REGISTRATION

Category1 Registration Type Fee
Club Member CSCC Members $150.00 plus applicable taxes
  Non-Members $175.00 plus applicable taxes
Single Roundtable CSCC Members $25.00 plus applicable taxes
  Non-Members $30.00 plus applicable taxes

All CSCC Education Roundtables will be held on Thursdays and will be one (1) hour in length.
Eastern Pacific Mountain Central Atlantic Newfoundland
ON, QC BC AB, SK* MB, ON (West) NB, NS, PE, Lab NL
11:30-12:30 08:30-09:30 09:30-10:30 10:30-11:30 12:30-13:30 13:30-14:30
14:00-15:00 11:00-12:00 12:00-13:00 13:00-1400 15:00-16:00 16:00-17:00
* SK - During daylight savings time; otherwise one hour later

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1Save today! Club members are entitled to join any or all of the Roundtables. Register once only and automatically receive an invitation for each Roundtable and access to the slides and recordings of past roundtables for the current year.

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  • Each registration is restricted to one (1) phone line; you may have as many participants using that line as you wish.  You are welcome to sign up more than one (1) phone line but each line must be a separate registration and payment. **COVID NOTE** During the pandemic when social distancing rules restrict gatherings, a group registration can apply to multiple lines and all members of the group can log in using their own line. If you are a member of a group please register without making the payment, and indicate your group name in the field provided.
  • Participants will be sent a 1-800 phone number for the audio and an internet url to view the slides.

2020-2021 SCHEDULE

  Date Time (Eastern) Presenter(s) Topic
1.  September 17, 2020 14:00-15:00     
   

cscc logo bilingual stacked100x80CSCC Special LectureshipRoche Logo

Sponsored by Roche

COVID-19 serology testing experience from Canadian clinical laboratories

  September 24, 2020 11:30-12:30  Zahraa Mohammed-Ali
Miranda Brun
Quality improvements from Canadian laboratories
Screening for Open Neural Tube Defects: Aligning with the Society of Obstetricians and Gynaecologists of Canada (SOGC) Guidelines 
3. October 8, 2020 14:00-15:00 Mathieu Provençal CSAN PRONTO a new era in mental health
4.  October 22, 2020 11:30-12:30  Jan Palaty

Ivan Blasutig

New tools for the qualitative and quantitiative analysis of fentanyl and its analogues
Evaluation of the N-latex serum free light chain assay on the Siemens BNII analyzer
5. November 5, 2020 11:30-12:30 Edward Randell Improving quality and efficiency through high performance auto-verification
6. November 19, 2020 14:00-15:00 Francis Lin

Sarah Delaney

Lab-on-Chip System Development for Chronic Disease Diagnosis (CKD and CRD assessment)
Point-of-Care Drug Testing in a Pain Management Setting
7. December 3, 2020 11:30-12:30 Bhushan Kapur Journey of a Druggie Doctor
8. January 7, 2021 11:30-12:30  Jessie Cameron  Approach to diagnosis of mitochondrial disorders 
9. January 21, 2021 11:30-12:30  Khosrow Adeli
Victoria Higgins
Nicole White-Al Habeeb 
Harmonized lipid reporting across Canada: CSCC hRI Recommendations
10.  February 4, 2021  14:00-15:00 Danijela Konforte  Quality Assurance Tools in Clinical Mass Spectrometry Labs 
11.  February 18, 2021  11:30-12:30  Lianna Kyriakopoulou

Isolde Seiden Long 

Canadian Standards Documents on Laboratory Developed Tests (LDTs). Developing application specific standards

Canadian national standard, CSA Z316.8- Requirements for the design, development, and validation of laboratory developed tests (LDTs) used for the screening, diagnosis, and management of clinical conditions

