Lab Medicine Rounds

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 headed? What are your thoughts on that? 23:35 Outro

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 in relation to supply chain management?24:42 Outro

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 see a convergence towards one over the other? Or, is there a reason to continue keeping these assays up because it really needs to be a battery in order to be accurate?11:35 Outro

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 journey so far?

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 staff either in an academic or nonacademic setting. Is there a way that you prepare trainees to develop their skills in delegating?17:05 Sometimes things take you by surprise, which is a great learning opportunity. You have really navigated the system quiet well. I’m curious, what has been easy about this process and what has really been a challenge?19:55 If you could do it all over again, what would you do differently this time?25:22 Getting feedback and developing relationship the way you can be, is that a lost opportunity?

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 differentiated does the education get?

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 having a strong collaboration during the COVID pandemic21:44 OutroResources:WHO IPE framework: https://www.who.int/hrh/resources/framework_action/en/ University of Toronto Center for IPE: https://ipe.utoronto.ca/ D’Amour, D. & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care , 19 (Suppl 1): 8-20.

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 like you guys really are the both the first and last line of defense on making sure that the information that is coming out of the laboratory is as accurate as possible?05:25 You know that front end is really something to highlight for our listeners about, we all got used to ordering tests based on how we were trained and what was available at the time we are training, and as with all things, medical science continues to advance. I think that’s a critical point to make. That Medical Technologist is really up to date on what is an older test, or what test is best to answer that question the physician has?06:46 If you could elaborate a little bit for students who are just starting to consider this field and maybe even, are there some thoughts for some people who are just starting in laboratory medicine about what the best path might be for them?8:05 So you’re saying that if I’m somebody that likes variety in my day, there’s a place for me in laboratory medical science, and if I like being an expert in something, there’s ALSO a place for me in laboratory medical science?08:35 You’ve had a really interesting and valuable career and you’ve kind of seen this profession from a couple of different angles. I was wondering if you have any words of wisdom for someone who is maybe just getting started in laboratory medical science in those first 3-5 years of practice? Do you have any advice for them as to what should they be focusing on and thinking about from a coaching perspective?13:43 Are there any plans for sharing laboratory pride this year (for Lab Week)?14:29 Do you have any kind of messages for how pathologists can work best with their laboratory technologists?16:38 Can you share how you found this field of laboratory science?21:26 What qualities make for a good lab tech?25:00 Outro Resources:Career Exploration: https://ascls.org/

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 far?14:37 Can you take us through what are some lessons learned or unexpected challenges for our laboratory professionals that are listening?18:19 I was wondering if we could reflect with our audience on some lessons learned for our learners to take away from this experience?22:33 OutroResources · https://www.cdc.gov/coronavirus/2019-ncov/index.html· https://coronavirus.jhu.edu/map.html

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 therapy lab has many connections with the clinical practice, a lot of co-dependence there when we're talking about transplant and cell therapy. What's that communication been like with the clinical practice? 18:03 I think there's lots of gems that you've laid out there for our listeners and really kind of a big part of this is keeping a humble, this inter-professional collaboration, whether it's working with your supervisors for staffing, communicating with clinical colleagues for what they are expecting as far as volumes and maintaining those lines of communication for how things are going to change. With that, is there anything that you want to add that we haven't touched about? 18:57 Outro

