Christmas decorations next to palm trees are a fun treat for your Philadelphia-based reporter at the Gaylord Palms Convention Center in Kissimmee, FL, where opening remarks for the 15th Annual Meeting of the Association for Molecular Pathology just wrapped up.

Tim O'Leary, MD, PhD, chair of the Program Committee, welcomed attendees to the meeting before AMP President Dr. Jan Nowak awarded the AMP Award for Excellence in Molecular Diagnostics to Kay Davies, PhD, for her work in Duchenne Muscular Dystrophy.

Dr. Davies discussed her work in assessing the gene responsible for the disease, called the DMD gene, and potential therapy for individuals with Duchenne Muscular Dystrophy. The DMD gene is the largest gene in the human genome; the size of the gene presents challenges for treatment. But, Dr. Davies stresses, "There is real cause for optimism."

Clinical trials are ongoing for dystrophin therapy, as well as for utrophin therapy to replace dystrophin.  Utrophin has shown promise, but therapy must start very early on, leading Dr. Davies to issue a challenge to the diagnostic community to improve screening methods for earlier diagnosis.

"There is real treatment possibility on the horizon," Dr. Davies concluded. "I can't give you a time frame, because these things always take some time to come to fruition, but the possibilities are there."

The recent meeting of the Infectious Diseases Society of America featured a study from the Henry Ford Health System in Detroit assessing a new strain of methicillin-resistant Staphylococcus aureus (MRSA). The strain, called USA600, is associated with poorer outcomes than other strains of MRSA and is associated with vancomycin resistance—the drug primarily used to treat MRSA.

According to the study, the strain typically appears in older, sicker patients with comorbidities and frequently occurs in nursing homes. Mortality in patients with USA600 was 50% in the study, although overall incidence was low and didn’t seem to grow over the past three years.

While this particular strain, in the scheme of all things MRSA, might not be of great concern now, remember that other strains of MRSA were once primarily a healthcare-associated infection, but community-acquired MRSA is now common.

This week, the FDA issued another emergency use authorization (EUA), this time allowing Focus Diagnostics to market and offer its Simplexa™ Influenza A H1N1 (2009) test for use on the 3M™ Integrated Cycler from 3M to CLIA high-complexity laboratories for the duration of the recently-declared national emergency.

For new viruses and in rapidly developing situations, EUAs may be necessary to give laboratorians the tools to monitor and identify infections, but there are concerns that safety and quality are compromised in such situations.

Greg Tsongalis, PhD, an ADVANCE editorial advisory board member and director of molecular pathology at Dartmouth Medical School at the Dartmouth Hitchcock Medical Center, voices these concerns: "With more laboratories becoming involved in molecular testing to some extent, it is clear that something different needs to be done with respect to oversight. Despite this however, the FDA has created an interesting situation for laboratories this flu season by allowing assays to be performed under the EUA label. Without any guidelines for validation requirements under this new label, have we taken a step backwards in allowing any laboratory to perform an assay, which itself has not been well characterized, under the auspices of an EUA? Given the status of most laboratories becoming involved in molecular testing, it seems that this approach would only add to the 'E.'"

What do you think? Are EUAs a necessary measure to give labs the tools they need to stay on top of new developments, or do they only exacerbate the problem?

CAP’s annual meeting is off like a shot at the Gaylord National Resort, and the College named Kevin B. Dole, MD, FCAP, as the 2009 Pathologist of the Year during a ceremony Sunday night.

Dr. Dole is medical director at Caritas Medical Laboratories, and director of Pathology and Laboratory at Carney Hospital, both in Boston. He is also the laboratory director at Dedham Medical Associates in Dedham, MA, an associate clinical professor of Pathology at Tufts University School of Medicine, Boston, and laboratory inspector for CAP. He received the award in recognition for his strong leadership of the CAP Council on Membership and Professional Development over the years in addition to his “significant contributions” to CAP spanning more than two decades.

