After a recent enrollment expansion, a Medical Laboratory Science program experienced a higher than desired student attrition rate due to a number of academic and non-academic student readiness factors. In an attempt to address retention and other issues, the program completed a curriculum update and revision as well as a conversion to a hybrid or flipped classroom delivery model, but in spite of an overall improvement in student learning outcomes, the program still experienced a high level of student attrition. Program faculty then developed and implemented a two stage holistic admissions selection process, which included an interview and skills test, in an attempt to assess candidate background knowledge and abilities in an equitable manner. Comparison of student factors associated with on-time successful graduation, probation (delayed graduation), or dismissal from the program indicated that the science and prerequisite science grade point averages were significantly higher for students who graduated on-time compared to delayed or non-successful (dismissed) students. Review of applicants' performance in the interview and skills test showed significant differences for multiple factors for students who graduated on-time from the program compared to delayed (probation) and non-successful (dismissed) students. Continuing reviews of program retention rates are needed, however the attrition rate for the next cohort dropped from 24% to 4% when the program focused the selection process on factors shown to be associated with successful graduation. ABBREVIATIONS: MCAT - Medical College Admission Test, ACT – American College Test, SAT – Scholastic Aptitude Test, GPA – Grade Point Average, AHPAT – Allied Health Professions Admission Test, MLS – Medical Laboratory Sciences, ANOVA - Analysis of variance, sGPA - Science GPA, preGPA – Prerequisite science course GPA, TOEFL - Test of English as a Foreign Language, PPB – Purdue Pegboard
{"title":"An Evidence-Supported Medical Laboratory Science Program Admissions Selection Process","authors":"Janice M. Conway-Klaassen","doi":"10.29074/ascls.29.4.227","DOIUrl":"https://doi.org/10.29074/ascls.29.4.227","url":null,"abstract":"After a recent enrollment expansion, a Medical Laboratory Science program experienced a higher than desired student attrition rate due to a number of academic and non-academic student readiness factors. In an attempt to address retention and other issues, the program completed a curriculum update and revision as well as a conversion to a hybrid or flipped classroom delivery model, but in spite of an overall improvement in student learning outcomes, the program still experienced a high level of student attrition. Program faculty then developed and implemented a two stage holistic admissions selection process, which included an interview and skills test, in an attempt to assess candidate background knowledge and abilities in an equitable manner. Comparison of student factors associated with on-time successful graduation, probation (delayed graduation), or dismissal from the program indicated that the science and prerequisite science grade point averages were significantly higher for students who graduated on-time compared to delayed or non-successful (dismissed) students. Review of applicants' performance in the interview and skills test showed significant differences for multiple factors for students who graduated on-time from the program compared to delayed (probation) and non-successful (dismissed) students. Continuing reviews of program retention rates are needed, however the attrition rate for the next cohort dropped from 24% to 4% when the program focused the selection process on factors shown to be associated with successful graduation. ABBREVIATIONS: MCAT - Medical College Admission Test, ACT – American College Test, SAT – Scholastic Aptitude Test, GPA – Grade Point Average, AHPAT – Allied Health Professions Admission Test, MLS – Medical Laboratory Sciences, ANOVA - Analysis of variance, sGPA - Science GPA, preGPA – Prerequisite science course GPA, TOEFL - Test of English as a Foreign Language, PPB – Purdue Pegboard","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123839614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As this is the end of my term as Editor-in-Chief, I thought I would spend a little time thanking the people who got me to the position. Since I truly believe that you cannot know where you are going without knowing where you have been, this will include some longtime lore. I want to start by thanking the people who taught me that professionalism does not start and stop with test tubes and slides. Sister Aloysia, my Education Coordinator, brought me to a Massachusetts Senate hearing on a bill to grant licensure to our profession. It didn't pass and I realized that there were people in the world who did not respect what I did. I couldn't understand why. Another person of influence was Roma Brown who became President of then ASMT, and obeyed a subpoena from Congress. She was rewarded by being fired from her Kansas laboratory. She and several other presidents and leaders engaged in a multi-year set of lawsuits about the independence of the profession. Each suit was settled in ASMT's favor and the rulings were based upon the 13th, 14th, and 16th Amendments (the anti-slavery amendments) to the US Constitution. These actions reinforced my belief that, in addition to knowledge and skill, action is a necessary criterion for a professional. Jean Shafer of New York was a world-class hematologist in the clinical laboratory. She taught both medical laboratory science students and residents. She convinced me that our field did indeed encompass patient care and treatment. Perhaps…