Time Stamps00:00 Podcast Intro 02:20 For those of us that aren’t in the education technology movement can you give us a little bit of that 50,000 foot view and orientate us, and where we should think about starting?03:15 Quick tips to consider as a starting place for Virtual Learning: 1.) Presence 2.) Communication 3.) Authenticity05:25 Synchronous vs. asynchronous environments07:21 What are some ways we can make this virtual environment work for effectiveness?09:48 Do you have some tips as far as, are there two or three things that come to the forefront of your mind? I think many people haven’t thought about wait time or down time in a virtual domain. Can you give an example or two of where someone might get off the ground trying this?12:16 What are your thoughts about how we can facilitate, encourage, and coach that engagement in our learners in a virtual environment?12:52 What is netiquette? 13:47 How does the netiquette feed into this engagement of learners?16:30 Free collaborative tools available: Google Forms, Google Docs and MindMeister17:58 Transitioning more to the learner mind and learner perspective, are there any recommendations for someone who hasn’t learned this way historically in the past, to give this virtual learning its best opportunity?21:04 How could educators monitor this environment to get that valuable feedback?24:35 A lot of things are changing when we are using a virtual environment. What things are not changing?27:28 Outro Additional Resources:Mayo Clinic:· https://mayocliniceducatorscentral.blubrry.net/2020/03/17/virtual-class-now-how-to-move-your-education-online-in-a-hurry-ep14/ Twitter:· @erhall1· @MayoFacDev· #HMICommunity MedEd/HPE: · https://www.aliem.com/teaching-age-covid-19-wrap-up/· Flipped Classroom in Medical Education: Engaging Students to Build Competency https://journals.sagepub.com/doi/full/10.4137/JMECD.S23895 Higher Education Resources:· Association of Colleges and University Educators: https://acue.org/online-teaching-toolkit/· Chronicle in Higher Education: Going Online in a Hurry· Recent Learning Scientist.org Blog · https://teachremotely.harvard.edu/· https://ai.umich.edu/keep-teaching/ 1. Learning to Teach Online: Understanding & Optimizing an Online Learning Experience by Elizabeth Syben King (@elizabethonline) for Medium.2. Welcome to ACUE's Online Teaching Toolkit by Association of College and University Educators (@ACUE_HQ)3. Uploading lecture videos on YouTube by Dr Megan Sumeracki (@DrSumeracki)4. Going Online in a Hurry: What to Do and Where to Start by Michelle D. Miller for the Chronicle VitaeAdditional Episode Notes:Virtual/Remote Learning – 50,000 Ft View Start simple when thinking shifting to virtual – even if you have to move fast (identity dissonance) Facilitator presence is key in virtual environments 1. Connect: How do connect with learners? · Synchronously - Shift to a video conferencing platform (Zoom, Blackboard Collaborate, other)· Asynchronously – Traditional and non-traditional learning management systems, email, Slack· Be available and accessible: Virtual Office Hours, 2. Communicate: What do my learners need to know? · Reduce cognitive load by sharing expectations of learners/ participants – help them understand how to interact in this new context (netiquette – virtual etiquette) · Audio: · Video: · Be Transparent – concise communication key and narrating the flow of the experience (be deliberate)· Include wait time – not only processing by muting and unmuting technology 3. Be Authentic: How can I maintain my personal touch? · Address people by name· Make eye contact · Encourage, acknowledge, and reinforce contributions · Reinforce what supporting each other looks like· Demonstrate appreciation and gratitude · Have fun – add humor · Give people grace – we are all in this together One you have done these three things we are ready to start thinking about: Delivery: Now, what do I do once I am connected to my learners? Engagement Strategies and Tactics –Learners contribute to Community I want to frame this question on the premise that learning is social by nature and science of learning principles. In other words: · How are we maximizing techniques in which people learn by engaging with others - active learning techniques to organize new learning and link to previous knowledge - exposure to how others think, think critically· How do we engage learners in retrieval of information, elaboration of ideas, and using specific examples to understand abstract ideas· How do we plan for learners to thinking about their thinking - metacognition It is common to think about content first which is important in order to scaffolding learning. Establishing what direction instruction is necessary – · Essentially how it can be used to a focal point for design...