CAP also bestowed the following honors on these individuals, leading up to and during the annual meeting:

• Laboratory Improvement Program Service Award: Alfred E. Hartmann, MD, FCAP, clinical professor of Laboratory Medicine emeritus, Sanford School of Medicine, University of South Dakota, Vermillion
• Laboratory Accreditation Program Service Award: Robert R. Rickert, MD, FCAP, recently retired chairman, Department of Pathology, Saint Barnabas Medical Center, Livingston, NJ, and clinical professor of Pathology and Laboratory Medicine and Dentistry of New Jersey, Newark
• Outstanding Service Award: Michael L. Talbert, MD, FCAP, chairman of the Department of Pathology, University of Oklahoma College of Medicine, and chief of Pathology Services at OU Medical Center, Oklahoma City
• Distinguished Service Award: Steven I. Gutman, MD, FCAP, professor of Pathology, University of Central Florida College of Medicine, Orlando, FL
• Distinguished Patient Care Award: Patrick L. Fitzgibbons, MD, FCAP, associate editor for Archives of pathology and Laboratory Medicine and editorial board member for the American Journal of Clinical Pathology
• Public Service Award: Jonathan L. Myles, MD, FCAP, pathology advisor to the American Medical Association (AMA) Relative Value Update Committee, member of the AMA Physician Consortium for Performance Improvement Pathology Work Group and member of the Board of Directors of the Academy of Medicine of Cleveland and Northern Ohio
• Lifetime Achievement Award: Kathleen G. Beavis, MD, FCAP, chair of the divisions of Microbiology and Virology, Stroger Hospital of Cook County, Chicago; John H. Eckfeldt, MD, PhD, FCAP, Ellis Benson Professor, department of Laboratory Medicine and Pathology, University of Minnesota Medical School; Seth L. Haber, MD, FCAP, founding chief of Pathology, Kaiser Permanente Medical Center, Santa Clara, CA; Grover M. Hutchins, MD, FCAP, professor of Pathology, The Johns Hopkins University School of Medicine, Baltimore, and visiting pathologist at the Baltimore VA Hospital; Dina R. Mody, MD, FCAP, professor of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, Ithaca, NY, and director of Cytology, The Methodist Hospital, Houston, and director of Cytology Laboratory at Obstetrical and Gynecologic Associates, Houston; and Thomas L. Williams, MD, FCAP, clinical assistant professor of Pathology, University of Nebraska College of Medicine, Omaha, director of the Department of Pathology, and associate pathologist, Nebraska Methodist Hospital, Omaha, and director of Laboratory Physicians Clinic, Omaha
• Outstanding Communicator Award: Sandra B. Grear, vice president of Membership and Professional Development for CAP, and executive sponsor for the College’s Transformation Communication work stream
• CAP Foundation Lansky Award: Stephen S. Raab, MD, FCAP, director of Anatomic Pathology, director of Cytopathology, and vice chair of quality, University of Colorado Denver School of Medicine, Aurora, CO
• CAP Foundation Humanitarian Grant: Ronald M. Harris, MD, MBA, FCAP, FAAD, associate professor, departments of Dermatology and Pathology, and vice president for Health Sciences Diversity, University of Utah Health Sciences Center, Salt Lake City, UT

The sun was shining just outside of Washington, D.C., as CAP ’09 kicked off its first official day at the Gaylord National Resort. Attendees funneled through registration and on to their first educational courses.

Bright and early, in the 8 am “Embracing the Future: An Introduction to Virtual Microscopy and Telemedicine,” Ronald S. Weinstein, MD, FCAP, former chair of Pathology, University of Arizona, and director, Arizona Telemedicine Program, and Keith J. Kaplan, MD, FCAP, associate professor of Medicine and Pathology, department of Anatomic Pathology, the Mayo Clinic, Rochester, MN, talked about the status of telemedicine and telepathology at their respective institutions and in the United States today.

They traced the history of the technology--from static images to virtual slides, discussed relevant research, available equipment/technology and current and future applications. They also noted benefits (e.g., bringing quality health care to rural sites, decreasing turnaround time, increasing surgical pathology consultations, etc.) along with weaknesses (e.g., sustainability, regulatory issues, telecommunications infrastructure costs, etc.)

To the question some may ask: “Radiologists did it, why can’t we?” Dr. Kaplan explained that radiologists give impressions while pathologists make diagnoses. Though pathologists are about a decade behind radiologists in implementing telemedicine, Dr. Kaplan says, “I think we’re gonna get there.”