12. March 4, 2021 11:30-12:30 Vilte Barakauskas
Catherine Jones
Nutrition Assessment and Monitoring of Hospitalized Patients
13. March 18, 2021 14:00-15:00 Danijela Konforte
Julie Shaw
Jennifer Taher
CSCC Special Interest Group on COVID-19: Consensus Guidance for SARS-CoV-2 POC testing
14. April 1, 2021 11:30-12:30  Christopher T. Sempos Hot Topics in Vitamin D
15. April 15, 2021 14:00-15:00  Daniel Holmes

Kathleen G. Beavis

Pooling samples in light of COVID-19 testing. Experiences from two sites 

Implementing pooled testing for COVID-19

16. April 29, 2021 11:30-12:30  Christopher Farnsworth
Joseph Wiencek 
Mitigating Preanalytical Errors in External and Internal Sample Transport
•   All shook up: Validating pneumatic tube systems for specimen transport
•   Current Lockboxes: Is the Wait The Hardest Part?
17. May 13, 2021  11:30-12:30 Fellows in training
Victoria Higgins 
Fellows in training- presentations 
Improving Utilization of Autoantibody Testing by Hepatologists: A 3-Year Retrospective Study 

  

#16 Apr. 29, 2021 Mitigating Preanalytical Errors in External and Internal Sample Transport
Overview: Sample collection, handling, transport and storage are essential areas to monitor in the preanalytical phase of laboratory testing. Before samples reach the clinical laboratory for analysis, they will often originate at either a remote collection site or in an inpatient setting. Each unique route presents numerous difficulties in the maintenance of sample integrity. This educational round table session will consist of two presentations that focus on challenges associated with 1.) courier lockboxes and 2.) penumatic tube systems in external and internal transport, respective. Strategies to mitigate errors in these essential areas of the preanalytical phase of laboratory testing will also be discussed.
  Courier Lockboxes: Is the Wait The Hardest Part? 
Speaker: Joe Wiencek, Ph.D., Assistant Professor of Pathology, Microbiology, and Immunology, Vanderbilt University
Objectives: At the end of this presentation, participants will be able to:
1)  list current challenges in transporting samples to the clinical laboratory
2) discuss the need for standard instructions for samples stored in courier lockboxes
  All Shook Up: Validating Pneumatic Tube Systems for Specimen Transport
Speaker: Christopher W. Farnsworth, Assistant Professor of Pathology and Immunology, Washington University in St. Louis 
Objectives:  At the end of this presentation, participants will be able to:
1)   list lab tests that may be affected from speciment traansport by pneumatic tube systems
2)   describe the available tools and methods for validating and monitoring pneumatic tube systems
#15 Apr. 15, 2021 Pooling samples in light of COVID-19 testing.  Experiences from 2 sites
Speaker: Daniel T. Holmes, MD FRCPC, Head, Department of Pathology and Laboratory Medicine, Providence Health, Vancouver BC
Overview: Pooling of virology samples for the purposes of increased analytical throughput presents numerous technical challenges from the perspective of sample tracking and data automation, especially given that there may be multiple instruments in the analytical workflow. We will present our solution for COVID sample pooling throughout the liquid handling, extraction, amplification and filing processes - all based on freely available open-source software. We will also discuss strategies we employed to divert samples away from pooling when the positivity rate climbed in the fall of 2020.
Objectives: At the conclusion of this session, participants will be able to:
1)  describe why viral nucleic acid testing is amenable sample pooling.
2)  identify the positivity rates wherein sample pooling is feasible and how to estimate the expected throughput gains.
3)  discuss best practices of data automation in the clinical laboratory environment.
4)  describe the mitigable hazards associated with liquid handling automation and the challenges of sampling the primary collection tube.
Implementing pooled testing for COVID-19
Speaker: Kathleen G. Beavis, MD, Professor of Pathology, University of Chicago
Overview: Background, benefits, and challenges of pooled testing for COVID-19 using a manual system will be discussed. Topics include loss of sensitivity, changes to the report, and managing pooled testing as prevalence increases and decreases.
Objectives: At the conclusion of this session, participants will be able to:
1)  review the benefits of pooled testing
2)  mitigate risks of decreased sensitivity
3)  describe validation for pooled testing
#14. Apr. 1, 2021 Hot Topics in Vitamin D
Speaker: Christopher T. Sempos, Ph.D., Coordinator, Vitamin D Standardization Program LLC, Office of Dietary Supplements, National Institutes of Health (NIH), Bethesda MD (Retired)
Overview: The vitamin D field is in a state of chaos. We have two very different sets of guidelines for defining vitamin d states, e. g. deficiency – the Canadian and US 2011 IOM and 2011 Endocrine Society guidelines. A principal reason for that chaos is the lack of assay standardization of the serum marker of vitamin D status, i.e., serum total 25-hydroxyvitamin D or 25(OH)D. To resolve that chaos, the international Vitamin D Standardization Program (VDSP) was initiated in 2010 through the auspices of the Office of Dietary Supplements, US National Institutes of Health in collaboration with health agencies and vitamin D researchers around the world. The focus of the session will be to outline tools and methods developed by the VDSP to correct this problem.