Time Stamps00:00 Podcast Intro 01:00 What exactly do you mean when you say, diversity in blood supply, and why does that matter?02:15 Are you saying that there might be differences in blood among different ethnic groups? 02:50 If we only issued O- blood to everyone, would we still need diversity in blood supply?04:25 You mentioned a hemolytic reaction, so if I have a friend or family member going in for a surgery, do I need to call up the blood bank and talking to them and demanding something? Or what should I be looking for to make sure they won’t have one of those reactions?07:51 Some of the patients that are going to be receiving multiple blood products throughout their lifetime, might be the people that matching is more important for? What types of characteristics do these patients have? 11:11 What happens if one of the patients that needs a special unit of blood comes in from a bad car accidents and we don’t have that blood on the shelf? 14:00 Is there some sort of barrier that needs to be overcome to help encourage more donations from diverse communities? 16:28 Red blood cells seem pretty simple, shouldn’t you be able to manufacture a red blood cell and then the diversity in blood supply wouldn’t be a problem because you can put whatever antigens on them that you wanted, couldn’t you?20:14 Are there other areas in regards to the diversity of blood supply that will be important to keep in the forefront for the near future?22:40 Are there any specific key takeaways you want people to take away from this topic?25:25 Outro

Time Stamps00:00 Podcast Intro 01:08 Introduction of Stacey Rizza, M.D.01:50 What is the natural course of HIV if left untreated, and what effects would it have on the body? 03:41 So given those numbers then, who should be tested for HIV?04:32 How should HIV be treated?05:29 Do people living with HIV then when they are on therapy need any additional, special kind of care?06:44 So if someone who’s living with HIV is actually receiving the treatment and doing everything they should be doing, will the disease naturally shorten their life?07:28 Now given that we’re talking about sexually transmitted diseases, is it safe for a person with HIV to have unprotected sex?09:57 Given those conversations, is that usually how it goes when people ask how HIV can be prevented, or is there more to it?11:59 Another thing that’s coming out every month or so we hear about the new technological advances towards a cure for HIV, so how are we doing on that? Is HIV curable? 13:35 So one of the things that comes up fairly frequently every few years is the Delta 32 mutation, which is a mutation that it’s my understanding intrinsically confers some level of resistance against HIV infection?15:50 HIV is a very large global burden and as a result there has been a lot of outreach around the world from many different organizations. Here in American in 2003, President George W. Bush signed PEPFAR, The President's Emergency Plan For AIDS Relief. What are your thoughts on how well it’s been doing?17:48 To shift gears here, we’re going to shift from viruses to bacteria. One in particular with a tumultuous history is syphilis. What is syphilis and what effects does it have on the body?21:08 So that being said, with it having an asymptomatic period where it doesn’t look like you have it at all, who should be tested for syphilis? 21:57 How is syphilis treated?22:36 So if someone is treated for syphilis, can it reoccur? 23:30 What about prevention? Can syphilitic infection be prevented?24:14 According to the CDC congenital syphilis cases has risen consecutively over the last five years, is there anything we should be doing for increased surveillance?25:42 What does congenital syphilis look like?26:23 Is there a vaccine for syphilis?27:39 Outro

Time Stamps00:00 Podcast Intro 00:31 Introduction of Matt Binnicker, Ph.D.01:07 Can you talk about why it’s so important for people to discuss chlamydia and gonorrhea and why healthcare providers and the general public today need to have a good understanding of the causes of these STDs? 02:32 So we just spoke to Dr. Rizza about how over the last five years, STDs have risen each year consecutively. Is there any reason why we have an increased incidence over this timeline with these infections?03:31 How are these diagnosed in the laboratory? How do we actually figure out if you have this or not?04:22 Those diagnostic processes, do you think those are going to change at all in the future or evolve, or do you think what we have is good?06:28 So why is important then to have accurate and rapid laboratory test results for chlamydia and gonorrhea? 07:17 So with regards to the disease itself, if a patient becomes infected how are they managed?08:50 With drug resistant gonorrhea being in the news so often, the next real concern is how worried should we be about it?09:58 What should be the big takeaway the audience should get from talking about gonorrhea and chlamydia?11:45 Outro

