This program is preliminary and subject to change.
Opening Keynote: Reducing the Global Burden of Disease by Half in a Decade
Sunday June 5, 1830-1930
Salim Yusuf, MD, BS, D.Phil, FRCP (UK), FRCP (C), FACC, Professor of Medicine and Executive Director Population, Health Research Institute. McMaster University and Hamilton Health Sciences
Learning Objectives:
At the end of this session participants will be able to:
- Discuss the global burden of CVD.
- Discuss the risk factors for CVD.
- Discuss strategies to reduce CVD.
This presentation will describe the burden of cardiovascular disease globally, and variations by countries at different economic levels. The presentation will also describe the risk factors for CVD and how large reductions in CVD can be achieved.
Symposium 1: Improving Patient Safety Through Quality Improvement in Laboratory Medicine
Monday June 6, 0900-1200
Mario Plebani, Università di Padova
Jannes Cadamuro, University Hospital Salzburg; Paracelsus Medical University
Vincent DeGuire, Maisonneuve-Rosemont Hospital; Optilab Montreal-CHUM Network
Quality Measurement in Laboratory Medicine
Mario Plebani, Università di Padova
Learning Objectives:
At the end of the session, the participants will be able to:
- Discuss the concept of quality in the total testing process.
- Update the knowledge on the model of quality indicators.
- Discuss further steps in the program.
- Improve cooperation and date sharing.
Dr. Plebani will present his research data on the concept of quality in Laboratory Medicine, the Harmonization of Quality Indicators, the Status of the Art of the MQI Program and Future Initiatives.
Is preanalytics really that important?
Jannes Cadamuro, University Hospital Salzburg; Paracelsus Medical University
Learning Objectives:
At the end of the session, the participants will be able to:
- Discuss the impact of preanalytical errors on medical decisions.
- Describe the impact of inappropriate laboratory testing on patient safety.
- Avoid most common preanalytical errors.
In the past decades, laboratory medicine has evolved greatly, currently contributing to the majority of medical decision-making. These achievements are mainly based on advancements in analytical methodology, including parameter spectrum and analytical sensitivity, as well as automation and resulting reduced turn-around-times. However, less emphasis has been put on the pre- and postanalytical quality. Minor errors in these extraanalytical phases may severely bias the result, regardless of the analytical quality. Such errors may subsequently lead to impaired patient safety due to unnecessary follow up diagnostics or treatments. Some of the errors, such as hemolysis, can be detected by the laboratory, while many others are impossible for the laboratory to identify.
One crucial step in the preanalytical process, which is often neglected or referred to as “pre-preanalytical”, is the test selection. Errors in this phase may lead to severe patient safety risk, as inappropriate laboratory diagnostics may end in missed or delayed diagnosis, one of the major contributors to medical errors in total.
One way of improving the preanalytical quality is to implement preanalytical Quality Indicators (QIs), such as the ones provided by the IFCC. Thereby, the laboratory is able to estimate the frequency of the errors, compare it to other labs and to monitor their trend. Thereafter, educational interventions should be planned in collaboration with the clinics to improve the situation. Overall, laboratory specialists should shift their attention from the highly standardized analytical part of their work to the extraanalytical phases.
Addressing the robustness of our pre-analytical processes to improve patient safety
Vincent DeGuire, Maisonneuve-Rosemont Hospital; Optilab Montreal-CHUM Network
Learning Objectives:
At the end of the session, the participants will be able to:
- Discuss Canadian initiatives promoting the standardization of the pre-analytical phase.
- Understand the value of Quality Indicators to improve the robustness our laboratory processes.
- Be aware of the EFLM guidelines of the WG-PRE for the ISO15189 accreditation of the Pre-analytical phase and discuss how we can implement it in our Canadian laboratories.
Quality improvement and monitoring of our pre-analytical processes is essential for patients’ safety and required for ISO15189 accreditation. Assessment of the robustness of our processes through benchmarking and laboratory comparison should be a priority. Standardization of our pre-analytical processes is also part of the solution. In this presentation international guidelines, Canadian standardization initiatives as well as specific strategies applicable in our laboratories will be discussed.
Symposium 2: Evidence Based Laboratory Medicine, Personalized Laboratory Medicine and Direct to Consumer Testing. Understanding Patient Needs and Wants in a Patient-centered Healthcare System
Tuesday June 7, 0900-1200
Chad Bousman, University of Calgary
Kristen Hauff, Interior Health
A.E. Zemlin, Stellenbosch University & National Health Laboratory Service
Clinical pharmacogenetics as a tool to facilitate personalized/precision medicine
Chad Bousman, University of Calgary, Cumming School of Medicine
Learning Objectives:
At the end of the session, the participants will be able to:
- Identify different pharmacogenetic testing implementation approaches.