{"title":"Hail and Farewell","authors":"S. Leclair","doi":"10.29074/ascls.29.4.198","DOIUrl":"https://doi.org/10.29074/ascls.29.4.198","url":null,"abstract":"As this is the end of my term as Editor-in-Chief, I thought I would spend a little time thanking the people who got me to the position. Since I truly believe that you cannot know where you are going without knowing where you have been, this will include some longtime lore. I want to start by thanking the people who taught me that professionalism does not start and stop with test tubes and slides. Sister Aloysia, my Education Coordinator, brought me to a Massachusetts Senate hearing on a bill to grant licensure to our profession. It didn't pass and I realized that there were people in the world who did not respect what I did. I couldn't understand why. Another person of influence was Roma Brown who became President of then ASMT, and obeyed a subpoena from Congress. She was rewarded by being fired from her Kansas laboratory. She and several other presidents and leaders engaged in a multi-year set of lawsuits about the independence of the profession. Each suit was settled in ASMT's favor and the rulings were based upon the 13th, 14th, and 16th Amendments (the anti-slavery amendments) to the US Constitution. These actions reinforced my belief that, in addition to knowledge and skill, action is a necessary criterion for a professional. Jean Shafer of New York was a world-class hematologist in the clinical laboratory. She taught both medical laboratory science students and residents. She convinced me that our field did indeed encompass patient care and treatment. Perhaps…","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114922965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION The laboratory is a vital and dynamic participant on the clinical team in healthcare. However, the laboratory often exists behind the scenes, quietly providing answers to many diagnostic questions while providing a critical role in patient care. It is unfortunate that this hidden nature of the laboratory begins during professional education. In many educational institutions, interprofessional simulations are gaining ground as an excellent way for different professions to work together in a safe environment, preparing them for their future real life experiences.1,2 In order for these simulations to be effective and authentic, it is crucial for the laboratory to be included. This manuscript serves as an example of how the University of Alabama at Birmingham's Clinical Laboratory Science Program was able to partner with the Office of Interprofessional Simulation for Advanced Clinical Practice and create an interprofessional simulation that highlighted patient safety, teamwork, and communication. The Value of the Laboratory in Simulation Including the laboratory in interprofessional simulation is imperative. For starters, it is not realistic for lab values to be pulled out of one's pocket at the exact moment the clinician in the simulation orders a test. This provides unrealistic expectations of turnaround time for lab results. Waiting on results affords the opportunity for providers to determine appropriate measures to take while lab analysis is being performed. Bedside healthcare providers need experience in multi-tasking with patient care during a simulation. They may receive a call that a specimen is being rejected for one patient, all the while dealing… ABBREVIATIONS: ACLS – advanced cardiac life support, CBC – complete blood count, CLS – clinical laboratory science, CMP – comprehensive metabolic panel, COPD – chronic obstructive pulmonary disease, CT – computerized tomography, ICU – intensive care unit, PT – prothrombin time, PTT – partial thromboplastin time
{"title":"Incorporating Clinical Laboratory Science Students into Interprofessional Simulation","authors":"Michelle R. Brown, Brianna V. Miller","doi":"10.29074/ASCLS.29.4.247","DOIUrl":"https://doi.org/10.29074/ASCLS.29.4.247","url":null,"abstract":"INTRODUCTION The laboratory is a vital and dynamic participant on the clinical team in healthcare. However, the laboratory often exists behind the scenes, quietly providing answers to many diagnostic questions while providing a critical role in patient care. It is unfortunate that this hidden nature of the laboratory begins during professional education. In many educational institutions, interprofessional simulations are gaining ground as an excellent way for different professions to work together in a safe environment, preparing