Time Stamps00:00 Podcast Intro 01:25 What is proficiency testing?04:10 Proficiency testing insures my lab is actually getting the accurate results? 05:26 What is proficiency testing referral and why is it important for laboratory medical directors, administrators, supervisors and staff to be aware of PT referral rules? 07:54 Why would laboratories refer proficiency testing to another external lab?12:05 What’s happening at working to reduce this risk for me? Taking Essential Steps for Testing (TEST) Act of 201215:23 These are “near-miss” events and definitely something to learn from, discussing how the holes lined up, what occurred, and now here’s your opportunity to patch that hole?17:04 What new trends in laboratory medicine have increased the risk of sanctions for proficiency testing referral?19:55 What are the most effective strategies to prevent proficiency testing referral?22:26 Are there good resources for this education? Or is every lab on their own to create content?23:17 In your experience, being on committees and doing inspections at hospitals, what has surprised you most about this issue of PT and referral?26:17 How do you approach training pathology residents and fellows in understanding proficiency testing, what they are responsible for, how do they trouble shoot a proficiency failure? I imagine it’s difficult to introduce that topic.28:10 Outro Additional Resources:CMS Brochure on PT Referrals @ cms.gov

Time Stamps00:00 Podcast Intro00:41 What do we know so far about the novel coronavirus? 02:35 How does this novel coronavirus stack up to influenza?04:35 Is there still value in getting your flu shot now (this year) if you haven’t gotten it yet?05:08 Where should people go to get the latest and best information related to the novel coronavirus?06:36 What should the health care provider be looking for related to the novel coronavirus?08:18 I’m glad you mentioned the incubation period, is that something we know with this novel coronavirus? 09:15 What do the laboratorians need to have in mind and what does this mean for the hospital clinical labs?10:50 So, people can test positive for the coronavirus without having this specific novel coronavirus strain? 12:02 So if somebody sent a sample down to a clinical lab, and I was truly positive for the novel coronavirus, I could have a negative result?12:45 Can you elaborate on when a physician should pick up the phone relative to the new novel coronavirus outbreak?14:43 Is there a risk to laboratory personnel for the infection to spread when they are handling the samples?15:20 When should we be suspecting this novel coronavirus?16:03 What should someone do if they suspect their patient has novel coronavirus?16:33 As this is an evolving outbreak, where should folks go for the latest information?Additional Resources:· Center for Disease Control (CDC)· World Health Organization (WHO)

Time Stamps00:00 Podcast Intro00:42 When is a genetic test useful?02:15 What situations would genetic testing not be helpful for?03:15 Since pharmacogenomic testing isn’t useful for every drug, how do we know when it is useful? 05:15 I’ve seen commercials for genetic testing. Can you talk about these? 05:55 So, you’re saying that a private citizen could get some genetic testing performed? 06:32 I imagine you have gotten a couple of phone calls from people asking what do to with their results? Do people sometimes call you about this?07:44 Can you talk about the differences between what you are going to do in your lab when you’re doing pharmacogenomic testing and what might be available to a patient as a direct-to-consumer?09:32 That makes me curious, does that mean that some of these direct-to-consumer tests are including alleles that are only for the white population? Or, are they including ones that are relevant to Latino, African-American, Asian communities too?11:00 Is there genetic testing that can talk about what type of diet I should follow and what type of exercise I should be doing? 12:45 Will everyone have their genomes sequences in a few years? 15:18 Can you explain what you mean when you say the test is getting better overtime?18:00 What is the role of the laboratory in performing a genetic test?22:58 OutroAdditional Resources:· CPIC webpage http://cpicgx.org to see guidelines for pharmacogenomics· Genetic Testing Registry https://www.ncvi.nlm.nih.gov/gtr/