Learning Objectives: At the end of this session, participants will be able to:
1.  Identify the Serum markers of vitamin D status
2.  Understand the Vitamin D Standardization Program (VDSP)
    a. Goals
    b. VDSP Reference Measurement System
    c. VDSP Steps to Standardization
3.  Recognize the importance of assay standardization to the development of serum cut-points to define vitamin D states.
#13. Mar. 18, 2021 CSCC Special Interest Group on COVID-19: Consensus Guidance for SARS-CoV-2 POC Testing
Speakers: Danijela Konforte, PhD, FCACB, Clinical Biochemist, LifeLabs
Julie Shaw, Regional Lead for Biochemistry and POCT, EORLA, The Ottawa Hospital, The University of Ottawa
Jennifer Taher, Clinical Biochemist, Mount Sinai Hospital
Overview: COVID-19 CSCC Special Interest Group (SIG) was formed in May 2020 as a forum for the CSCC members to share provincial experiences and best practices related to selection, validation, implementation, and interpretation of testing for COVID-19. With the support of CSCC Council the SIG aims to be proactive in raising visibility of the role Canadian clinical biochemists have in response to COVID-19 through public outreach and engagement of other professional organizations. One of SIG's recent projects was development of a consensus guidance document for SARS-CoV-2 POC testing. This webinar will summarize key recommendations presented in the document, including test selection, analytical methods and performance, as well as clinical and public health utility. Quality management approach used in the recent implementation of SARS-CoV-2 rapid antigen and molecular tests in Ontario will also be discussed.
Learning Objectives: At the end of this session, participants will be able to:
1)  Learn about CSCC COVID-19 SIG mandate and main objectives for 2020/2021
2)  Familiarize themselves with CSCC Consensus Guidance Document for SARS-CoV-2 POC Testing, including advantages and limitations of different methods and their clinical and public health utility
3)  Learn about a framework for quality management of and challenges related to SARS-CoV-2 POC testing through real-life examples of test implementation in Ontario
#12. March 4, 2021 Nutritional Assessment and Monitoring in Hospitalized Patients
Speakers: Vilte Barakauskas, Clinical Biochemist, BCCWH
Catherine Jones, Registered Dietician, BCCWH
Overview: Nutritional status of patients needing healthcare can be variable. Assessment of a patient’s nutritional status is important as poor nutrition can impact day to day functioning, development, ability to thrive, and in the case of critical illness, outcomes such as mortality, length of stay and re-admission rates. Although laboratory testing is part of nutritional monitoring, nutritional assessment consists primarily of clinical and dietary evaluation. This session will introduce the core components of a nutritional assessment and provide examples of patient populations at increased risk of nutrient deficiencies. Different forms of nutritional therapy will be reviewed, and the role of the laboratory in monitoring will evaluated in the context of guidelines and specific laboratory tests. Some limitations of laboratory testing that may lead to their misuse, obsoletion or add confusion to nutritional monitoring will be highlighted.
Learning Objectives At the end of this session, participants will be able to:
1)  describe major components of nutritional assessment for patients entering the healthcare system
2)  list different ways nutrition therapy can be achieved in patients at risk of malnutrition
3)  appraise the utility of laboratory testing in monitoring medical nutritional therapy and malnutrition in general
#11 Feb. 18, 2021 1) Canadian Standards Documents on Laboratory Developed Tests (LDTs): Developing application specific standards
Speaker: Lianna Kyriakopoulou, Director, Genome Diagnostics, Hospital for Sick Children
Overview: Recognizing a gap in requirements in this area of laboratory medicine, the Canadian Standards Association (CSA) has developed a national standard for the validation of Laboratory Developed Tests (LDTs) (CSA Z316.8). After the publication of CSA Z316.8, it was identified that there is national interest in expanding the original scope of this project to providing more specific guidance documents with a focus on discipline-specific considerations. These efforts have commenced in the area of molecular diagnostics. We will discuss key aspects and special considerations for molecular diagnostics and why certain applications may benefit from additional standards.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  Discuss the current status of standards for molecular diagnostics.
2)  Understand the key elements required for validating LDTs in the molecular diagnostics laboratory