them for their future real life experiences.1,2 In order for these simulations to be effective and authentic, it is crucial for the laboratory to be included. This manuscript serves as an example of how the University of Alabama at Birmingham's Clinical Laboratory Science Program was able to partner with the Office of Interprofessional Simulation for Advanced Clinical Practice and create an interprofessional simulation that highlighted patient safety, teamwork, and communication. The Value of the Laboratory in Simulation Including the laboratory in interprofessional simulation is imperative. For starters, it is not realistic for lab values to be pulled out of one's pocket at the exact moment the clinician in the simulation orders a test. This provides unrealistic expectations of turnaround time for lab results. Waiting on results affords the opportunity for providers to determine appropriate measures to take while lab analysis is being performed. Bedside healthcare providers need experience in multi-tasking with patient care during a simulation. They may receive a call that a specimen is being rejected for one patient, all the while dealing… ABBREVIATIONS: ACLS – advanced cardiac life support, CBC – complete blood count, CLS – clinical laboratory science, CMP – comprehensive metabolic panel, COPD – chronic obstructive pulmonary disease, CT – computerized tomography, ICU – intensive care unit, PT – prothrombin time, PTT – partial thromboplastin time","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128354512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The profile of today's college students looks quite different than it did decades ago, when the average student was a recent high school graduate moving directly from high school to university. Students today are older, work to support themselves and their families, and are ethnically more diverse than their peers of decades past. The student demographic shifts necessitate regular evaluation of academic programs including reevaluating admissions requirements, financial aids availability, and schedule flexibility to meet the demands of the new student demographics. Clinical Laboratory Sciences (CLS) at California State University Dominguez Hills (CSUDH) is the largest CLS program in Southern California and is accredited by National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). The program admits both undergraduate and post-baccalaureate candidates for training as Clinical Laboratory Scientists for careers in healthcare or research. Despite the great success in graduating well qualified candidates, there has been a trend in which a larger portion of students spend more time than expected to complete the program requirements. This phenomenon prompted the faculty at CSUDH to seek the causes for such lengthening time towards graduation. In the current study, we report the results of survey questionnaire that was submitted to CLS students at CSUDH in 2015. The results confirm the recent shift in student demographics in the CLS program and identify the primary obstacle towards a timely graduation to be inability to register for required courses due to schedule conflicts and/or intense competition for available seats. ABBREVIATIONS: CLS – Clinical Laboratory Sciences, CSUDH- California State University Dominguez Hills
{"title":"Identifying Factors that Influence Student Success in Clinical Laboratory Sciences Program","authors":"P. Nasr, Cheryl Jackson-Harris","doi":"10.29074/ASCLS.29.4.212","DOIUrl":"https://doi.org/10.29074/ASCLS.29.4.212","url":null,"abstract":"The profile of today's college students looks quite different than it did decades ago, when the average student was a recent high school graduate moving directly from high school to university. Students today are older, work to support themselves and their families, and are ethnically more diverse than their peers of decades past. The student demographic shifts necessitate regular evaluation of academic programs including reevaluating admissions requirements, financial aids availability, and schedule flexibility to meet the demands of the new student demographics. Clinical Laboratory Sciences (CLS) at California State University Dominguez Hills (CSUDH) is the largest CLS program in Southern California and is accredited by National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). The program admits both undergraduate and post-baccalaureate candidates for training as Clinical Laboratory Scientists for careers in healthcare or research. Despite the great success in graduating well qualified candidates, there has been a trend in which a larger portion of students spend more time than expected to complete the program requirements. This phenomenon prompted the faculty at CSUDH to seek the causes for such lengthening time towards graduation. In the current study, we report the results of survey questionnaire that was submitted to CLS students at CSUDH in 2015. The results confirm the recent shift in student demographics in the CLS program and identify the primary obstacle towards a timely graduation to be inability to register for