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WSLH Proficiency Testing

Wisconsin State Laboratory of Hygiene

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Going? Staying? “Home” for the Holidays

A few of the biggest questions this holiday season will be, “to travel or not to travel?” and “to gather or not to gather?” For some people, they’ve quickly answered these questions, taking the lowest level of risk as outlined by the CDC: celebrating with people in their immediate household and planning for virtual visits. For others, they may be making elaborate travel plans, with itineraries that include pre-testing, quarantining, post-testing and hoping for the best. You may find yourself weighing various levels of vigilance and care, as you find ways to meet the basic human need of social interaction and contact with others. Regardless of where a person’s boundaries fall in caring for oneself and one’s family, people will tap into their sense of risk assessment and make the decision that seems the most right for them and their loved ones. Below are a few ideas to help you plan, whether you stay home and celebrate virtually or plan to take the risk of traveling and visiting relatives and friends this holiday season.

Staying Home/Virtual Visits
If you are leaning towards staying at home and not gathering in-person this year, here are a few ways you can reach out and find connection this holiday season.

Consider setting up a gathering with multiple people over a video conferencing platform like Zoom, Hangouts, Skype or Facebook: share some of your favorite family recipes in your respective kitchens; have a cookie decorating contest; send each other gifts ahead of time and open them together. All that’s required is a little know-how of the technology, some imagination, and maybe a Pinterest account for a plethora of ideas to celebrate virtually in ways that are meaningful to you and yours. If the technology required for virtual hosting sounds a like more of a headache that you are willing to handle or accessibility is an issue, maybe ask another family member who might use the conferencing platforms more often to see if they would help host.

Another option is to only celebrate in-person with those who live in your immediate household and find ways to connect with others outside of virtual conferencing. (Zoom-fatigue is real for many!) Make time to send plenty of cards and notes by mail to your friends and loved ones, especially those who might be living alone and may feel the weight of isolation over the holiday season even more so this year. Call people or sing them sweet and kiddy holiday songs on their voicemail. There’s also video messaging app options, like Marco Polo, that allow you to leave personal video messages anytime to anyone else who might be on the app. To get you in the spirit this giving season, you may also want to elect to volunteer for contactless food drive donations or raise funds online for your favorite charity.

Holiday Travelling/Visiting
“Fall and winter celebrations, such as Rosh Hashanah, Yom Kippur, Halloween, Día de los Muertos, Navratri, Diwali, Thanksgiving, Día de la Virgen de Guadalupe, Hanukkah, Kwanzaa, Christmas, and New Year’s, typically include large gatherings of families and friends, crowded parties, and travel that may put people at increased risk for COVID-19,” says the Center for Disease Control (CDC) on their website.

If you still plan to visit relatives this year, please take a look at some considerations the CDC has outlined for assessing risk if you’re are planning for holiday celebrations. Considerations include before and after-gathering preparation, hosting advisories, and traveling guidelines that include basic public health practices such as avoiding indoor spaces, especially poorly ventilated indoor spaces, mask-wearing, minimizing the guest list, and social distancing. The CDC also advises that individuals follow local, county, and state-wide regulations that are put in place to help slow the spread.

Infection experts have indicated that inter-household gatherings are key factors in rapid spread of the SARS-CoV-2 virus. As early as May of this year, a Twitter thread from Muge Cevik, an infectious disease researcher at the University of St. Andrews, covered a lot of the relevant research.

“High infection rates seen in household, friend & family gatherings, transport suggest that closed contacts in congregation is likely the key driver of productive transmission,” she wrote, adding that “while we have limited data, similar high risk transmission pattern could be seen in other crowded & connected indoor environments such as crowded office spaces, other workplace environment, packed restaurants/cafes, cramped apartment buildings etc.”

Since the virus is spread by respiratory droplets, minimizing the number of households gathering, outdoors and especially indoors, will help make the other basic public health practices of mask wearing, ventilation, social-distancing, and hand-washing effective.  A recent article by Vox shares stories of people making travel plans as it relates to their own understanding of the risks involved. Reading such stories may help you process risk-assessment and brainstorm any ideas you may have for traveling and visiting this year. For some, as the article indicates, taking the risk of travel and visiting relatives is better than other alternatives, and has provided some much needed reprieve from the day-to-day isolation and stress of coping under a global pandemic.