3)  Understand why molecular diagnostic tests in particular require more specific guidance.
2) Canadian national standard, CSA Z316.8- Requirements for the design, development, and validation of laboratory developed tests (LDTs) used for the screening, diagnosis, and management of clinical conditions
Speaker: Isolde Seiden Long, Clinical Biochemist, Alberta Precision Laboratories and the University of Calgary
Overview: This session will provide an overview of the Canadian national standard, CSA Z316.8- Requirements for the design, development, and validation of laboratory developed tests (LDTs) used for the screening, diagnosis, and management of clinical conditions. The CSA Group’s accredited, consensus-based standards development process was followed to develop the national standard. The standard was developed as a standard project managed by CSA staff. In order to make this document widely applicable to all areas of laboratory medicine, committee membership for standards development included representatives from Chemistry, Toxicology, Microbiology, Genetics and Anatomic Pathology. This document represents the completion of Canada’s first voluntary standard on the design, development and validation laboratory-developed tests for the screening, diagnosis, and management of clinical conditions.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  Discuss how national standards are developed in Canada.
2)  Be aware of the current status of CSA Canadian standards for developing and validating LDTs.
3)  Understand the key elements required for validating LDTs in the medical laboratory
#10 Feb. 4, 2021 Quality Assurance Tools in Clinical Mass Spectrometry
Speaker: Danijela Konforte, PhD, FCACB, Clinical Biochemist, Discipline Head Special Chemistry, LifeLabs
Overview: Many hospital and reference laboratories offer mass spectrometry (MS) testing for a wide range of clinical applications such as small molecules and protein/peptide testing. MS-based tests are considered lab-developed tests. Due to the highly complex and predominantly manual nature of MS testing, as well as its multi-dimensional data, clinical laboratories require MS-specific quality assurance (QA) system to continuously ensure accurate and timely results. This session will describe and discuss pre-analytical, analytical, and post-analytical QA tools that can be considered in clinical MS testing.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  Describe common approaches for detection of pipetting errors and sample cross-contamination prior to MS testing
2)  Choose appropriate system suitability checks, quality control, internal standard monitoring, and carryover detection approaches in MS testing
3)  Describe post-analytical tools such as automated data analysis, exception-based results review as well as approaches to monitor inter-operator variability
#9 Jan. 21, 2021 Harmonized lipid reporting across Canada: CSCC hRI Recommendations
Speakers: Khosrow Adeli, Head and Professor, Clinical Biochemistry, University of Toronto
Victoria Higgins, Clinical Chemistry Fellow, University of Toronto
Nicole White-Al Habeeb, Clinical Biochemist, LifeLabs
Overview: A CSCC Working Group on Reference Interval Harmonization (hRI) was developed in 2015 to assist with post-analytical reporting and interpretation of laboratory test results. One of the key aims is to harmonize reporting format and clinical interpretation of lipid parameters for cardiovascular risk stratification that could be used across Canada. The hRI Working Group is developing evidence-based harmonized reference interval and decision limit recommendations, and will be supporting their implementation in clinical laboratories across the country. For lipid reporting in particular, it is important to consider both decision limits for flagging, which can be used to recommend initiation of treatment or provide treatment targets, as well as interpretative comments. The Lipid Team of the hRI Working Group has developed a harmonized lipid report which reflects the recommendations of the 2016 Canadian Cardiovascular Society (CCS) Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult1 and the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III2.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  Review the current status of lipid reporting for adults and children across Canada.
2)  Assess the available lipid guidelines for cardiovascular risk stratification.
3)  Discuss a harmonized approach to lipid reporting and interpretation in clinical laboratories across Canada.
#8 Jan. 7, 2021 Approach to diagnosis of mitochondrial disorders
Speaker: Dr. Jessie Cameron, Biochemical Geneticist, Genetic Metabolic Lab, Division of Biochemistry, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children 
Overview:  Mitochondrial Disease is a group of disorders affecting energy production in 1 in 5000 Canadian children. The symptoms are so variable that the spectrum covers simple exercise intolerance, mild or severe neuromuscular disease or neurodegenerative disease (Leigh Syndrome), cardiomyopathy, liver disease, nephropathy, autistic behaviour, Sudden Infant Death Syndrome and diabetes.

