Lab Medicine Rounds

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 Intro00:48 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 

In this engaging discussion, Ann Moyer, a molecular genetic pathologist from Mayo Clinic, shares her insights on the evolving field of lab medicine. She delves into the daily life of a pathologist, emphasizing the importance of collaboration with clinicians. Moyer highlights the rapid advancements in lab tests, particularly in pharmacogenomics, and discusses the challenges of navigating laboratory utilization for optimal patient care. She also encourages medical students to consider pathology, showcasing its dynamic and rewarding nature.

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