Time Stamps00:00 Podcast Intro01:00 How is influenza different from other respiratory infections, such as the common cold?02:02 Why is influenza such a big deal? Many people think about influenza for different reasons, but how can we hit this home for the everyday person?04:43 Can we unpack the idea of getting vaccinations, specifically getting vaccinations every year?06:36 Can you address some of the common misperceptions when it comes to getting the flu vaccine? 11:02 Who should see their doctor when they exhibit flu-like symptoms?12:36 How is the influenza test changing?14:45 The idea of point-of-care testing that bridges the patient/clinical practice and the laboratory supporting that practice caring for that patient. Can you discuss what some of the logistics and challenges are that come in to point-of-care testing?16:02 What does it mean in regards to treatment of influenza with having a more sensitive test that is rapidly available? 17:55 How are we spreading this knowledge to all of our physicians so they can understand how to make the decision of who needs be treated and why?19:23 Are there any questions or feedback that either of you have gotten from other physicians or nurses on this topic that surprised you?21:25 Is there a future state on the horizon where you think we may not need to be getting the influenza shot every year?23:57 This podcast is really centered on building bridges between the clinical world and the lab world. Would you mind sharing a story that highlights where this collaboration has really helped the patient? 26:47 I’m curious, for the trainees in your program, how are they trained/mentored on crossing the boundaries between the clinical and laboratory?28:59 Is there anything you would like to add that we haven’t talked about so far?Additional resources:https://www.cdc.gov/flu/index.htm

Time Stamps00:00 Podcast Intro00:30 Introduction of Robin Patel, M.D. the Division Chair of Clinical Microbiology at Mayo Clinic 00:42 What is the 16S Ribosomal RNA gene?1:28 How is it detected and sequenced in clinical microbiology?2:33 What does this mean for physicians and their patients now that this is something that can be done in the microbiology lab?4:23 How has the testing for this gene changed?5:58 Can you take us through an interesting case you have come across?9:47 What are the limitations when you’re talking about this kind of testing?11:15 Where is this headed? Are we headed towards next-gen sequencing for 16S?11:51 So, that will be helpful when you’re talking about using it directly on a patient sample vs. a pure colony that you’re using the testing on?12:29 What’s the turnaround time for this kind of test? 14:08 Where does this 16S Ribosomal RNA gene testing fit in the toolbox of who should be ordering this?15:21 What is it that you wish the medical community knew about the microbiology lab?16:34 OutroResources:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652441/ https://jcm.asm.org/content/55/9/2599

Time Stamps00:00 Podcast Intro00:58 What is clinical decision support? How does that fit in to patient blood management?02:37 Can you tell us how clinical decision support is similar to education and how it is a little different than straight forward education?04:53 How do you make clinical decision support successful? 07:11 Can you share how the collaboration between you and IT has gone? How have you navigated to make sure you can come out with the best and most meaningful clinical support?10:14 What are some of the pitfalls from implementing clinical decision support? 13:55 Will you share your thoughts on evaluating a clinical decision support program?16:33 It sounds like there is a lot of quantitative measurements, how about qualitative measurements?17:45 What has surprised you most about patient blood management? 19:39 What does the future look like regarding clinical decision support?21:33 As a bedside physician, what do you wish the laboratory understood about your practice?25:01 Can you share a personal story on how reaching out to the lab has made a difference for one of your patients?

Time Stamps00:00 Podcast Intro00:37 Introduction of Joaquin Garcia, Vice Chair of Laboratories in the Division of Anatomic Pathology and Medical Director of the Histology Laboratory at Mayo Clinic.00:57 Can you give us a little background as to how you came in to this world of anatomic pathology and also where did this interest of salivary gland tumors come from?02:09 What are the things that come to your attention when people are asking about salivary gland tumors?03:13 When you talk about getting a small biopsy, are we talking about getting a punch biopsy for skin or are we talking about a fine needle aspirate where your just getting cytology? 04:11 Can you get in to a little bit on where this challenge comes from, whether something is benign, malignant, kind of predicting that behavior?05:46 How do you train up pathologists to make these calls and recognize malignant from benign?07:04 Can you elaborate on some of the additional testing you’re talking about (immunohistochemical staining and liquid kind of samples)?08:48 So, in a more targeted way you are able to make a diagnosis. Is that also true for how we are treating these cancers? Are we able to do targeted therapy based on the pathology that we are getting?09:54 You’ve just recently completed a book “The Atlas of Salivary Gland Pathology.” What surprised you most about what it took to put together this atlas?10:35 Is it true that head and neck pathology is the most challenging sub-specialty within all of anatomic pathology?11:02 What sort of things should be features that are concerning, so that when you hear this in the history you really want to do a thorough exam of the patients mouth, face, and neck features? 13:35 OutroResources: Atlas of Salivary Gland Pathology, 2019, Springer Publishing (JJ Garcia)