In the afternoon, Richard J. Zarbo, MD, DMD, FCAP, chair of Pathology, and senior vice president for Pathology and Laboratory Medicine at the Henry Ford Health System, and Rita D’Angelo, MS, CQE, SSBB, quality improvement specialist, Henry Ford Production System, department of Pathology and Laboratory Medicine, Henry Ford Health System, talked about implementation of LEAN principles at their facility. They explained how the continuous improvement system empowering employees creates more engaged, satisfied workers. The essential ingredient to changing an organization: a cultural shift embraced by the least to the most senior members.

During “2009 Special Scientific Presentation: CAP and ASCO Join to Develop ER/PR Guidelines,” Diana Rowden, breast cancer survivor and vice president of the Affiliate Network for Susan G. Komen for the Cure^®, shared her personal story and highlighted the importance of breast cancer patients and pathologists, who are often “just a name on a report,” becoming more familiar with each other.

Following Ms. Rowden’s talk, C. Kent Osborne, MD, professor of Medicine and Molecular and Cellular Biology, director of the Lester and Sue Smith Breast Center, and director of the Dan L. Duncan Cancer Center, all at Baylor College of Medicine, Houston, a key contributor to the ER/PR guidelines being developed, discussed how the guidelines would help pathologists achieve a more accurate diagnosis.

Later in the day, CAP held its Spotlight Reception titled “Leadership Lessons: How the Past Can Help You with Change Today” featuring historian and storyteller Doris Kearns Goodwin with lessons in leadership for today’s pressing issues.

All in all, these offerings (just a smattering of available courses) were interesting and engaging, with much promise for more to come.

CAP Announces Election Results

CAP officials have released the names of winners of this summer’s ballot. Winners are:

President: Stephen N. Bauer, MD, FCAP 

Secretary-Treasurer: Gene N. Herbek, MD, FCAP

Governor: M. Elizabeth H. Hammond, MD, FCAP; George F. Kwass, MD, FCAP; Gail Habegger Vance, MD, FCAP; and R. Bruce Williams, MD, FCAP.

Results will be officially announced and winners will be sworn in Oct. 10 at the CAP Business Meeting (in conjunction with the House of Delegates meeting) prior to the start of CAP ’09, being held Oct. 11-14 outside of Washington, D.C. All CAP members are welcome to attend the House of Delegates meeting (8:30 am-noon, 1:30-5 pm).

In just a few days, the ADVANCE team will be among the 1,000-plus attendees making their way around the CAP ’09 meeting site at the lovely waterfront Gaylord National Resort, just outside of the nation’s capitol. We look forward to attending sessions led by some of the country’s leaders in pathology and seeing what new technology is on the market or will be in the not-too-distant future. We’ll keep you posted on news from the show.

We’ve begun our online coverage--click here for an exclusive interview with CAP President Jared N. Schwartz, MD, PhD, FCAP, on preparing for CAP ’09 and his reflections on pathology, in addition to a faculty slideshow highlighting this year’s courses, and articles that may help show-goers get the most out of their conference experience.

We’ll also post photos and updates on Facebook and Twitter. If you’re using social media at CAP ’09, we’d love you to drop us a line or tweet about what you’re enjoying. Catch up with us if you’ll be at CAP ’09, and for those of you who can't attend, we'll supply you with a sample of the goings-on.

Stay tuned for more!

This press release from the National Institutes of Health clarifies that while the current strain of H1N1 will predominate in the upcoming influenza season, there doesn’t seem to be biological pressure for the virus to re-combine with other circulating viruses. Some scientists have speculated such reassortant viruses would be more virulent or transmissible than either 2009 H1N1 or seasonal flu viruses alone.