required courses due to schedule conflicts and/or intense competition for available seats. ABBREVIATIONS: CLS – Clinical Laboratory Sciences, CSUDH- California State University Dominguez Hills","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"49 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123690647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION In 1998, the Institute of Medicine (IOM) published the report, To Err is Human, in which they stated that up to 98,000 people die each year due to medical errors.1 A more recent study, published in 2013, estimates that preventable adverse events contribute to nearly 210,000 premature deaths per year.2 The body of literature on patient safety and error prevention continues to grow with much of this literature focusing on effective communication and teamwork.3-5 In the report, Improving Diagnosis in Healthcare, the IOM recommends increasing collaboration among medical professionals to reduce diagnostic error. Working in interprofessional teams is also encouraged in the educational realm.6 Graduating students who are knowledgeable about and proficient in interprofessional teamwork and communication should be a priority in healthcare education programs, including Clinical Laboratory Science (CLS). Simulation-enhanced interprofessional education is one way to promote and practice effective communication and teamwork. Interprofessional Education Interprofessional education (IPE) is defined as people from different professions learning about, from, and with each other.7 This differs from multiprofessional education, where students learn side by side, but interaction is not required. The Interprofessional Education Collaborative (IPEC) was formed to promote and encourage interprofessional learning. They developed four core competencies for interprofessional collaborative practice to use as a framework for activity development and curriculum design in education (Table 1).8 The goal is to transform healthcare education and, in turn, have graduates of these programs change and strengthen the quality of patient care in our healthcare systems. As laboratory science students progress through… ABBREVIATIONS: IPEC – Interprofessional Education Collaborative, IPE - Interprofessional education, CLS – Clinical laboratory scientist
{"title":"Strengthening the Clinical Laboratory with Simulation-Enhanced Interprofessional Education","authors":"Michelle R. Brown, Dana Bostic","doi":"10.29074/ASCLS.29.4.237","DOIUrl":"https://doi.org/10.29074/ASCLS.29.4.237","url":null,"abstract":"INTRODUCTION In 1998, the Institute of Medicine (IOM) published the report, To Err is Human, in which they stated that up to 98,000 people die each year due to medical errors.1 A more recent study, published in 2013, estimates that preventable adverse events contribute to nearly 210,000 premature deaths per year.2 The body of literature on patient safety and error prevention continues to grow with much of this literature focusing on effective communication and teamwork.3-5 In the report, Improving Diagnosis in Healthcare, the IOM recommends increasing collaboration among medical professionals to reduce diagnostic error. Working in interprofessional teams is also encouraged in the educational realm.6 Graduating students who are knowledgeable about and proficient in interprofessional teamwork and communication should be a priority in healthcare education programs, including Clinical Laboratory Science (CLS). Simulation-enhanced interprofessional education is one way to promote and practice effective communication and teamwork. Interprofessional Education Interprofessional education (IPE) is defined as people from different professions learning about, from, and with each other.7 This differs from multiprofessional education, where students learn side by side, but interaction is not required. The Interprofessional Education Collaborative (IPEC) was formed to promote and encourage interprofessional learning. They developed four core competencies for interprofessional collaborative practice to use as a framework for activity development and curriculum design in education (Table 1).8 The goal is to transform healthcare education and, in turn, have graduates of these programs change and strengthen the quality of patient care in our healthcare systems. As laboratory science students progress through… ABBREVIATIONS: IPEC – Interprofessional Education Collaborative, IPE - Interprofessional education, CLS – Clinical laboratory scientist","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132402549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary Peterson, Randy C. Gruhlke, R. Sims, Virginia Wright-Peterson, B. Karon, Troy A. Tynsky, Darci L. Lammers, C. Bender, M. Silber, Bethany Krom, M. Lessard