“At Home” During The Holidays
Whatever you decide to do, whether you are sheltering-in-place or travelling to visit relatives, it’s important to note that not everyone in your family or friend network will share the same idea of what it means to stay safe as they make celebration plans. Please also listen to those who might feel the most vulnerable, the least safe, or the most anxious as you make your plans in a group and consider collectively what your group consensus will look like. Not everyone will have the same boundaries or same level of comfort in considering both the risks of isolation and the risks of gathering. It’s important to do your best to openly discuss with your immediate household what is best to stay safe, to find ways to celebrate and to reach out and connect to those you will be missing this year.

As you and your loved ones navigate these difficult times, we hope that you are finding ways to fulfill the basic human need of connection and joy-making. Stay safe and take care.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up for your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

A Conversation with Dr. Kurtycz

Recently, our outreach coordinator, Megan Flowers had an opportunity to sit down with Dr. Dan Kurtycz, who has served as medical director for the Wisconsin State Lab of Hygiene (WSLH) since 1998. Dr. Kurtycz or, “DK” as his students call him, will be retiring at the end of this year. Before he sets sail for his retirement years, we wanted to gather his reflections on his time in the medical community and in the world of proficiency testing through his eyes as medical director for WSLH, the public health lab which is the home of WSLH Proficiency Testing. Below you’ll find an excerpt of the interview Megan had with DK and some of the fascinating conversations shared.

Megan Flowers: How have you seen the world of proficiency testing change since you began your career?

Dan Kurtycz: It’s really come a long way since I started out as a junior pathologist. There were about a dozen proficiency testing providers during the time of my residency where they would start sending samples out of known concentrations and got to see if laboratories would get the same answers. People began complaining, well, you weren’t testing properly and my method is better; so, you began to start seeing controversies.
When I finished residency, there was a program run by the College of American Pathologists called QAS today, where you would send samples out to people and you would test them and give them an answer in their peer group. I was involved in this program as a junior pathologist, and had signed up with CAP to help them. We were in charge of a region where we reviewed everyone’s numbers and notified them when they failed or when they were too far out.

What constitutes being too far out? Dr. Jim Westgard was really important in all of this.  I actually did a fellowship with Dr. Westgard around 1983. Dr. Westgard had involved these things called control rules. If you are running a series of controls with relatively good tolerance limits there is a bell-shaped curve of results that people are going to get. Within this bell-shaped curve, you want everyone to be within at least your results within at least 95% acceptance limits, which by the way is a much higher success rate than what clinicians do when they are diagnosing patients. Westgard evolved a series of rules based in part on 95% confidence limits, 2 standard deviations out from a mean. Westgard’s control rules became very important in the literature and then became built into the machines.  For example, if you have one error in which everything is on one side of the mean then that is likely a systemic error and something is likely wrong with your machine’s calibration or the reagents you are using. Westgard’s series of rules became very important and was promulgated across the nation and around the world from right here in Wisconsin. Everyone was building his methods into their day-to-day practice. I really learned a lot from Dr. Westgard and the whole bevy of people who got involved in Westgard rules and helping refine them.

MF: In the case of the Wisconsin State Lab of Hygiene, what is the significance of having a public health lab also operate as a proficiency testing provider, that entity being  WSLH Proficiency Testing?

DK: Having a division of our lab focused on providing proficiency testing programs was from my predecessor’s efforts, Dr. Ronald Laessig, who was the Medical Director of WSLH at the time. It was important for WSLH as a national public health lab to outreach and provide support to clinical labs on all fronts, including helping labs improve their patient testing through proficiency testing. This was at the same time Laessig was working with Westgard to expand improved methodology and machines. Historically I’ve been more involved with CAP, since I work with CAP as the Medical Director of WSLH. However, what makes WSLH Proficiency Testing stand out in the world of proficiency testing is the ability to provide personable, one-on-one consultations when the laboratory professional needs it. That means a lot.