Despite major advances in the understanding of these diseases in the past 30 years, less than 40% of children with suspected mitochondrial disease are given a definite genetic or biochemical cause for their problem. Therapies available usually involve dietary and nutritional intervention, coupled with administration of high doses of vitamins and cofactors.

Disease diagnosis is complicated by the fact that over 1000 nuclear genes encode mitochondrial proteins, as well as a number of crucial genes encoded by the mitochondria’s own DNA. This DNA is inherited maternally, and is present as many copies in each cell, such that manifestation of disease phenotype can actually be variable in different tissues and between affected family members. For this reason, biochemical testing of enzyme activities in key energy-requiring tissues (such as muscle) is still a vital part of the mitochondrial diagnostic odyssey.

Learning Objectives:   At the end of this session, participants will be able to:
1)  Understand that mitochondrial disease can be caused by mutations in nuclear or mitochondrial DNA
2)  Understand why clinical phenotypes are so variable in patients with mitochondrial disease: between tissues, with age, and between family members.
3)  Understand what mitochondrial enzyme testing is offered at The Hospital for Sick Children, and sample requirements.
#7 Dec. 3, 2020 Journey of a Druggie Doctor
Speaker: Bhushan Kapur, PhD, FCACB
Overview: The presentation includes highlights of some of the innovations and research I was involved in. Information presented includes the development of an alcohol dipstick, CSF acidosis in alcoholics, and, formic acid as a potential teratogen in Fetal Alcohol Spectrum Disorders. GGT biomarker used as a scale to treat alcoholics is also presented.
Learning Objectives: At the end of this session, participants will be able to:
1)  understand formic acid as a teratogen in FASD
2)  understand the role of folic acid in mitigating cyto-toxicity caused by formic acid
3)  understand the process to develop an alcohol rapid test
#6 Nov. 19, 2020 What's New in POCT
  Point-of-Care Drug Testing in a Pain Management Setting
Speaker: Sarah Delaney, PhD, Clinical Biochemist, Unity Health Toronto - St. Michael's Hospital 
Overview:  The misuse and abuse of opioids remains a serious public health issue across Canada. This session will describe the importance of urine drug testing in pain management and identify the role of point-of-care in supporting controlled substance monitoring. The advantages and challenges associated with point-of-care drug testing devices will be discussed. 
Learning Objectives:  At the end of this session, participants will be able to:
1)  Understand the importance of urine drug testing (UDT) in the context of pain management
2)  Identify the advantages and limitations associated with POC devices used for testing drugs of abuse
3)  Understand how to interpret positive/negative POC UDT results
  Lab-on-Chip System Development for Chronic Disease Diagnosis (CKD and CRD assessment)
Speaker: Francis Lin, Professor in Physics, Immunology and Biological Sciences, University of Manitoba
Overview: Timely and accurate medical assessments are important for the management of various chronic diseases. Emerging lab-on-chip technologies (LOC) offer a promising approach for chronic disease evaluation at point-of-care (POC). In this presentation, recent development of LOC-based chronic disease POC diagnosis applications will be introduced with a focus on chronic respiratory disease and chronic kidney disease. Selected examples will be discussed and future directions will be highlighted.
Learning Objectives: At the end of this session, participants will be able to:
1)  Describe examples of lab-on-chip (LoC) systems for chronic disease diagnosis
2)  Compare lab-on-chip systems with conventional methods for CKD or CRD assessment 
#5 Nov. 5, 2020 Improving quality and efficiency through high performance auto-verification
