CSCC 2020 VIRTUAL CONFERENCE PROGRAM

“This event is an Accredited Group Learning Activity as defined by the CSCC/CACB Professional Development Program.”
« Cette activité est une activité de formation collective agréée selon la définition établie par le Programme de perfectionnement professionnel de la SCCC et l’ACBC. »

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  Thursday July 30, 2020

1200-1430 EDT

Symposium 3: Evidence Based Lab Medicine

 Co-chairs: Andrew Don-Wauchope, VP Clinical Affairs, Lifelabs, Toronto ON
Jenisa Naidoo, Medical Director /Lab Operations, Gamma-Dynacare Medical Laboratories
1200 Welcome
1205 Application of EBLM in the Age of Precision Medicine
Speaker: Annalise Zemlin, Head of Division, Chemical Pathology, Stellenbosch University and National Health Laboratory Services
Objectives: At the end of the session participants will be able to:
1. Define and be aware of the challenges associated with evidence-based medicine2
2. Define and be aware of the challenges associated with the introduction of personalized medicine to routine patient care3
3. Appreciate the need for high quality evidence for personalized medicine
Overview: The presentation will deliver the theory behind evidence-based and personalized medicine as well as challenges associated with each. It will discuss the “one size fits all” assumption of classic guidelines and how the understanding of personalized medicine may benefit individual patient care in certain scenarios. Ultimately, for ideal patient care, an integration of the two is necessary to advance medicine i.e. personalised evidence-based medicine. This session will be of value to clinical laboratory staff and geneticists as well as to clinicians.
1235 Guidelines Implementation
Speaker:  Andrew Don-Wauchope, VP Clinical Affairs, Lifelabs, Toronto ON
Objectives:  At the end of the session participants will be able to:
1. Discuss the considerations for implementing a guideline
2. Summarize how to make a guideline applicable to their environment
3. Find the tools to support guideline implementation
Overview:  The presentation will deliver the theory of guideline implementation and provide some examples of how this can be done. It will include the reasons for developing guidelines, why the implementation of the guideline needs to be tailored to the local environment and the tools that can be used to support guideline implementation. This session will be of value to clinical laboratory staff at all levels of experience and to clinicians.
1305  Evidence for Implementing POCT 
Speaker:  Karina Rodrigues Capote, Clinical Biochemist, Interior Health Authority, Kelowna General Hospital, Kelowna, BC
Objectives:  At the end of the session participants will be able to:
1. Define point-of-care testing (POCT)
2. Discuss the advantages, disadvantages and challenges of POCT
3. Discuss whether POCT confers any advantage in clinical decision making in different scenarios
4. Explain the laboratory's role in POCT
Overview:  In this presentation, we apply the principles of Evidence Based Laboratory Medicine (EBLM) looking for evidence of whether point-of-care testing (POCT) confers any advantage in clinical decision making in different scenarios. We will review the advantages, disadvantages and challenges of POCT. In addition, we will discuss the laboratory's role in POCT. This session will be of value to clinical laboratory professionals, trainees, medical students, residents and geneticists as well as to clinicians.
1335  Stopping Tests and Starting New Test: Application EBLM 
Speaker: Seema Bhargava, Chairperson & Sr. Consultant, Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi India
Objectives: At the end of the session participants will be able to:
1. Rationalize starting/stopping or not starting/stopping a new analyte test or method.
2. Make an informed decision on basis of available literature and the clientele their laboratory serves.
3. Set down a policy within the institute /laboratory with regard to the stopping/starting of any test.
Overview: Change is the mainstay of all aspects of life and laboratory medicine is no different. The evolution of the medical testing laboratory actually exemplifies this.  

This presentation would serve as an initial guide through a series of questions to ask before either starting or stopping any test in a medical diagnostic laboratory. The questions could be:
i) What is the clinical question it answers?
ii) Was this question answered by any other previously available test?
iii) If the answer to ii) is ‘yes’, how is the new test better in terms of specificity, sensitivity, proven clinical efficacy, cost.
iv) If the answer to ii) is ‘no’, how is it adding to the patient’s outcome?
v) Does it replace any test being used previously? Or is it an adjuvant?
vi) If it replaces a test already in use, what are its advantages over that analyte/method and have these been demonstrated adequately?

These queries summarize why the start/stop process must be structured. Several examples would be discussed and compared, answering these questions with the evidence thereof. This would demonstrate the process of logical decision-making for a test being started or stopped.

This session would be of value to clinicians, laboratory consultants and residents.

1405  Appropriate Stewardship in the Laboratory; Cut Out the Noise and Bring on Reflective Testing 
Speaker:  Manal Elnenaei, Head of Clinical Chemistry, Nova Scotia Health Authority & Dalhousie University, Halifax NS 
Objectives: At the end of the session participants will be able to:
1. Define appropriate stewardship and indicate the goals of this ideology
2. Provide an overview on local utilization strategies
3. Indicate what reflex and reflective strategies means, with examples of their clinical value
4. Outline the issue & consequences of missed/delay in diagnosis of pituitary disorders.
5. Describe how the laboratory can leverage its resources in reducing missed diagnosis
6. Present a local study incorporating an algorithm for reflex strategies and reflective testing and demonstrate success in early detection of pituitary disorders
Overview: Laboratory Stewardship is currently a hot topic that is aimed at capturing best lab practices that ensures the responsible and judicious use of laboratory resources. This entails both reducing testing of low clinical value while promoting and supporting testing that enhances quality of patient care. This talk will provide insights into both aspects, including relevant local experience that the presenter will share with the audience on strategies and outcomes of reducing unnecessary testing while introducing reflex and reflective approaches to add tests deemed to be of clinical value.

Reflex strategies involve fixed algorithms that capture a particular criteria of test results and either “reflex” additional tests or present these captured results for further consideration through “reflective testing”. The latter entails the addition of further tests at the discretion
of the laboratory clinician after contemplation of the clinical and biochemical information related to the particular patient and is a concept that has been gaining popularity, especially in Europe, over the past decade. Particularly if coupled with interpretive commenting, it has been advocated to add clinical value by allowing more rapid and accurate diagnosis and reducing misinterpretation of results.

This session will be of value to trainees, medical students, residents as well as clinical and medical biochemists.