MF: What advice would you give clinical laboratories regarding their approach to proficiency testing today?

DK: Well, it’s not only about getting the numbers right. It has to be a part of a whole quality assurance program. They have to pay attention to everything from the pre-analytics through the actual testing, running the controls, and to the post-analytics. Quality isn’t only just about making sure your controls are in nowadays. The biggest errors in the laboratory are clerical, where we mess up, don’t track the specimens, and don’t get the right answers to the right people. Also, as laboratory professionals, we need to make it as easy as possible for the clinician to get what they need to take care of people. We tend to run our laboratories as factories and we forget sometimes about the patient at the end of every sample, including those proficiency testing samples that, in the end, help us better alleviate a patient’s suffering. We are not isolated in this work. We are part of the medical community. Let’s not forget the important work we do.

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WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Finding some R&R this summer

As the state of Wisconsin begins to open up in a patchwork of local phases and plans, many people are understandably feeling the itch to travel, if they haven’t packed their bags already!  However there are still many conditions that require people to stay put, especially those who are chronically ill or are healthcare or laboratory professionals who are not able to take the time off that they feel would make a trip worth the travel.

In the midst of a global pandemic and various recommendations and restrictions on travel, you may be waiting to catch those summer vibes another time. (hopefully next year!) Or if you are amongst the kind of people who would agree with the statement, “I’m just planning this life day-by-day” then a vacation of sorts sounds like worlds away. Below are some ideas that we hope will inspire you to find rest and relaxation this summer that is likely long overdue.

Planning a “staycation”
Find some summer fun right in your hometown or backyard. Try organizing a socially-distanced Cook-Out or BBQ. Grab a book and set up a hammock. Connect with your inner child and run under some sprinklers to cool off or chalk some positive messages for passerbys on the sidewalk. Check out some offerings at your local park or activities that local organizations are hosting virtually, like how to start a container garden or learning how to paint with watercolors.

If you are the kind of person who really likes to make and check off lists, it may be difficult for you to find some rest and relaxation at home without diving entirely into all of those house projects you have been wanting to finish. However, for some, this may be your idea of achieving rest and relaxation on a smaller, everyday level by finishing those projects you’ve been setting aside.

Traveling outside of your town
If you are planning to travel outside of your local area, read the CDC’s “Considerations for Travelers” document to help you discern where and when to travel. Here’s the link for more information:
https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html

Additionally, if traveling outside of your town, please also take into account the following safety tips:

  • Check the state or city health department travel guidance for your visit and along your route. Plan to keep checking for updates as you travel.
  • State or city governments may enact travel restrictions, such as stay-at-home or shelter-in-place orders, mandated quarantine upon arrival, or even state or border closures.
  • Talk with your doctor before you go, especially if you are 65 years or older or have medical issues.
  • Do a pre-trip check on your car and tires. Fewer roadside services may be available and you may become stranded if you have car troubles.
  • Clean and disinfect your car, especially the steering wheel, safety belts, door handles, and the fob or keys you use to start the car.
  • Pack plenty of charging cords and external batteries for electronic devices. If your car’s navigation system contains emergency calling, enable it.
  • Pack a cooler with drinks and snacks, including high-protein foods that will not go bad to limit visits inside of rest stops or gas stations.

-source: Wisconsin Department of Health Services 

Places to visit in Wisconsin 
At the time of publication, cases have overall decreased in Dane County, Wisconsin, where WSLH Proficiency Testing is located. Providing some opportunity for rest and travel, our staff are beginning to plan time off from work and would like to share some places they like to visit locally as well as around the state.

