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Knowing the Risks: Prenatal Testing and You

1/4/2017

Pregnancy can be an anxious time for women, especially those who may be at higher risk for certain complications.  

prenatalUR Medicine offers prenatal testing for expecting mothers at the Biochemical Genetics Laboratory at Strong Memorial Hospital.

Together with Department of Obstetrics and Gynecology, this team of clinical professionals helps provide families with answers to crucial questions before a baby is born.   

How it Works

In New York State, all pregnant women in their first trimester are offered an optional blood test to screen for certain fetal defects. The patient’s OBGYN can order the test and have her sample sent to the laboratory.

From there, a team of medical technologists process the sample on an automated lab instrument that issues a report with the odds of certain complications. These results go to the ordering physician within 24 hours.

The first trimester maternal serum screening test assesses the risk for chromosomal defects – Down syndrome and Trisomy 18 – by combining the blood test result with a specific ultrasound measurement. Expecting mothers can later have a second trimester AFP only screening for spina bifida. 

If the first screen comes back negative, no further testing is required. If the result is positive, patients are directed to a prenatal counselor who meets with them to take a more in-depth look.

The risk level depends on a number of factors including age, ethnicity and family history. While the first trimester screening provides an assessment of the risk, it is still too early to determine a diagnosis.  

Peterson

Jeanne Peterson

Jeanne Peterson is a reproductive genetics counselor at URMC who has spent more than 30 years consulting families facing possible or likely issues during pregnancy.

The vast majority of positive screens in the first trimester are actually false positives, she explains. Still, parents are often alarmed when they hear there is a higher-than-average risk of something going wrong.    

“Once the patient gets that phone call from their doctor that they weren’t expecting, this cloud comes over them,” said Peterson. “Many times they’re not getting all the information about the results, and even the information they’re getting they might not understand very well.”

For example, an expecting mother with a 1 in 200 chance (0.5 percent) of having a baby with a birth defect is at much lower risk than someone with a 1 in 6 chance. By learning about their test results and what the numbers mean, many walk out the door feeling reassured and prepared for next steps, whatever they may be.

“You have to help people through it,” said Peterson. “You have to empower them by giving them information at the level they can understand.”

Higher risk individuals with a positive first screen can decide whether to have optional follow up testing for chromosomal abnormalities.

Advances in the last decade have provided a less invasive option than the traditional procedures, explains Dr. Robert Mooney, director of the Biochemical Genetics Laboratory at URMC.

Patients used to be limited to amniocentesis – a test that samples the amniotic fluid around the fetus – or CVS – which requires a small sample of the placenta early in pregnancy – to get a definitive diagnosis. Today, there is a less invasive option that often eliminates the need for more invasive procedures.

Mooney

Robert Mooney, Ph.D.

The cell-free fetal DNA blood test is available for mothers as early as 10 weeks of gestation. This test analyzes genetic material from the placenta that is present in a woman's blood during pregnancy. It can accurately eliminate most false positives and identify those pregnancies with a high risk of an abnormality.

“This has really taken over as the next step after we identify a screen positive,” said Dr. Mooney. “In most cases this eliminates the false positives and identifies those who are at very high risk. We’ve now narrowed the population down to a few at very high risk rather than 3 to 5 percent who have screened positive by our (first trimester) blood test.”

Patients who still test positive after the cell-free DNA test can then choose to have amniocentesis or CVS to obtain a definitive diagnosis.  

A Team Effort

The prenatal screening program at URMC is a combined effort of the Department of Obstetrics and Gynecology and the Biochemical Genetics Laboratory. Representatives from both areas meet regularly to review individual cases, changes to testing, or population trends.

“We’re part of a team,” said Dr. Mooney. “Prenatal Screening is successful only because we all work together. We communicate (with OBGYN) constantly and they give us information to help us interpret the results appropriately.”

The lab considers each test to represent a person and a family waiting anxiously for answers. The team operates on the presumption that every single result is important, says lab supervisor, Matthew Morriss. 

“Each sample is unique,” he said. “It has a person at the end of it and we treat each one with the same urgency. These results are important and we want the doctor and the patient to have all the information that we can give them.”

As a counselor, Peterson says she finds it rewarding to help expecting parents be better prepared for the next step of their journey.

“I tell them that most babies born to all couples are healthy and normal and most likely this baby is healthy and normal, too,” said Peterson. “These screening tests sometimes create bumps in the road but the majority of the times, things turn out okay.” 

UR to Launch New Clinical/Medical Technology Program

12/15/2016

They say the best way to learn is to teach, and for the first time ever, licensed laboratory technologists at URMC will do just that through a new clinical laboratory technology program.