The Government Accounting Office (GAO) concludes in a July 29 report that the country has much more work to do to prepare for flu season. Several high-priority areas that need immediate attention include:

• clarification, testing and exercising of leadership roles/responsibilities for influenza pandemics, and better utilization of existing mechanisms to improve coordination between federal, state and local governments and the private sector;
• more complete information to assist countries at the greatest risk;
• federal planning to maintain essential operations/services and protect employees during a pandemic;
• the need for additional capacity in patient treatment spaces, and better procedures for acquisition/distribution of medical and other critical supplies (e.g., antivirals and vaccines);
• increased distribution of information on school closures, state border closures and other topics by federal agencies to state/local governments; and
• greater agency accountability to protect federal workers, as no mechanism exists to monitor agencies' progress in developing workforce pandemic plans.

The report points out that federal agencies have taken action on 13 of 24 GAO recommendations over the past three years, but haven’t fully implemented 11 other recommendations. Since the H1N1 virus could become more virulent this fall or winter, it recommends administration officials and federal agencies use this time to address preparedness gaps.

The GAO adds, somewhat ominously, “The current H1N1 pandemic should serve as a powerful reminder that the threat of a pandemic influenza, which seemed to fade from public awareness in recent years, never really disappeared.”

[Guest entry from Amanda Koehler, associate editor of ADVANCE for Medical Laboratory Professionals]

Many people say there is a strong correlation between science and art. One person who wholeheartedly agrees with this statement is Darlene Katz, an oil painter who started out as an immunologist.

ART SAMPLING: Darlene Katz's      painting "Garcon."      ADVANCE thanks Darlene Katz

Starting Out

For Katz, who was born and raised in Syracuse, NY, art and science were intertwined right from the get-go.

"I was always interested in both science and8 art starting when I was a young kid," she explained. "I had doctors in my family, and I was accustomed to that kind of life and hearing about those things. My mom had been taking some immunology courses when I was young. I went into grad school and did immunology, and I always did artwork on the side."

"It was just a relaxing thing for me and it just seemed to work different areas of the brain. As a matter of fact, I was trying to make a decision if I should go into science or art. I talked to a gentleman who was a microbiologist, and he said if you have a God-given gift of being a creative artist, you should go and do that--those kinds of gifts don't come easy in this world. I went to an artist I knew and she said I could be a good artist. But my mom said I needed to go into something that paid well and do art on the side."

Taking Mom's advice to heart, Katz got her doctorate in immunology at SUNY at Buffalo. Afterwards, she moved to San Diego and did some post doctorate work in tissue typing and compliment assays.

She was working on chronic mono markers when she decided she didn't want to do basic research anymore. She wanted to get involved with a clinical start-up company, so she went to the Graduate School of Business at San Diego State University. After she was there for about a year, she got her first clinical research job that put her in charge of heading up clinical trials and doing consulting work with different companies.

The Switch

After a while, Katz decided to leave her job. "I left because I really wanted to be at home more with my children," she explained. "So I came home and started doing more consulting. Eventually, the consulting petered out and the artwork started taking up more of my time and I got more serious about it."

Even though she was surrounded by a family of doctors, including her husband, sister and brother-in-law, her loved ones supported Katz's career switch.

"They knew I had talent and it was something I really wanted to do, and I was in a position where I could do it," Katz told ADVANCE. "The path to success isn't really laid out--it's a struggle. Painting requires a lot of forethought, a lot of planning and a lot of work. When someone says to me, 'How long did it take you to paint that painting?,' I say, 'A few hours and 15 years of experience.'"

PLAY DAY: Darlene Katz's painting      "At Play on the Beach."     ADVANCE thanks Darlene Katz

She no longer keeps up with the immunology field, but her son is taking an immunology class. "He thinks it's pretty hard but pretty interesting," Katz noted. "He's learning about things we didn't know about in grad school."

Two Interrelated Disciplines

Katz believes scientists and artists should use the skills of each other to be better in their respective fields. "I think scientists who are the most successful are those who really use their creativity, even though they are technically trained," she said. "They really have to use both sides of their brain. The same thing is true with art. I know a lot of people who are artists who have some sort of medical or scientific degree. It's a huge number."

Drug resistance strikes again. U.S. health officials have detected Tamiflu-resistant cases of H1N1 along the U.S.-Mexico border. According to this AFP article, experts gathered in La Jolla, CA, at the Pan-American Health Organization office and warned that resistant strains were developing due to overuse of antivirals.