  • Madison, Wisconsin–Come visit the beautiful capital city of Wisconsin, where WSLH Proficiency Testing is located. Plan a trip to the Wisconsin Memorial Union Terrace and enjoy some refreshments with friends or family with a scenic view of Lake Mendota, now open by appointment. Visit a number of lovely public parks, including Olbrich Botanical Gardens. You can also now rent a kayak, canoe, or paddle boat at a municipal park offering rentals. Visitors can also some shopping as many local businesses have re-opened with 50% capacity allowance. For more information, visit: https://www.visitmadison.com/
  •  Amnicon Falls State Park–Are you wanting to get out in nature? Amnicon Falls State park in the northwestern part of the state offers many waterfalls to visit along the Amnicon river as well as many activities including hiking, picnicking, and overnight camping. For more information about this park and other Wisconsin state park offerings, visit:
    https://dnr.wi.gov/topic/parks/
  •  Minocqua, WI–Have you and your family been dreaming of a “Northwoods” experience? As the tourist bureau asks people to “Minocqua Responsibly” the area is opening up in ways that will allow people to enjoy their favorite activities in the “Island city” surrounded by 2,300 lakes. Enjoy a fish fry with a scenic view. Go swimming, fishing, hiking, biking, kayaking, or canoeing. The shopping districts are also open to the pubic at 50% capacity and offer many locally-made products and crafts. For more information, visit: https://www.minocqua.org/things-to-do/

Whether any of these ideas inspire you to make your travel plans for this summer or next, or have you dreaming of visits with Slow TV from the comfort of your living room couch, we hope you are finding some ways to rest and recharge. We all need it in some way to come back fully to our everyday lives and work.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up for your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

A Little Change Can Do Us Some Good

 

A FEW ADJUSTMENTS TO OUR INTERNET-FILLED WORLD CAN BRING US SOME CALM TO OUR LIVES

It seems lately that you cannot read an article without some mention of Covid-19. Even if you are actively avoiding the subject, which is difficult to do in our line of work amidst a global pandemic, just having to read prefaces like this can make you feel unsettled. Feeling those familiar feelings of discomfort and exhaustion mark our days now of living, working, and learning as laboratory professionals.

It’s difficult for many of us to feel connected in meaningful ways with busy schedules, social distancing, and loved ones in various levels of quarantine. Sometimes getting on social media to see how our family, old college friends and even that guy we met at a conference 6 years ago is doing can be an opportunity for the joy of human connection and, at other times, an anxiety-filled click hole down subjects and topics we were hoping to avoid.

How can we take care of ourselves while still having some sort of life shared with others, albeit so much of it lived out on the internet and with hectic-as-ever work schedules?

Limit your access to social media
Have a smart phone? Delete the social media apps on your phone or turn off the notifications your receive from these platforms. Such moves to limit access can encourage us to check our news feeds less frequently. If you have a habit of getting on social media more than you would like or would like to care less about your social media presence, try some of these tactics.

Adjust Your Friends List
It is really not cool, at least for the adult version of ourselves, to “collect” a lot of “friends” on social media, like Facebook for example. Having a lot of friends, however vestigial, can often lead to seeing content that we might not want to see or that we find somewhat negative or depressing.

It is okay to occasionally clean up your friends list, unfollow people, or select to see people first who post content that you find positive, uplifting or inspiring.

Share Don’t Compare
Stress from social media happens when we use it to “see what others are doing.” This approach may seem casual and certainly not pernicious to our mental health, but when we scroll and scroll we begin to compare ourselves to others rather than sharing our lives with others. This is a recipe for never seeing our lives and selves as enough. You are enough right now as you are.

Use your accounts to share positive things about your life and then log off. Then, feel free to log back on to see who may have commented and respond to those people. As this Huffington Post article says, “Share Don’t Compare.”

Use other ways to connect
If you are not on social media, but you have made it this far through the article just out of boredom or curiosity, thank you! What are ways that you connect with others? Sometimes picking up the phone can feel like a ton, especially when we are very busy. Try texting a friend or two a funny or adorable pet video or something that reminds you of your friends. Next time maybe the phone won’t feel so heavy. Seven to ten minute phone conversations are also great (and can be achieved with some people, if that’s what you are into). Also, sending a short and sweet postcard is a great way to break up a “ho-hum” routine. Plus, the process of finding adorable stamps and postcards to send can be fun.