MTThe program will provide full-time clinical lab education for prospective medical technologists, with lectures and hands-on clinical training leading to an advanced certificate. The University and the New York State Education Department have approved the program, and it will welcome its first class of students in fall 2017.

Applicants must have a bachelor’s degree in the biological, chemical or physical sciences and have completed the coursework required for state licensure.

The University had previously partnered with Rochester Regional Health System (RRHS) to provide clinical training to students who received the lecture and exam portion of their training at Rochester General Hospital (RGH), but will now provide both facets of training on its own.

Vicki Roberts, program director and manager of education for the Department of Pathology and Laboratory Medicine, says the region needs every training program working at full capacity to fill a growing number of vacancies in the field.

“This is a benefit to the University and the region because it gives people who are unable to find a practical application for their degree entry into a licensed professional position,” Vicki says.

In 2006, New York State changed its licensing requirements for medical technologists (“med techs” or MTs). This law meant that staff who previously needed a B.S. degree in an applicable major must now complete 1-2 years’ worth of additional clinical training and pass a certification exam in order to be state-licensed.

While many MTs were “grandfathered” in when the law changed, others have balked at the new, more demanding educational requirements. This has made it more challenging than ever for employers to fill vacancies in the lab.

Leadership’s hope is that this new training program allows UR Medicine Labs to have a steady pipeline of trained, certified technologists to fill these vacancies as we grow and affiliate with more partners throughout the region—from Strong Memorial Hospital (SMH), Strong West and Highland hospitals, to medical campuses at FF Thompson in Canandaigua, Dansville, Wellsville and Hornell.

“UR Medicine’s need for additional licensed medical technologists could not be more urgent,” says Kathy Parrinello, chief operating officer of SMH. “This training program allows us to bring in current and prospective medical technologists to train in our excellent labs at SMH, graduate, and get their licenses so we can hire them into positions,” she adds. “We are grateful to Vicki and the entire team for their diligence and perseverance in bringing this program to fruition.”

The majority of lab staff at URMC is comprised of licensed MTs that work around the clock to perform a range of diagnostic tests. These tests help doctors learn what’s making patients sick and properly diagnose and treat them.

Med techs work in labs including Blood Bank and Transfusion Medicine, Microbiology, Chemistry and Hematology, Flow Cytometry and Bone Marrow Testing, Molecular Diagnostics, Surgical Pathology and more.

HarrisGeoffrey Harris (right) spent the last four years as Education Coordinator in the Hematology Lab. He’s one of many MTs that will serve as instructors in the new program.

“When everyone in a lab is an instructor and everyone teaches, it keeps people on their game,” Geoffrey says. “You realize this is a good thing for the whole lab and I think it makes everyone stronger.”

The new class will have between eight and twelve trainees who must complete 35 credits of non-clinical work and 720 hours of clinical experience before taking their certification exam.

BrownPeople like Caroline Brown (right) know what it’s like to have a long path to licensure. She works in Clinical Microbiology, which is one of the largest labs at SMH—in terms of staffing and number of specimens.

When she started as a med tech at URMC, she simply had a B.S. degree. She took time off for family reasons and soon found that returning to work was not as easy as she’d hoped.

“In that timeframe, the licensing all came into being and I fell through the cracks,” Caroline says. “I had to do something in order to get back into the lab.” 

She was accepted into the RRHS training program, which she completed, and later returned to UR as a licensed MT. Today she teaches trainees like herself who are hoping to grow their careers.

Teaching means MTs have new responsibilities on top of their regular workload, taking extra time and preparation to educate students.

For Caroline, that means strategically preparing live cultures days in advance so that students are able to simulate the work that licensed techs perform on a daily basis. This kind of prep is critical in making students’ experiences as authentic as possible so they are prepared to work in a lab.

Caroline says playing a part in this instruction is the best way to give back so others can have the same opportunity she did. “I feel for the future of the career in the lab,” she says. “We need people who want to learn and want to be here.”

The Medical Technologist program is now accepting online applications. For questions, contact Vicki Roberts at (585) 276-3688 or Vicki_Roberts@URMC.Rochester.edu.

Two Receive Cytopathology Travel Scholarships

12/6/2016

KielyThe American Society of Cytopathology (ASC) has recognized two individuals linked to the Department of Pathology and Lab Medicine at URMC. 

Kathryn Kiely (top, right) was one of five cytotechnologists from across the U.S. selected to receive a travel scholarship to attend the ASC's Annual Scientific Meeting to be held in Phoenix, AZ in November 2017.  

Kelsey Snyder, (below, right) the first student to graduate from the Roswell Park Cancer Institute/Daemen College cytopathology training program, where Donna K. Russell, M.Ed, CT (ASCP) HT is the program director, also received a travel scholarship to the ASC meeting. 

snyderSnyder was additionally named a recipient of the 2016 Geraldine Colby Zeiler Award, which is given to five cytotechnology students who show great microscopic diagnostic skill, leadership and initiative within their program.

