?3:00 What do recommend that students do to prepare for those interviews? Is it looking at websites online or going to PubMed?05:35 Assuming many interviews will be virtual, is it fair game for an applicant to reach out to the program interviewers ahead of time to ask them if they can test out the system if they are unfamiliar with it?08:45 Do you have any thoughts on how students can manage stress inducing questions if they cannot come up with a response immediately? 11:35 What are your thoughts an applicant’s background during online interviews, should they use virtual backgrounds or not? 15:20 It can be difficult to ask relevant questions of the program and program director. Knowing what you know, what are a few questions or areas that pathology residents may want to consider asking that would be helpful for getting a pulse or feel for that individual program? 

Time Stamps00:00 Podcast Intro00:35 Now that the EAP is closed, how are doctors getting convalescent plasma for their patients? 08:50 What new information have we learned about convalescent plasma in recent months? 13:28 If we are in a period of shortage and there is only low titer available, is it ideal to transfer two units of convalescent plasma in that context?15:30 What remaining questions about convalescent plasma are you most curious about?18:52 How can study design enable or inhibit certain questions to be asked and answered?21:00 Are there any additional transfusion therapies on the horizon?23:50 Outro 

Time Stamps00:00 Podcast Intro00:40 Why is it important for a laboratory to detect or quantify opioids?02:00 What are the challenges you have had to navigate in the laboratory specific to opioids?04:47 Is it like a pregnancy test or is it important to quantify as well?05:19 Can you help us understand how you collaborate with other health care professionals? 07:07 In terms of new or illicit street drugs, are you having to constantly design new tests to detect these things?07:53 Can you elaborate a little about that collaboration with law enforcement?09:07 Are you also periodically going to testify in court on cases?09:35 What do you think the future of opioid testing looks like?12:25 Outro 

Timestamps00:00 Podcast Intro00:45 Why is it important for laboratory medicine and pathology to be deliberate about diversity and inclusion? 03:11 How do you recommend we transform the question “will they fit?” or “do I fit?” so that it invites diversity?05:33 So, it’s not so much of transforming the question but putting it ahead of the interview and thinking about what you are trying to recruit for? 06:22 What information have we recently learned about diversity and inclusion in the newer findings? 10:35 How is it easier and/or harder to move the needle on diversity and inclusion in the laboratory?13:35 In 5 years, where will Laboratory Medicine and Pathology be with respect to diversity and inclusion?16:05 Outro 

Time Stamps00:00 Podcast Intro00:50 Why does this landscape of COVID testing seem so dynamic? 03:47 So it sounds like we have two sort of rapid tests that are on the market now. Can we dive into that so that we can appreciate a little bit of the compare and contrast between those two rapid assays?07:17 What are these unique challenges with regards to sensitivity and specificity when it comes to these rapidly evolving tests?11:08 Highlighting the connection between laboratory medicine and the clinical practice as it applies to COVID-19 testing.12:49 What new struggles have emerged when it comes to testing for COVID?15:15 What’s a thought process that you recommend for folks to think about when people are trying to think about what should I offer in my lab, or how should I offer COVID testing? 17:25 Dr. Binnicker, if you were king for a day, what would you make happen for COVID testing?19:09 Outro Resources:Centers for Disease Control and Prevention (CDC)U.S. Food and Drug Administration (FDA)

Time Stamps00:00 Podcast Intro00:51 This is a nice time of year for the academic calendar with new trainees starting residency, and new faculty starting their jobs, and people still in their first couple of years of being an academic pathologist. Why is it important for these individuals to be deliberate about how they begin their career?04:18 When somebody is in training, there is a lot that is decided for them and things are predetermined. In residency that opens up quite a bit. Can you give us some insight into these goals you are talking about? On a smaller scale, how do you set yourself up so you can be consistent in making progress?07:55 Are you pretty deliberate about revisiting where you are with your goals? How do you check yourself?10:30 Your success as a resident and as an attending, what advice works in both roles and what advice is good for a resident versus the attending?13:53 When evaluating trainees there is a component regarding delegating work. The skill is critical to have when coming on st

Time Stamps00:00 Podcast Intro01:05 Why is it important to explain the laboratory to patients? How important it is to have open/honest communication with patients?07:05 With your experience in talking with children and their families is your focus on the child and the parents picks up on your efforts? Or are you addressing the child separately from their parents?  11:10 What tips would you have for pathologists as they approach certain situations (approaching the bedside, engaging with patients, answering questions regarding lab tests or biopsies, etc.)16:26 What are your tips for clinicians on explaining the laboratory to patients? 20:22 For our student listeners, what has been your most impactful lesson learned?23:17 You started to create a video to show kids and their families what is happening in the lab behind the scenes, where does their samples go, etc. How are you approaching this? 27:00 Do you envision that material will be geared towards grades K-5 and then different content for teenagers? How diffe

00:00 Podcast Intro00:53 There seems to be a lot of buzz around the need for interprofessional education and interprofessional collaboration. Can you kind of take us through these concepts? How are they the same, or how are they different?02:37 What’s the why here? Why should health care institutions, us as individuals, why should we prioritize this interprofessional education or collaboration in practice?05:34 I imagine there are a lot of people listening who have meetings…for example we have medical technologists that are involved in a meeting and pathology residents, pathologists, and so you have people together. Does that mean that intercollaboration is happening, or happening well? Is there some way to understand that? 11:03 What do you think that the challenges are that get in the way of developing this skill of interprofessional collaboration?16:17 Critical reflection19:20 What has surprised you most about interprofessional collaboration?20:42 Underscoring the importance of laboratorians and clinicians