We hope that some of these suggestions have inspired you to find make healthy adjustments and changes to your ways of connecting and socializing that help you lower your stress and find positivity

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up for your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Public Health: A Heroic History

L0025222 Plague doctor
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk
http://wellcomeimages.org
Plague doctor: ein Kleydung under den Todt.
Aesculape
Published: 1932
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

By Kristine Hansbery
Director of WSLH Proficiency Testing

With the recent Covid-19 outbreak our nation is realizing the importance of having a strong public health presence both to avert disaster and protect the wellbeing of our public. During these tumultuous times I am reminded of the words of Jon Snow from Game of Thrones, not to be confused with the “father” of epidemiology, John Snow. However, the John Snow of public health would probably agree with the Game of Thrones Jon Snow, that “There is only one war that matters. The Great War. And it is here.” Yes, the fight against the Coronavirus has become our great war and it is indeed here.

So, why is public health such an important part of this war against the pandemic? Using a historical lens, we can better understand the important role public health labs play in supporting clinical labs in this fight.

Tracing the conceptualization of “public health” and how it has translated into actions in the United Kingdom and the United States can illuminate the important role public health labs play in supporting clinical labs. In particular, the role of public health labs today in providing statistical analysis and reporting to prevent and respond to epidemics is salient to elucidate historically.

John Snow, the father of epidemiology, first made his mark on disease prevention with the “Broad Street pump.” In late August of 1853, cholera broke out in the Broad Street area of London. Snow believed the outbreak was linked to the communal pump located there. To prove his theory, he tracked and recorded incidences of cholera in and around the pump. This was the beginning of using statistics to define disease patterns so interventions could be performed.

The rise of epidemiology and subsequent interventions to stop the spread of disease, gave rise to the creation of government entities who could implement and enforce such mediations for the overall health of the public. The first public agency for health in the United States was the New York City Health Department, which was founded in 1866. This event in history marked the very beginning of the concept of “public health” in the United States. At the end of the 19th century, newly established state and local health departments in the United States began to establish laboratories to develop and apply the new scientific knowledge. (Winslow, 1923)

The early part of the 20th century in the United States saw the creation of federal programs of disease control, research and epidemiology, including the establishment of the Communicable Disease Center in 1946, now known as the Center for Disease Control and prevention (CDC). During this time, state and federal passed regulations to incorporate the concepts of sanitation and disease control using the scientific findings of public health labs.

Today, public health labs all over the U.S. work together under the CDC’s Laboratory Response Network (LRN) in order to quickly and efficiently respond to emerging infections and other public health emergencies. The Wisconsin State Lab of Hygiene (WSLH), which is the home of my organization WSLH Proficiency Testing, works closely with the CDC to provide reference and specialized testing services. Currently the Communicable Disease Division of WSLH is providing validations to help prepare clinical laboratories for Covid-19 testing.

What this dive into the history of public health has taught us is that the rise of epidemiology may have provided the foundation for public health, but social values, including community intervention and health goals, have brought about its system as we know it today. Collaborative partnerships and networks between public health labs and clinical labs will need to continue to grow to adapt and respond to today’s challenges in maintaining the health of our communities.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up for your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Who’s who of laboratory regulations

By Kristine Hansbery
Director of WSLH Proficiency Testing

I am perpetually surprised at how confusing the world of laboratory regulations can be; so, I decided to write a brief summary that gets down to the basics.

All laboratories at minimum must meet CMS requirements as stated in CLIA 88 and can be inspected by their state agency.

If laboratory chooses to do more the agencies listed above are the most common alternates selected.

Proficiency testing is separate from the regulatory agencies. CLIA mandates which laboratory tests require proficiency testing; however, your regulatory agent may require more.

Proficiency testing providers provide unknown samples and score performance of laboratories testing those samples. The scores are reported to CMS and any other regulatory agent the laboratory is signed up with.

A list of proficiency testing providers can be found here.

In summary:

  • Laboratories must comply with CLIA 88 regulations. Laboratories can be inspected by their state agency (CLIA office) or sign up with an alternate regulatory agent approved by CMS/CLIA
  • Laboratories performing testing that is not waived must sign up for proficiency testing and there are several choices.

For further information, visit our Resource page.

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