- Assess the strengths and weaknesses of pharmacogenetic tests.
- Recognize patient care situations that could benefit from pharmacogenetic testing.
This session provide an overview and examples of current pharmacogenetic testing approaches being employed in clinical practice, emphasizing the pros and cons of each approach. The lecture will also highlight how concerns related to standardization, applicability, and feasibility of pharmacogenetic testing are being addressed and will use case examples to illustrate the challenges and opportunities of implementing pharmacogenetics in practice.
Direct to Consumer Testing: where is the evidence?
Kristen Hauff, Interior Health
Learning Objectives:
At the end of the session, the participants will be able to:
- Define direct to consumer testing in the context of Evidence Based Laboratory Medicine.
- Identify major factors driving the direct to consumer testing.
- Compare benefits and risks of direct to consumer testing.
- Formulate a plan to manage direct to consumer testing in your organizations.
More and more marketing is aimed at the patient as a consumer of clinical testing. Increasingly, the patient is empowered to make their own decisions and access their own testing, with or without physician intervention. In the context of test utilization, Choosing Wisely and evidence-based medicine, patient-pay testing seems an irreconcilable problem, but is it so hopeless or can patient driven testing co-exist with evidence based medicine?
Reconciling evidence-based laboratory medicine and precision medicine
A.E. Zemlin, Stellenbosch University & National Health Laboratory Service; Chair IFCC Committee for Evidence-based Laboratory Medicine
Learning Objectives:
At the end of the session, the participants will be able to:
- Understand the concepts of evidence-based laboratory medicine (EBLM) and personalized medicine (PM).
- Appreciate the lack of evidence and need for more evidence in PM and how this can be addressed.
- Appreciate how PM and EBLM may be used to decide on best personalized treatment options.
This talk will introduce the concepts of evidence-based laboratory medicine (EBLM) and personalized medicine (PM) and the challenges associated with each. While evidence-based medicine (EBM) focuses on results of studies to establish the best treatment for the “average” patient, PM focuses on “individual” patients, including the outliers not included in EBM. PM aims to optimize patient care through tailored treatment – however for this, the best evidence is needed. There is a lack of understanding of PM and a hesitancy amongst clinicians, and importantly the evidence linking PM to better patient outcome is lacking. This is the evidence required by policy makers, insurance companies (etc) to incorporate the use of PM testing into the clinical practice. EBM and PM should be integrated and for this, data sharing is needed. An evidence-based approach to PM should be adopted and ultimately instead of generalised evidence-based guidelines, personalized guidelines based on best evidence will be used. These individualized treatment recommendations based on evidence will allow clinicians to make fully informed treatment decisions.
Symposium 3: Health Care Equity: Role of Decentralized Laboratory Services
Tuesday June 7, 1330-1630
Navdeep Tangri, University of Manitoba
Ryan Sneath, Winnipeg Fire Paramedic Service
Byron Berenger, University of Calgary and Alberta Precision Labs
Wade Hawkins, Southern Alberta Institute of Technology
Eliminating race from the equation: A more equitable approach for estimating GFR
Navdeep Tangri, University of Manitoba
Learning Objectives:
At the end of the session, the participants will be able to:
- Describe the inequalities created by inclusion of race in the GFR estimate.
- Present the advantages and disadvantages of the new race free GFR estimation equations.
- Understand the potential of newer filtration markers for estimating kidney function.
In 2021, the American Society of Nephrology and the National Kidney Foundation developed a taskforce to recommend a race free measure of kidney function (eGFR). In response, the Canadian Society of Nephrology developed a working group to evaluate the potential alternatives and recommend the best one for Canadians. As the chair of this working group, I will highlight the challenges we faced, our ultimate recommendations and the path forward.
Delivery of lab testing in non-lab setting
Ryan Sneath, Winnipeg Fire Paramedic Service
Learning Objectives:
At the end of the session, the participants will be able to:
- Identify other health care professionals that may assist in the delivery of lab testing.
- Understand the role of paramedics, and how they may be used to perform remote lab testing.
- Identify unique opportunities within their own communities for implementing alternative lab testing services.
The role of the Paramedic has evolved significantly over the past number of years that has created unique opportunities for innovations in the delivery of Health Services. The Community Paramedicine Program with the Winnipeg Fire Paramedic Services is a prime example of a Health Service focused on a Collective Impact model, that is providing more and more in-home health services with the delivery of Laboratory and Diagnostics in unique environments. This presentation will provide an overview of some of those services, the impact they have had on patient outcomes, and opportunities for the future.