Healthcare providers of all walks are familiar with drug resistance, particularly antibiotic resistance in superbugs like Staphylococcus aureus, enterovirus and Clostridium difficile. The challenges these resistant bacteria and viruses have presented makes the knowledge that Tamiflu is being overused in H1N1 treatment all the more troubling.

Uncertainty remains regarding more severe outbreaks when the weather cools in a few months and we enter “traditional” influenza season. Let’s hope that practitioners exercise care in prescribing Tamiflu to avoid contributing to antiviral resistance, or we could be in for a troubling winter.

[Guest commentary by Cheryl McEvoy, from the ADVANCE for Health Information Professionals blog, "ADVANCE Perspective: HIM"]

Theory: healthcare is going the way of the fast food industry. A bit counter-intuitive, I know, given the usual wars between those factions over nutrition facts, whole grains and "lighter" meal options. But I'm talking about the business model. More and more often, I've seen news of quickie clinics popping up to serve a patient's healthcare needs in a convenient one stop shop. Instead of advertising its sale on Revlon products, CVS may soon boast signs about its MinuteClinic that seem strangely reminiscent of McDonald's burger count: "More than 10 million health patients."

A recent article in USA Today even points to this trend, comparing what a doctor is hoping to deliver through express clinics to what "Papa John's did for pizza." That doctor, whose name is--ready for it?--Burger, is hoping to set up 3,000 Doctors Express centers across the country to make sure patients--much like a Taco Bell enthusiast with the munchies--can get what they need, when they need it. The centers will include X-rays, lab and pharmacy, with staff working around the clock. It's a way to ease overcrowded emergency rooms, and Dr. Burger hopes it becomes a model for efficiency, the article noted.

The food/health merge doesn't stop there. As much as I hate the ice cream truck and the tune it blasts around my neighborhood, I was delighted to hear about a new cupcake mobile launching in Philadelphia. (Now I only need a reason to order from the truck, and perhaps a locale further downtown to receive said cupcakes.) Well, that brings me to exhibit B, the mobile healthcare enterprise. As this week's Top Story shows, HIT vendors are taking products and know-how on the road to get patients and providers jazzed about healthcare's future. From EHRs to PHRs, it's quite a menu to choose from. Even big-wig Kaiser Permanente is in on it; a mobile health care unit will be cruising the Hawaiian coast, bringing healthcare services to both members and uninsured residents. Let's hope those patients hunt down the truck with the same fervor as kids chasing a Mr. Softee. For convenient access to preventive care, I just might.

And finally, exhibit C, home-based care. Physicians are abandoning the office setting and going straight to patients' bedsides, and some are finding it's a way to cut costs. In the food industry, we call this good old home cooking. When you're sick of the lines, poor service and piling costs of take out, there's nothing like the comfort of a familiar face and the cost savings of a meal made from scratch. Or, if you're one of the few who's thriving in the down economy, you can sign up for premium concierge care--the personal at-home chef of the healthcare field.

Challenges for the use an implementation of electronic health records (EHRs) are well documented, but this study in the journal Genetics in Medicine discusses another notable aspect—EHRs will need vast improvements to meet the needs of genetics and genomic medicine. The study notes that EHRs will need improved structure, standardization and functionality to house the genetic information that is slowly changing patient care.

Most EHRs—even state-of-the-art ones—lack the ability to systematically record genetic information, let alone use it for medical decision making, the report notes. Although the need to house and utilize such information now may be relatively low, it’s a safe assumption that the need will only continue to increase.

Preparing for these future needs now could save many headaches when the time comes that genetic information is routinely used. As vendors roll out updates and new products, hopefully the need for genetic and genomic data is considered.

It may be true that the term “going green” has turned into quite the trite cliché, but that doesn’t make environmentally aware practices any less important.

For an event as huge as the AACC Annual Meeting and Clinical Lab Expo, eliminating waste and being environmentally conscious can be a challenge—but small efforts can have major impacts. This year, conference program and exhibit guides, CLN Convention Dailies and promotional materials are all printed on 30 percent recycled paper, and the conference tote bag that all attendees receive is made of 51 percent recycled fabric (of course, the benefits of these bags extends far past the few days we’re using them at the meeting—keep yours in your car and take it with you when you go grocery shopping to reduce your plastic bag use).

