Monthly Archives: March 2015

“Money for Nothing”

Confessions of a Microbiologist,

Taking a minute from a procedure time  in the laboratory might not sound like much. After all, what can one do in a minute? Hardly enough time to blow your nose. Is it really worth it? 

However let’s say you are doing 70,000 of those procedures in a year e.g. a decent sized laboratory getting 200 urines in a day will process approximately this number of urines per annum.

Then the minutes start to add up…

70,000 minutes equals approximately 1150 hours, which equates to approximately 20 hours a week, which is approximately 0.5 FTE, more actually when you take annual leave etc into account.

Gaining processing efficiency in the lab often involves sitting down, looking at the high volume tests in detail, breaking down the procedure into its component parts and then asking yourself. “Is this the best we can do here?”

When dealing with high volume processes, even small changes; moving an incubator, removing a redundant media plate, automatically signing out negative results etc can make big differences.

Never be scared to suggest improvements, no matter how small they seem, it all adds up in the end. Not all the suggestions will work, but some will, and once you have made a few, they become easier to make…..

Michael

“HPV primary screening: Treading carefully…”

The Science of Microbiology, virology,

Screening for cervical cancer is traditionally carried out by cytology of a cervical smear.

"Nasty looking cells on a cervical smear"
“Nasty looking cells on a cervical smear”

 

 

 

 

 

Over the next 5 years or so, this will change worldwide to primary screening with Human Papilloma Virus (HPV) testing by PCR. This has massive implications for cervical screening services and also staff that perform cervical cytology.

In 1975, Professor zur Hausen hypothesized that human papillomavirus was a necessary cause of cervical cancer. For this he won the Nobel prize in 2008.

Professor zur Hausen
Professor zur Hausen

 

 

 

 

 

There is little doubt that the evidence supporting primary screening (more or less) in place of cytology is overwhelming, but this raises a few secondary questions…

  • What is the optimal screening interval, given that it takes several years for cervical cancer to develop from primary HPV infection.
  • When is the optimal age to stop screening?
  • What future impact will the recently introduced HPV vaccine have on the cost effectiveness of screening?

This is where we need to be careful. The majority of research trials into HPV testing for cervical cancer screening are carried out/sponsored by the large corporate companies that produce and sell HPV tests. These companies have a clear conflict of interest in the answers to the three questions above. This is not their fault, but the conflict is there nevertheless. We just need to be very careful with anything we read (or are given to read) on the topic

HPV is a fascinating area. If I was setting an exam on molecular testing, then HPV would be more or less at the top of my list of questions, and I am afraid I would be a ruthless examiner!

Michael

Check out this related post, “My Little Darling would never do that!”

 

“The Whole Picture”

The Art of Microbiology,

For the clinical microbiologists and ID physicians….

It might be the most susceptible antibiotic on the report but the child will only take syrup and not tablets.

It might be the most susceptible antibiotic on the report but there is little chance that this patient will take antibiotics four times a day.

It might be the most susceptible antibiotic on the report but it tastes horrible. Is this patient likely to stomach it?

It might be the most susceptible antibiotic on the report but it causes diarrhoea in a good proportion of patients. Will this patient “run” with it?

It might be the most susceptible antibiotic on the report but this patient swears by another antibiotic.

These are only a few of the things that should be considered when individualising treatment. Advising on the best antibiotic is not just about looking at the report and looking for the most susceptible antibiotic available. It is about “What antibiotic is most likely to work best in this particular patient?”. Getting good at this sort of decision making takes time and experience and a good deal of background knowledge, not all of which can be learned from textbooks. We certainly don’t always get these decisions right.

Michael