Blended learning, a combination of online and face-to-face classroom experiences, is of particular interest in health sciences education. Mayo School of Health Sciences, one of the five schools within the Mayo Clinic College of Medicine, assessed the use of blended learning across three allied health education programs: clinical neurophysiology, histology, and phlebotomy. The process involved analysis of the individual programs and the establishment of a philosophy to underpin the use of blended learning within the school. To evaluate the results of the redesigned blended phlebotomy program that was implemented in September 2012, we collected data on resource use, program accessibility, student performance, and student satisfaction. The results showed that the blended learning environment enhanced the overall course framework, by providing greater accessibility (geographically and temporally), and improved efficiency in the use of faculty, classroom and laboratory space; while maintaining strong student performance. Although student satisfaction decreased initially, program adjustments resulted in subsequent student cohorts reporting high satisfaction. We showed the utility of blended learning being adopted in health sciences programs traditionally delivered face-to-face and the value of technology used effectively in teaching and learning. ABBREVIATIONS: MSHS - Mayo School of Health Sciences, NAACLS - National Accrediting Agency for Clinical Laboratory Sciences
{"title":"Blended Learning: Transformation of Phlebotomy Education at Mayo Clinic","authors":"Mary Peterson, Randy C. Gruhlke, R. Sims, Virginia Wright-Peterson, B. Karon, Troy A. Tynsky, Darci L. Lammers, C. Bender, M. Silber, Bethany Krom, M. Lessard","doi":"10.29074/ascls.29.4.219","DOIUrl":"https://doi.org/10.29074/ascls.29.4.219","url":null,"abstract":"Blended learning, a combination of online and face-to-face classroom experiences, is of particular interest in health sciences education. Mayo School of Health Sciences, one of the five schools within the Mayo Clinic College of Medicine, assessed the use of blended learning across three allied health education programs: clinical neurophysiology, histology, and phlebotomy. The process involved analysis of the individual programs and the establishment of a philosophy to underpin the use of blended learning within the school. To evaluate the results of the redesigned blended phlebotomy program that was implemented in September 2012, we collected data on resource use, program accessibility, student performance, and student satisfaction. The results showed that the blended learning environment enhanced the overall course framework, by providing greater accessibility (geographically and temporally), and improved efficiency in the use of faculty, classroom and laboratory space; while maintaining strong student performance. Although student satisfaction decreased initially, program adjustments resulted in subsequent student cohorts reporting high satisfaction. We showed the utility of blended learning being adopted in health sciences programs traditionally delivered face-to-face and the value of technology used effectively in teaching and learning. ABBREVIATIONS: MSHS - Mayo School of Health Sciences, NAACLS - National Accrediting Agency for Clinical Laboratory Sciences","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123491239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Index to Volume 29, Numbers 1 Through 4","authors":"","doi":"10.29074/ascls.29.4.260","DOIUrl":"https://doi.org/10.29074/ascls.29.4.260","url":null,"abstract":"","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116730577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypernatremia is biochemically defined by a blood sodium concentration ([Na+]) above the normal reference range for the laboratory performing the test (typically >145 mmol/L). The clinical relevance of an above normal blood [Na+] is largely determined by the severity of the clinical signs and symptoms associated with cellular shrinkage (crenation). High blood sodium concentrations are largely caused by: 1) excessive water loss with inadequate fluid replacement (thirsting); 2) excessive salt ingestion; or a likely combination of too little fluid with too much salt. Morbidity and mortality from hypernatremia has been documented in infants accidentally poisoned with salt or having difficulties breastfeeding, children ingesting excessive amounts of salt as an emetic or punishment, mentally or physically disabled individuals (often living in nursing homes) who cannot express thirst or have free access to fluids, athletes who refrain from drinking during heavy exercise in hot conditions, and hospitalized patients with under-replaced fluid or over-replaced sodium administration. Poor clinical outcomes and delayed recovery have been documented in hospitalized patients with hypernatremia, compared with patients who are admitted and remain normonatremic throughout their hospital stay. Clinically significant hypernatremia in free living humans is extremely rare, with “salt poisoning” often an indicator of abuse, neglect, or mental illness. Thus, the secret stories of hypernatremia often whisper tales of suicide from soy sauce, death by exorcism and salting rituals, extreme parental punishment, hunger strikes, getting lost in the sea or desert, and mass accidental poisonings whereas salt is mistaken for sugar. ABBREVIATIONS: [Na+] – sodium concentration, ICP – intracranial pressure, ICU – intensive care unit, TBI - traumatic brain injury
