Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play

Background: Phlebotomy is a medical procedure that is performed frequently in the blood collection activities of medical institutions. The procedure involves close interaction with different types of patients—some of whom are cooperative and others, who, for many reasons, are not (for example, patients who have a fear of needles). Blood extraction is an essential skill in several medical specialties, such as in laboratory sciences. Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy. In this paper, I propose a lesson plan for teaching communication skills to medical laboratory sciences and nursing students based on Gagne’s instructional design. Methods: The training session included two main parts: training session using Gange’s instructional design and at the end of the session, the participants were surveyed for the effectiveness of the training session. Results: 17 participants were included in the study. Overall, the majority of the participants were highly satisfied with the effectiveness of the training session in teaching communication skills with all seven survey questions receiving a mean score of 4.58 on a Likert scale of 1-5. Conclusion: We demonstrated the effectiveness of Gange’s instructional beyond theoretical lesson planning to teach communication skills through role-play in phlebotomy education.

Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.

Early signatures of breast cancer up to seven years prior to clinical diagnosis in plasma cell-free DNA methylomes

Limited studies to date have investigated the detectability of cell-free DNA (cfDNA) markers in asymptomatic individuals prior to a cancer diagnosis. Here, we performed cfDNA methylation profiling in blood of individuals up to seven years prior to a breast cancer diagnosis in addition to matched cancer-free controls (n=150). We identified cfDNA differentially methylated signatures that discriminated cancer-free controls from pre-diagnosis breast cancer cases over five years prior to diagnosis and demonstrate that these markers were reflective of methylation profiles in breast cancer tissue. We report classification of a range of pre-diagnosis breast cancer cases detected at Stage I (area under the receiver operating characteristic curve (AUC) of 0.771), and in cases with a negative mammogram screening within a year of blood collection (AUC of 0.852). This study provides evidence that cfDNA methylation markers indicative of breast cancers can be detected in blood among asymptomatic individuals prior to clinical detection.

Sensitive Quantification of Cell-Free Tumor DNA for Early Detection of Recurrence in Colorectal Cancer

The detection of plasma cell–free tumor DNA (ctDNA) is prognostic in colorectal cancer (CRC) and has potential for early prediction of disease recurrence. In clinical routine, ctDNA-based diagnostics are limited by the low concentration of ctDNA and error rates of standard next-generation sequencing (NGS) approaches. We evaluated the potential to increase the stability and yield of plasma cell–free DNA (cfDNA) for routine diagnostic purposes using different blood collection tubes and various manual or automated cfDNA extraction protocols. Sensitivity for low-level ctDNA was measured in KRAS-mutant cfDNA using an error-reduced NGS procedure. To test the applicability of rapid evaluation of ctDNA persistence in clinical routine, we prospectively analyzed postoperative samples of 67 CRC (stage II) patients. ctDNA detection was linear between 0.0045 and 45%, with high sensitivity (94%) and specificity (100%) for mutations at 0.1% VAF. The stability and yield of cfDNA were superior when using Streck BCT tubes and a protocol by Zymo Research. Sensitivity for ctDNA increased 1.5-fold by the integration of variant reads from triplicate PCRs and with PCR template concentration. In clinical samples, ctDNA persistence was found in ∼9% of samples, drawn 2 weeks after surgery. Moreover, in a retrospective analysis of 14 CRC patients with relapse during adjuvant therapy, we successfully detected ctDNA (median 0.38% VAF; range 0.18–5.04% VAF) in 92.85% of patients significantly prior (median 112 days) to imaging-based surveillance. Using optimized pre-analytical conditions, the detection of postoperative ctDNA is feasible with excellent sensitivity and allows the prediction of CRC recurrence in routine oncology testing.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

ABSTRACT Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Evaluating the Importance of Patient Blood Management During COVID-19 Pandemic

: Due to the COVID-19 pandemic, the demand for blood products may decrease as the health care system shifts toward treating the increased number of patients afflicted with COVID-19 and delaying selective surgeries and emergency procedures. One of the most important problems for blood transfusion services during COVID-19 pandemic is the reduction in the number of donors and a decrease in blood stocks. This happens due to the limitations of attendance of donors in blood centers, lack of awareness, misinformation, fear of being infected while donating blood, and restricting the freedom of blood collection teams to attend public places. Blood transfusion services should be prepared and well-responded in a timely manner. In this regard, appropriate use of blood, diminishing unnecessary transfusions, and implementation of patient blood management (PBM) principles are considered as significant measurements. PBM can help maintain blood supply throughout the crisis and reduce the pressure on blood demand. As a result, blood products can be saved for patients who need it urgently. PBM focuses on the patient, as well as the conditions that make patients transfuse blood, such as blood loss, coagulopathy, platelet dysfunction, and anemia. Thus, the majority of health systems in different countries have made recommendations to the PBM in hospitals.

A sample-to-answer electrochemical biosensor system for biomarker detection

We interfaced with a painless blood collection device and integrated on-chip blood-to-plasma separation with an electronic bead-based biomarker detection assay to enable true sample-to-answer detection of biomarkers.

Clinical use of Anti-Müllerian Hormone to Monitor Resumption of Ovarian Activity following Removal of a 4.7 mg Deslorelin Implant in Queens.

Objective: The use of deslorelin implantsto control reproduction in cats is increasing but because of its prolonged duration, cat breeders oftenrequest implant removal before the end of the treatment. Assaying Anti Mullerian Hormone (AMH) concentrations might be useful to predict time of resumption of ovarian activity in deslorelin-treated queens following implant removal. In queens a minimum of 3 weeks during increasing photoperiod after implant removal has been described for resumption of ovarian activity but no information about AMH concentrations were observed for determining ovarian activity.Animals: Sixteen queens in whichdeslorelinimplants were surgically removed after3, 6 or 9 months (n= 6, 4 and 6 queens, respectively) were used in this study. Procedures: A general and reproductive health check with a GnRH stimulation test were performed before the treatment.After implant removal queens were checked every 1-2 weeks withreproductive ultrasonography, a vaginal smear and blood collection to assay AMHconcentrations. Results: AMH concentrations decreased significantly during treatment to < 2.5+0.6 ng/ml (p<0.05) and reached a nadir at 1.9+0.9 (p<0.05) one-week post-removal.Following implant removal AMH concentrations started to rise reaching a value of 4.3+1.2 ng/ml on the third week and were not different from pre-treatment levels on week 6 post-removal (5.8 ng/ml +0.9, p>0.05).AMH values did not differ depending on duration of deslorelin treatment but were lower in adult queens (p<0.05).Clinical relevance: AMH assay can be a useful tool to follow resumption of feline ovarian function following a deslorelin treatment.