The badge holders will also be recycled at the end of the show, and AACC carefully used more trunks than cardboard boxes to ship supplies to the convention center. The AACC staff will also use china instead of disposable dining materials.

Even better, McCormick Place Convention Center is a Leadership in Environmental and Energy Design (LEED®) Certified Green Building. LEED is the system used by the U.S. Green Building Council (USGBC) to design and construct energy efficient buildings. According to the convention center’s press release, a few features that led to this certification include:

• One of Chicago’s largest green roofs, covering approximately 150,000 square feet.

• A 3,100 foot long storm water tunnel, located 150 feet below grade, which will divert approximately 55 million gallons of storm water into Lake Michigan every year.

• A highly efficient irrigation system consisting of timed sprinklers, moisture sensors, and drip irrigation tubes, reducing the use of potable water for landscape irrigation by 50 percent.

• A well-insulated building envelope, energy efficient mechanical systems, and lighting, which will reduce the energy cost of the building by more than 20 percent.

• Materials with high-recycled content, including steel, gypsum board and acoustic ceiling tiles.

• Building materials (more than 20 percent) that were extracted and manufactured within 500 miles of the building site, thereby supporting local economies and reducing the environmental impact resulting from long-distance transportation.

McCormick Place will also help the AACC in its green efforts by recycling exhibiting companies’ discarded packing materials and making it easy for exhibitors and attendees alike to recycle throughout the facility. We encourage everyone attending the conference to play their role by recycling and reducing the waste they produce and help the AACC and McCormick Place Convention Center achieve their green goals.

Your ADVANCE reporters are arriving on scene to the AACC Annual Meeting in Chicago, and the McCormick Place Convention Center is bustling with attendees eager to check out a variety of sessions before the exhibit hall opens tomorrow.

The conference is also the time that important leaders in the field of clinical laboratory medicine are recognized. This year's award recipients are:

• The Wallace H. Coulter Lectureship Award-Jerome E. Groopman, MD, the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School, and chief of experimental medicine at Beth Israel Deaconess Medical Center.
• Outstanding Lifetime Achievement Award in Clinical Chemistry and Laboratory Medicine-Christopher P. Price, PhD, FACB, an independent consultant focused on outcomes research, a visiting professor in clinical biochemistry at the University of Oxford, and clinical director of the Cumbria and Lancashire Pathology Commissioning Network.
• The Morton K. Schwartz Award for Significant Contributions in Cancer Research Diagnostics-Catharine M. Sturgeon, PhD, FRCPath, FACB, a consultant clinical scientist in the department of clinical biochemistry at the Royal Infirmary of Edinburgh, director of the National External Quality Assessment Service’s proficiency-testing center, and an honorary senior lecturer at the University of Edinburgh.
• Award for Outstanding Contributions through Service to the Profession of Clinical Chemistry-Donald S. Young, MD, PhD, FACB, acting director of clinical chemistry at the Hospital of the University of Pennsylvania.
• Award for Outstanding Contributions in Education-Michael Laposata, MD, PhD, professor of pathology and medicine at Vanderbilt University School of Medicine, and pathologist-in-chief and director of clinical laboratories at Vanderbilt University Hospital.
• Award for Outstanding Contributions to Clinical Chemistry in a Selected Area of Research-Fred S. Apple, PhD, DABCC, medical director of clinical laboratories, clinical chemistry, toxicology, and POCT at Hennepin County Medical Center in Minneapolis, professor of laboratory medicine and pathology and of kinesiology at the University of Minnesota School of Medicine, and a forensic toxicology consultant for the Hennepin County medical examiner’s office.

Dr. Groopman also delivered the opening plenary session titled "How Doctors Think," based on his recent book of the same title, discussing how physicians diagnose and prescribe treatment to patients and how misdiagnosis can occur.
Hot topics at the conference will be familiar to readers of ADVANCE for Administrators of the Laboratory: Vitamin D testing, cardiac biomarkers, improving methods for diabetes diagnosis and management, and personalized medicine and pharmacogenomics.

Stay tuned for coverage of these topics and many more!