Time Stamps 00:00 Podcast Intro  03:19 How did you choose forensic pathology as a career? 04:30 Where did you train and where were you prior to Mayo? 05:08 Can you discuss in general the practice of forensic pathology, and the difference between hospital and medicolegal autopsies? 06:37 How often do forensic pathology and microbiology intersect? 07:57 What are the challenges of performing microbiology studies in your practice? 08:54 What types of interesting microbiology cases have you seen so far? 13:13 You practiced in Dallas for almost 15 years.  Can you tell us about the Ebola scare in 2014? Were you involved in the one fatality? 21:26 Given the information you now have learned regarding the Ebola outbreak in 2014 and the COVID outbreak now, to what level are we prepared for what comes next?Resources:https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963?_ga=2.125131913.207068228.1583341931-1731071377.1580216385https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Time Stamps 00:00 Podcast Intro 00:40 What is COVID-associated coagulopathy and why is it important to recognize this? 02:45 How is this coagulopathy similar to or different from other coagulopathies that we commonly see in clinical practice? 04:30 Is there recommended testing for COVID-associated coagulopathy? 06:30 Can you explain what the soluble fibrin monomer test is? 08:09 How is COVID-associated coagulopathy managed in terms on prophylactic anticoagulation, therapeutic anticoagulation, and prophylactic transfusion? 14:23 What are a few lessons that you have learned during this pandemic so far? Resources:1.       F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer, et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19,Thrombosis Research (2020), https://doi.org/10.1016/j.thromres.2020.04.013   2.       doi:10.1111/JTH.14810 

Time Stamps 00:00 Podcast Intro 00:39 What is they ‘why’ behind starting up a convalescent plasma program? 04:00 If physicians are taking care of a patient and wanting to get this product how do they go about it?   11:23 With the Expanded Access Protocol and Emergency IND, how many products does that get for the given patient? 13:00 Where should we direct people who are interested in being a donor? 14:51 Can you give us an idea on who would be eligible to donate convalescent plasma? 17:16 What are some lessons learned from your perspective as you have navigated through COVID-19 and the dynamic situation?  Resources: https://ccpp19.org  https://covidplasma.org   https://uscovidplasma.org 

00:00 Podcast Intro 00:56  On a lot of T.V. shows that I’ve watched over the years, I see the surgeons and emergency medicine docs after they see the patient pop back in the lab and perform those critical tests. In reality, is that really what’s going on? 01:42 Myself as a pathologist, I understand for a lot of physicians I’m probably one degree removed from the bedside, so one degree outside of their mind, and  maybe the medical technologist is another degree. So for our physicians and clinicians listening to this podcast, can you maybe share some of the biggest misconceptions about laboratory technologists and the value that they are actually contributing behind the scenes to that patient care?03:05 I know in our day to day we kind of think about those patients or situations where we’ve really been challenged and made a difference for the patient. Can you share one of those stories about where you specifically really played a role behind the scenes that made a difference for patient care?04:39 It sounds lik

Time Stamps 00:00 Podcast Intro 00:50 Why is it important to have a serologic test for COVID-19 when there are already molecular PCR assays for diagnosis? 01:38 How are we going to b using the serologic test in clinical practice?  03:02 When should and when shouldn’t we be ordering the serologic assay? 04:34 Can you elaborate on some of the limitations of this test? 06:05 Should we be listening to their local area is recommending related to COVID-19? 06:49 What are the challenges that you have to navigate with serologic testing for COVID-19? 09:32 This has really been a collaborative effort across the country to implement this test. Would you mind sharing what implementation of this serologic assay looked like?  12:58 What are some lessons learned at this point that you think would be worth sharing to the lab professionals and students that listen to this podcast?

Time Stamps00:00 Podcast Intro 00:52 Can you start off and give us kind of the status update on where we are on this COVID-19 pandemic?02:13 When you talk about it has gone from an epidemic to a pandemic, can you highlight for our listeners what the difference between those two are?03:22 Now to dive into laboratory testing. There have been a couple of tests talked about in the media and I know that you have led a team here at Mayo that has developed a test for COVID-19. Can you help us summarize these different tests that are potentially orderable?04:00 Molecular Tests05:10 Serologic Tests07:14 I’ve been seeing in the news a lot of speculation based on past experiences about low sensitivity of SARS-CoV-2 diagnostic testing. Can you speak to that and help us understand this from the lab medicine professional’s point of view?11:00 We’ve been hearing a lot about rapid tests, point-of-care tests for SARS-CoV-2. I was wondering if you could help us understand those, and how do they fit with what we’ve discussed so

Time Stamps 00:00 Podcast Intro 01:26 Why is it important to consider how we're staffing our laboratory during this pandemic?  02:58 What are the different models or what are some different ways people have been talking about running a lab to mitigate this risk of the lab going down?  07:07 I like how you know, you're also talking about these challenges of space and some of the conversations that you're having with infection control at the institution level. 09:05 When you were talking and looking at those different schedules and going to the different shifts, you mentioned that there was a lot of time that was invested in doing that. Do you have any tips for our listeners about lessons learned from that experience about how they can do that and learn from your experience?  12:17 If we could follow that thread a little further, I'm curious about how your communication has been with the clinical practice. I know that you mentioned you actually have three labs that you oversee. I know especially the cellular th