Time Stamps00:00 Podcast Intro00:34 Introduction of William Morice, II, M.D., Ph.D., the Chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic 00:48 When did you first become interested in leadership?2:15 What surprised you most once you took on a leadership role?5:32 What advice do you have for the learners (residents, fellows) who may be interested in leadership? What should they be focusing on during training and during their early career?8:01 What do you think would be your message to clinicians? What do you wish they knew about the laboratory that would really strengthen the relationship at their center?10:21 How do you approach setting a team up for success?14:41 Opposing Dynamic: People getting the work done for the business vs. people that are the innovators. Do you see yourself as trying to model how to have a respectful disagreement?16:59 At this point in your career, what’s the real challenge for you?20:28 Do you have a practice of reflection or what’s your practice for self-reflection and discovery?22:39 Do you have any book recommendations for our listeners who are interested in developing their leadership skills?26:23 Outro

Time Stamps00:00 Podcast Intro00:39 Introduction of Bobbi Pritt, M.D. 00:56 What are ticks?1:42 What diseases can be transmitted by ticks?2:03 Background on ticks2:46 What should we be suspicious of for the diseases ticks carry? (Location)4:03 When should I be really concerned about tick borne disease? (Timing)4:56 Laboratory Testing 6:15 Links to Resources (Algorithm & CDC website): https://www.mayocliniclabs.com/it-mmfiles/Acute_Tick-Borne_Disease_Testing_Algorithm.pdfhttps://www.cdc.gov/ticks/index.html6:44 When should I not test?8:30 How can we protect ourselves from these tick borne diseases?9:23 ABC’s of Tick Bite Prevention: https://news.mayocliniclabs.com/ticks 11:03 Key Takeaways 12:10 Outro

Time Stamps00:00 Podcast Intro00:32 Introduction of Ann Moyer, M.D., Ph.D. 00:49 How did you decide to go into Molecular Genetic Pathology?2:33 What do you do all day (as a pathologist)?4:25 Can you take one test and talk us through how you look at a case?7:32 What’s your favorite part about being a pathologist?8:28 What’s the worst aspect?9:18 Is it true that a lot of the tests that are run in your lab didn’t exist five years ago?10:20 What have you learned on the job that you weren’t exposed to in your training?11:36 How can clinicians build that bridge of collaboration with their pathologist?13:11 What would you tell medical students as to why they should consider pathology?14:39 What are the top five things that medical professionals should know about laboratory medicine?17:39 Outro

Time Stamps00:00 Podcast Intro00:48 Introduction of Elitza Theel, Ph.D. 1:03 What is the deadliest creature in the world?2:30 How many types of mosquitoes are there?3:50 Why do mosquitoes bite us?4:54 What types of infections do they cause?6:33 What advice do you give students and learners regarding this topic? 7:37 How does somebody make the diagnosis?7:54 How can you use lab testing to keep on the right track?10:49 What are some of the frequent calls received as a Laboratory Director?13:26 Are these mosquito borne diseases treatable?13:53 Where do you figure out the species?14:59 What about treatment for mosquito borne viruses?15:17 What about vaccines for mosquito born viruses?16:27 What do you see as the future trends in the world of mosquito borne disease?18:13 What are your recommendations for protecting against mosquitoes? 19:33 Fun fact on how spreading infections may occur 21:31 OutroAdditional Resources:https://www.cdc.gov/ncezid/dvbd/index.html

Coming Soon: Lab Medicine Rounds, a podcast to help you connect lab medicine and the clinical practice through insightful conversations.