Speaker: Edward Randell, Professor of Laboratory Medicine, Memorial University
Overview: Manual review of test results by laboratory technologists represents the last opportunity for the laboratory to identify potentially erroneous test results. Auto-verification programs make use of test specific rules to select out for review test or sample characteristics requiring intervention. Building a safe and effective high-performance auto-verification system requires careful planning, and customization to local laboratory practices and patient demographics. When part of a continuous process improvement strategy, high-performance auto-verification programs reduce wasted effort and time, and improve effectiveness with each iteration. Computer assisted auto-verification processes coupled with manual review by experienced laboratorians optimize error detection capability.
Learning Objectives: At the end of this presentation, participants will be able to:
1.  Describe how the auto-verification process can be used to improve laboratory efficiency and add value.
2.  Identify which factors have the greatest impact on auto-verification efficiency and describe how they can be safely adjusted
3.  Describe how auto-verification can be used to standardize laboratory test review and troubleshooting
4.  Begin design of a customized, safe and high performance auto-verification program customized to local settings.
#4 Oct, 22, 2020 New tools for the qualitative and quantitative analysis of fentanyl and its analogues
Speaker: Jan Palaty, Clinical Biochemist, LifeLabs Medical Laboratories
Overview: Novel psychoactive substances (NPS) present a challenge for both point of care (POC) health care providers and the clinical laboratory. We will show the potential of mass spectrometry (MS) as a POC tool to provide quantitative information to patients on the contents of their street drugs. This targeted analysis can be informed by urine drug screening for hypothesized NPS in a larger population by searching for predicted metabolites and MS fragment ions. This strategy was used by a routine clinical lab to identify the novel analogues cyclopropyl-fentanyl in urine samples from substance use disorder clinics.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  understand the principle of paper spray MS
2)  understand how precursor ion scanning can be used to search for NPS
3)  recognize pejorative terms such as "drugs of abuse" and "addict"
Evaluation of the N-latex serum free light chain assay on the Siemens BNII analyzer
Speaker: Ivan M. Blasutig, Clinical Biochemist and Lab Director, CHEO - EORLA
Overview: The accurate quantification of immunoglobulin free light chains (FLC) in the serum is an important test in the management of plasma cell dyscrasias. The first assay introduced to detect serum FLCs was the Freelite assay introduced in 2001 and in 2011 N-latex FLC were introduced. This presentation will review our study published in Clinical Biochemistry in 2018 (Vol.51 p90-96) where we evaluate the performance of the N-Latex assay and assess agreement with the FreeLite assay. Effects of dilution and susceptibility to antigen excess will be emphasized.
Learning Objectives: At the end of this presentation, participants will be able to:
1)  better understand some of the inherent limitations of Free Light Chain measurement
2)  know the performance of the Siemens N-latex FLC assays on the BNII nephlelometer observed in our study
3)  have a better understanding of the challenges faced if switching Free Light Chain assays.
#3 Oct. 8, 2020 CSAN PRONTO a new era in mental health
Speaker: Mathieu Provencal, Clinical Biochemist, POCT supervisor, Maisonneuve-Rosemont Hospital, OPTILAB Montreal-CHUM 