Delivering COVID-19 diagnostics to rural, remote and indigenous communities using point of care tests and drones
Byron Berenger, University of Calgary; Alberta Precision Laboratories
Wade Hawkins, Southern Alberta Institute of Technology
Learning Objectives:
At the end of the session, the participants will be able to:
- Recognize the performance and the use cases for COVID-19 POCT in rural and remote communities.
- Discuss case studies with lessons learned for deployment of testing to rural/remote communities in a Canadian province.
- Recognize the benefits and hurdles to utilizing drone/remote piloted aircraft systems to delivering diagnostics to rural and remote communities.
This session will review the point of care tests for COVID-19 available and their use to deliver diagnostic testing to rural and remote communities to reduce healthcare inequities experienced by these populations. The approaches to and lessons learned by implementing these tests and delivering test supplies will be discussed using case studies from Alberta in a variety of settings. We will also discuss experiences with delivering supplies and equipment to provide remote care to First Nations communities using with remote piloted aircraft systems (drones).
Symposium 4: The Clinical Toxicology Lab and the Forgotten Public Health Crisis
Wednesday June 8, 0900-1200
Christophe Stove, Ghent University
Christiana Stefan, Centre for Addiction and Mental Health
Christina Zagnelli, Alberta Health Services
Rachael Edwards, UVIC
Dried Specimens in Toxicology
Christophe Stove, Ghent University
Learning Objectives:
At the end of the session, the participants will be able to:
- Point out the advantages and limitations of microsampling.
- Choose for what application(s) microsampling may be useful.
- Discuss the utility of microsampling for toxicology testing.
Microsampling, and more particular the collection of dried blood microsamples following a fingerprick, is increasingly receiving attention in the clinical and toxicological field. This presentation will provide an outline of the possibilities offered by microsampling, with applications in the field of therapeutic drug monitoring and toxicology. Special attention will be paid to the dried blood microsample-based follow-up of the direct alcohol marker phosphatidylethanol 16:0/18:1 (PEth) in the context of driving license regranting programs, an application which is routinely run at the Laboratory of Toxicology at Ghent University, Belgium. Besides the advantages, this presentation will also highlight potential pitfalls associated with (analysis of) microsamples, as well as the need for harmonization.
The opioid crisis, drug checking and clinical laboratory: is there a link?
Christiana Stefan, Centre for Addiction and Mental Health
Learning Objectives:
At the end of the session, the participants will be able to:
- Describe drug checking as a public health response to reduce the harms associated with substance use and prevent overdose.
- Understand the role of the clinical laboratory in drug checking and related legislative requirements in Canada.
- Discuss the service goals of the Toronto’s Drug Checking Project for drug identification.
- Evaluate the importance of advanced analytical strategies in the identification of novel drugs.
- Discuss outcomes of Toronto’s Drug Checking Project regarding drug findings, laboratory, clinical and public health impacts.
This presentation is based on speaker’s direct involvement and experience with Toronto’s Drug Checking Project, launched in October 2019 as part of an interdisciplinary partnership focusing on opioid harm reduction. It introduces the audience to the concept of drug checking in the context of unregulated (street) drug use that expands beyond mere drug testing. 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. The speaker will discuss the Health Canada legislative requirements to incorporate drug-checking services into the clinical laboratory operation; followed by an outline of the service goals for drug identification along with the advanced mass spectrometry strategies used to identify novel drugs. This presentation will include the reporting design of qualitative and quantitative results as well as the project’s drug findings since implementation, focusing on fentanyl and fentanyl analogues, benzimidazole (nitazene) opioids, designer benzodiazepines and synthetic cannabinoids. The speaker will conclude by discussing the public health impact of project’s drug findings along with laboratory and clinical impacts based on clinical scenarios at the Centre for Addiction and Mental Health.
Harm reduction/Safe consumption sites
Rachael Edwards, UVIC
Cristina Zagnelli, Alberta Health Services
Learning Objectives:
At the end of the session, the participants will be able to:
- Develop an understanding of harm reduction strategies, challenge stigma and assumptions around substance use and the approaches needed to turn the tide on the public health crisis of drug poisonings.
- Integrate knowledge of established and emerging approaches to opioid agonist therapy into the clinical laboratory setting.
- Recognize the role of clinical chemistry in a public health crisis.
- Demonstrate awareness of the broader social implications of provincial strategies to address the drug poisoning crisis, availability of harm reduction services, and the integration of novel opioid agonist therapies.
This presentation will introduce a harm reduction philosophy of care using narratives and practical examples that support the dignity of people who use drugs (PWUD). We will report on the current state of drug poisoning in Alberta and offer examples of approaches necessary to turn the tide on this public health crisis. Traditional and emerging, novel practices in opioid agonist therapy will be highlighted. We will challenge assumptions to counter the stigma that PWUD experience accessing care while highlighting how to integrate harm reduction principles into any practice setting.