Alumni Spotlight: Dr. Ben Fialkow of the American Red Cross

11/17/2016

Fialkow

Name: Lawrence (Ben) Fialkow, D.O.

Hometown; Originally from Columbia, S. Carolina and now lives in Brighton

Family; Wife, Alice Rutkowski, son, Duncan, 8

Occupation; He is Medical Director of Blood Services (East Division) for the American Red Cross. This coverage area spans seven states in the Northeast including NY and PA.

Education; He earned his D.O. degree from Des Moines University and began post-graduate training in Internal Medicine at Maimonides Medical Center and at the University of Louisville. He spent the first year of his pathology and laboratory medicine residency at the University of Pittsburgh and finished at the University of Rochester. He later did a fellowship in Transfusion Medicine at Emory University Hospital.

Connection to UR; He was a resident in Pathology and Laboratory Medicine from 2004-08. He now serves as faculty for the Transfusion Medicine Fellowship at UR and is a regular judge for Pathology Research Day.

What first brought you to Rochester?

I had never heard of Rochester before I came here for residency and my wife. She’s a tenured professor at SUNY Geneseo, but even before she got tenure we knew we wanted to stay in the area. I targeted this Red Cross job after my training and it’s worked out very well.

Describe a typical day for you at the Red Cross.

I am part of a team of three physicians located in the Upstate NY, Boston, MA and Farmington, CT, who are responsible for all the Red Cross issues in NY, PA, Massachusetts, Maine, Connecticut, Vermont and New Hampshire. Basically, I’m responsible for any donor issues, blood product issues, or any issues with blood products being transfused at the hospital. During the day I get numerous questions about donors – if they’re okay to donate or how to handle some sort of reaction to a donation. I spend a lot of time on the phone with hospitals giving them recommendations. I’m not necessarily in the office a lot

Why did you choose blood banking?

I was actually trained in internal medicine. I wanted to pick something that would allow me to stay as close to patient care as possible. With transfusion medicine, you’re essentially involved with patient care all the time, and that’s why I went in this direction.

What’s something people may not know about your job?

As a medical director at the Red Cross, I’m one step removed from patient care. A lot of times when I’m discussing issues over the phone, it’s hard for people to understand that I don’t have an office where I see patients on a daily basis. I’m almost more of a manager where I oversee the laboratory and the blood products, but it’s more of a managerial role with a little bit of patient care. I don’t fit into the mainstream of what most consider a physician to be.

What advice can you give medical students or trainees?

If you’re not already decided on a field in medicine, when you go out and do your different rotations, pay attention. I went into internal medicine because I liked the lifestyle and the attitude of internal medicine docs, and was turned off of other careers because I didn’t necessarily see myself as that type of individual.

It’s the same thing with pathology. When you’re going through your pathology residency, think about whether you want to be a clinical pathologist because you like the laboratory side of things versus the anatomical side. Really pay attention to what you what you see yourself being in 10 or 10 years because, ideally, this is the job you are going to keep for the rest of your working life. Make sure you’re happy.

Do you have any professional goals for the future?

I did a lot of research when I was in training, and I’d like to get back more into the research field and maybe publish more.

Do you have any hobbies?

I am an avid runner. In the rain or snow, I am out there running every day. Otherwise, I love reading cheap science fiction and horror novels. The rest of my time is spent being a fulltime dad. It keeps me busy but it’s very rewarding. 

Chang Receives Patent for Prostate Cancer Treatment Method

10/28/2016

This month, Chawnshang Chang, Ph.D. received a U.S. patent for a new way to treat and prevent the recurrence of prostate cancer. 

In his description Chang notes that patients who are treated with the commonly used method of androgen deprivation therapy (ADT) often experience a return of the disease, even after remission.

ChangThis second wave of prostate cancer has no known cure and there are few treatment options available. According to the patent, Chang’s method can reduce the chance of recurrence of prostate cancer in patients who have been treated with ADT. To do this, patients are given an anti-androgen agent that prevents cancer cells from rapidly multiplying.

Chang lists several anti-androgen agents that can be used in this way to suppress cancer growth, one of which is ASC-J9, a chemically modified derivative of ginger. One of the most significant findings in this patent is that the cancer-fighting chemotherapy drug cisplatin is able to re-sensitize cancer that is resistant to the anti-androgen drug, enzuluamide.

This is the third patent for Chang, who is the George Hoyt Whipple Distinguished Professor of Pathology, Urology, and Radiation Oncology at URMC and Wilmot Cancer Institute.

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