Overview: Treatment-resistant Schizophrenia (TRS) is known to affects almost 30% of patients with a diagnosis of schizophrenia. Despite its unique efficacy in TRS, Clozapine is underprescribed in most countries, and that’s specifically true in Canada. One important reason for this includes a real fear of side effects. Another reason is that clozapine treatment comes with an inconvenient necessity of therapeutic blood monitoring (TDM). This explain that many who could benefit from clozapine actually do not. CSAN-PRONTO is a new and innovative POCT device enabling adequate TDM for patient initiating Clozapine treatment. 
Learning Objectives:  At the end of this session, participants will be able to:
1)  understand the context and issues around schizophrenia treatments
2)  discover the new POCT CSAN-PRONTO device
3)  learn about the ongoing pilot projects conducted in Montreal 
 #2 Sept. 24, 2020 Quality Improvements from Canadian Laboratories 
Speaker: Zahraa Mohammed-Ali, University of Toronto
Overview: This presentation is aimed at exploring the impact of reformulating a family medicine laboratory requisition as a quality improvement (QI) intervention to prevent unnecessary laboratory testing. First, we will introduce appropriate versus inappropriate laboratory testing, while highlighting solutions to improve laboratory testing. Then we will explain the PLAN-DO-STUDY-ACT (PDSA) strategy for QI projects using the reformulation of the family medicine laboratory requisition as an example. We will discuss the outcome, process and balancing measures employed as part of the study phase of the PDSA cycle to assess the effectiveness of our QI strategy. We will conclude by examining further steps and emphasizing the overall result and cost savings of our QI initiative.
Learning Objectives: At the end of this session, participants will be able to:
1) Review the importance of appropriate laboratory testing.
2) Understand the Plan-Do-Study-Act cycle in the context of reformulating a family medicine laboratory requisition to prevent unnecessary testing.
  Screening for Open Neural Tube Defects: Aligning with the Society of Obstetricians and Gynaecologists of Canada (SOGC) Guidelines
Speaker: Miranda Brun, Clinical Biochemist, Alberta Precision Laboratories, Edmonton 
Overview: The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends second trimester anatomical ultrasound for the detection of open neural tube defects. Screening by ultrasound should replace second trimester serum alpha fetoprotein screening for open neural tube defects except in settings when ultrasound examination is difficult. To adhere with these guidelines in Alberta, the second trimester screening team undertook a utilization project. A phased approach was implemented. First, the requisition was updated to list the specific indications for second trimester serum alpha fetoprotein screening with checkboxes. These indications are: i) no access to second trimester ultrasound, ii) pre-pregnancy BMI greater or equal to 35 kg/m2 , and iii) suspected neural tube defect by ultrasound. Following education and communication, directed feedback was utilized. For a period of two months, requisitions with no indication specified were accepted, and an informational bulletin regarding the indications for screening faxed to the ordering physician. At the end of this two months, requisitions with no indications were cancelled. This combined intervention resulted in a decrease of second trimester serum alpha fetoprotein screens from an average of 267/month in the six months prior to the change to <2/month after. Second trimester serum alpha fetoprotein screening for open neural tube defect remains available when clinically indicated. 
Learning Objectives: At the end of this session, participants will be able to:
1) Identify prenatal screening methods for open neural tube defects in pregnancy
2) Distinguish the screening method for open neural tube defects in pregnancy recommended by the Society of Obstetricians and Gynaecologists of Canada
3) Discuss potential tools to support implementation of guideline recommendations in screening programs