{"title":"Hypernatremia","authors":"T. Hew-Butler, Kevin Weisz","doi":"10.29074/ascls.29.3.176","DOIUrl":"https://doi.org/10.29074/ascls.29.3.176","url":null,"abstract":"Hypernatremia is biochemically defined by a blood sodium concentration ([Na+]) above the normal reference range for the laboratory performing the test (typically >145 mmol/L). The clinical relevance of an above normal blood [Na+] is largely determined by the severity of the clinical signs and symptoms associated with cellular shrinkage (crenation). High blood sodium concentrations are largely caused by: 1) excessive water loss with inadequate fluid replacement (thirsting); 2) excessive salt ingestion; or a likely combination of too little fluid with too much salt. Morbidity and mortality from hypernatremia has been documented in infants accidentally poisoned with salt or having difficulties breastfeeding, children ingesting excessive amounts of salt as an emetic or punishment, mentally or physically disabled individuals (often living in nursing homes) who cannot express thirst or have free access to fluids, athletes who refrain from drinking during heavy exercise in hot conditions, and hospitalized patients with under-replaced fluid or over-replaced sodium administration. Poor clinical outcomes and delayed recovery have been documented in hospitalized patients with hypernatremia, compared with patients who are admitted and remain normonatremic throughout their hospital stay. Clinically significant hypernatremia in free living humans is extremely rare, with “salt poisoning” often an indicator of abuse, neglect, or mental illness. Thus, the secret stories of hypernatremia often whisper tales of suicide from soy sauce, death by exorcism and salting rituals, extreme parental punishment, hunger strikes, getting lost in the sea or desert, and mass accidental poisonings whereas salt is mistaken for sugar. ABBREVIATIONS: [Na+] – sodium concentration, ICP – intracranial pressure, ICU – intensive care unit, TBI - traumatic brain injury","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125871280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Every number tells a story. As such, clinical laboratory science empowers modern medicine with a vast yet growing repertoire of analytes, which subsequently guide the diagnosis, treatment and prognosis of most – if not all - medical conditions. The body's integrated response to dynamic perturbations in homeostasis creates an elusive trail of biochemical footprints, each providing clues to where pathophysiology began and how far the body has strayed off course (i.e. severity of the insult and appropriateness of the response). The ubiquitous cation, sodium, is one of the main markers of whole body homeostasis. The sodium concentration ([Na+]) within the extracellular fluid space is essential for maintaining cellular size and adequate tissue perfusion. As such, the inherent regulation of water and sodium balance is strict, precise, and fiercely protected by the body. Therefore, when blood sodium levels venture outside of the heavily guarded trails of normonatremia (normal blood [Na+]), into hyponatremia (low blood [Na+]) or hypernatremia (high blood [Na+]), each deviation foretells tales of health and disease - and in rare cases, of abuse and neglect. Water and sodium within the exterior milieu is essential to life. However, within the interior milieu, it is the balance between the two that is critical for individual human survival. We refer to this balance, between water and sodium within the internal milieu, as “fluid homeostasis.” The physiological mechanisms that govern fluid intake (thirst) and output (urine), as well as sodium intake (sodium palatability) and output (urine) have been well-described.1-3 Of historical note,… ABBREVIATIONS: [Na+] – sodium concentration, ADH - anti-diuretic hormone, AVP – arginine vasopressin, CVO - circumventricular organs, ECF – extracellular fluid, ICF – intracellular fluid, IV – intravenous, K+ - potassium, RAAS - renin-angiotensin-aldosterone system
{"title":"The Secret Stories of Sodium How Infants, Athletes, Psychotics, And Otherwise Healthy People Die from Sodium Imbalance","authors":"T. Hew-Butler, Kevin Weisz","doi":"10.29074/ASCLS.29.3.163","DOIUrl":"https://doi.org/10.29074/ASCLS.29.3.163","url":null,"abstract":"INTRODUCTION Every number tells a story. As such, clinical laboratory science empowers modern medicine with a vast yet growing repertoire of analytes, which subsequently guide the diagnosis, treatment and prognosis of most – if not all - medical conditions. The body's integrated response to dynamic perturbations in homeostasis creates an elusive trail of biochemical footprints, each providing clues to where pathophysiology began and how far the body has strayed off course (i.e. severity of the insult and appropriateness of the response). The ubiquitous cation, sodium, is one of the main markers of whole body homeostasis. The sodium concentration ([Na+]) within the extracellular fluid space is essential for maintaining cellular size and adequate tissue perfusion. As such, the inherent regulation of water and sodium balance is strict, precise, and fiercely protected by the body. Therefore, when blood sodium levels venture outside of the heavily guarded trails of normonatremia (normal blood [Na+]), into hyponatremia (low blood [Na+]) or hypernatremia (high blood [Na+]), each deviation foretells tales of health and disease - and in rare cases, of abuse and neglect. Water and sodium within the exterior milieu is essential to life. However, within the interior milieu, it is the balance between the two that is critical for individual human survival. We refer to this balance, between water and sodium within the internal milieu, as “fluid homeostasis.” The physiological mechanisms that govern fluid intake (thirst) and output (urine), as well as sodium intake (sodium palatability) and output (urine) have been well-described.1-3 Of historical note,… ABBREVIATIONS: [Na+] – sodium concentration, ADH - anti-diuretic hormone, AVP – arginine vasopressin, CVO - circumventricular organs, ECF – extracellular fluid, ICF – intracellular fluid, IV – intravenous, K+ - potassium, RAAS - renin-angiotensin-aldosterone system","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"467 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123051303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Morgan, Ryan A Rowe, A. Kirkham, D. Hanks
Vitamin D binding protein (DBP) is the primary transport protein for the multiple forms of vitamin D in the body. Variations in the structure of DBP can affect the binding affinity with vitamin D, which can result in a vitamin D deficiency. Vitamin D deficiency is seen in various autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and diabetes mellitus type 1 (DM1). The increasing prevalence of autoimmune disorders highlights the importance of identifying possible associations with deficient vitamin D serum levels. The objective of this research was to examine the relationship between the serum concentration of 25-hydroxyvitamin D and the concentration of the specific DBP isoforms in diabetic individuals. Vitamin D concentrations were measured using an EIA method, DBP concentrations were measured using an ELISA test, and the likely DBP isoform was determined using SNP TaqMan® analysis. Diabetic participants were compared to control participants. Allele frequencies were consistent with the standard European Ancestry reference population. A Mann Whitney U test revealed no significant difference among the DBP isoform values between the diabetic group and control population. Linear regression showed no correlation between DBP levels and vitamin D levels (R2=0.3402). There was no observed dosage effect in individuals having one or two copies of the mutant allele to the levels of DBP and vitamin D. DBP isoforms and concentrations of DBP had no effect on vitamin D concentrations in our DM1 testing population. ABBREVIATIONS: DBP - Vitamin D binding protein, DM1 - Diabetes mellitus type 1
{"title":"Vitamin D Binding Protein Isoforms and Vitamin D Levels in Diabetes Patients","authors":"Samantha Morgan, Ryan A Rowe, A. Kirkham, D. Hanks","doi":"10.29074/ascls.29.3.152","DOIUrl":"https://doi.org/10.29074/ascls.29.3.152","url":null,"abstract":"Vitamin D binding protein (DBP) is the primary transport protein for the multiple forms of vitamin D in the body. Variations in the structure of DBP can affect the binding affinity with vitamin D, which can result in a vitamin D deficiency. Vitamin D deficiency is seen in various autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and diabetes mellitus type 1 (DM1). The increasing prevalence of autoimmune disorders highlights the importance of identifying possible associations with deficient vitamin D serum levels. The objective of this research was to examine the relationship between the serum concentration of 25-hydroxyvitamin D and the concentration of the specific DBP isoforms in diabetic individuals. Vitamin D concentrations were measured using an EIA method, DBP concentrations were measured using an ELISA test, and the likely DBP isoform was determined using SNP TaqMan® analysis. Diabetic participants were compared to control participants. Allele frequencies were consistent with the standard European Ancestry reference population. A Mann Whitney U test revealed no significant difference among the DBP isoform values between the diabetic group and control population. Linear regression showed no correlation between DBP levels and vitamin D levels (R2=0.3402). There was no observed dosage effect in individuals having one or two copies of the mutant allele to the levels of DBP and vitamin D. DBP isoforms and concentrations of DBP had no effect on vitamin D concentrations in our DM1 testing population. ABBREVIATIONS: DBP - Vitamin D binding protein, DM1 - Diabetes mellitus type 1","PeriodicalId":263458,"journal":{"name":"American Society for Clinical Laboratory Science","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128203995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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