Celebrating 10 years of Point of Care testing

December 18, 2023 by Renee Mantle Leave a Comment

At NSW Health Pathology (NSWHP), we manage the largest accredited Point of Care Testing (PoCT) service in the world.

This vital service has been growing since the day we went live in Narromine ten years ago, with over 1100 PoCT devices now in 190 health services across NSW.

PoCT uses mobile devices to analyse pathology samples, like blood and saliva, and provide on-the-spot results at a patient’s hospital bedside or in the community. We help to make sure that patients can get quality, reliable pathology tests, at the time they need them the most.

To celebrate the 10-year anniversary of PoCT and reflect on just how much the service has evolved, we caught up with a member of the original PoCT team who launched our Narromine service in 2013, Gayle Warnock, Acting Operations Manager PoCT.

What did the PoCT service look like when you launched the service at Narromine in October 2013?

Prior to 2013 when NSWHP began rolling out our PoCT network, local point of care testing was disjointed. There weren’t enough services to cover the growing demand, particularly in our rural and regional areas.

How has the PoCT service changed over 10 years?

Our service has been expanding since day one and it is amazing to reflect on what has been achieved.

We’ve added devices in more rural and remote hospitals to ensure more patients in NSW can access urgent and sometimes lifesaving pathology services.

We have worked with our NSW Health colleagues to connect existing PoCT devices that were in regular use in hospitals and clinics to electronic medical records (eMRs) and quality management systems, helping us to provide truly connected care.

We’ve continued to add new and higher-quality devices to improve our services as new technology and more point of care pathology tests became available.

Our POCT service has matured so much over the past 10 years. We have a comprehensive governance system, world leading Quality Control (QC) and Quality Assurance Plan (QAP) management tools and have developed simpler and more accessible training systems to support our health care providers and clinical teams.

We are even now branching out into AI systems and a stronger IT infrastructure to provide better insights into our PoCT service. PoCT is not just pathology! It’s a combination of technology, people and data management, melding together to shape what NSW Health and our patients and communities need now, and into the future.

What does the growth in PoCT testing mean for clinicians and patients in regional and rural communities?

The availability of PoCT can be lifesaving for people in rural and remote communities. In its most extreme examples, it provides vital emergency and primary health services like the Toll Ambulance Rescue Helicopter Service and Royal Flying Doctor Service (RFDS) with access to critical pathology results that give seriously injured and unwell patents the best chance at survival.

On a day-to-day level, local PoCT services help people to stay in their homes and communities and avoid unnecessary travel and hospital admissions. It’s so much better to be near friends and family when you’re unwell, rather than need to be transferred hundreds of kilometres from home for care.

In more metropolitan areas, PoCT also helps to break down barriers for people with challenges accessing healthcare. Those who don’t have English as a first language, who struggle with transport, isolation, or mental health issues. Having a result straight away when seeing their specialist or clinic can help provide the best care to everyone accessing NSW Health services.

What do you love most about working in the PoCT space?

I love the problem solving! There is never a dull day and I get to work with so many diverse groups both within pathology and in the clinical space. We have so many opportunities to develop systems that really contribute to patient care, to pathology and even into the growth of PoCT nationally as our peers in other states develop their own systems.

What is your vision for PoCT?

My vision is for PoCT to be a fully connected clinical resource. To support our health care colleagues, connect into clinical decision tools and patient management systems and maintain a laboratory quality standard of results.

There are so many new PoCT options available now as technology allows for smaller and smaller systems, new diagnostic markers are being found and everyone wants an immediate answer.

I want to see NSW Health Pathology as the leading voice on PoCT. To see us lead the way with validated high-quality systems that provide meaningful results to people, no matter where they are in NSW.

We are committed to developing and improving our PoCT service and can’t wait to watch it continue to grow over the next 10 years. Learn more about the service here.

Using art to connect sorry business with healing at Forensic Medicine

December 16, 2023 by Liz Farquhar Leave a Comment

These beautiful painted leaves help families mourning the unexpected or unexplained death of someone close. But they’re also helping to heal the women who paint them.

In a sun-filled room near the shores of Lake Macquarie a group of First Nations women gather to paint, share stories and food, and most of all, to support each other.

The Nikinpa art group began as a short-term art therapy program, but several years later it’s still going strong, thanks to the women who say it’s helping to change their lives for the better.

Aunty Brenda Simon is a proud Wiradjuri woman from the small town of Gulargambone in Central West NSW. All seven of Brenda’s children were taken from her by government authorities in the 1970s, and her story is now the subject of a powerful new documentary, The Last Daughter, on Netflix.

Aunty Brenda attends the art group each week and says painting leaves has helped build connections in her community.

An elderly First Nations woman stands in a garden wearing a black shirt with red, yellow and white Aboriginal designs. — Wiradjuri woman, Aunty Brenda Simon says the art group helps to keep her connected to the local First Nations community.

“It just gives you that good feeling just to come in and sit down, just to paint leaves and get your mind going. I just love it,” she said.

Aunty Jill Jessop is a Wailwan woman, also from Central Western NSW, and says the group provides an important gathering place for the women, as well as a chance to create something that makes a big difference in the lives of others.

“It’s a safe place for all women, it’s just been amazing to see how much the women have grown. It’s given them a purpose,” Aunty Jill said.

The women collect the gum leaves either from the local Newcastle area, or from across regional NSW when they travel back home to country.

The leaves are then dried for several weeks and brought into the Nikinpa art room at Toronto where the women paint intricate designs in a rainbow of colours.

A First Nations woman stands on a sunny walkway. — Aunty Jill Jessop says the Nikinpa Art Group is a safe space for women and has helped them heal and grow together.

“The picking of the gum leaves is a thing, finding the right gum leaves. We’re always out in the bush looking,” explains Aunty Jill.

“A lot of us use the traditional symbols, but there’s no right or wrong way, there’s no story, really to our leaves. It’s the purpose of why we do them, that’s our story.”

“A conversation starter”

The gum leaves they paint end up at NSW Health Pathology’s forensic medicine facility in Newcastle, where specialist social workers support families who are grieving after an unexpected death reported to the Coroner.

Families are encouraged to place the leaves with their person and can also take a leaf home to remember them and their ongoing connection.

“It’s a real conversation starter,” said Danny Nugus, Senior Forensic Medicine Social Worker. (pictured below – back row, second from left)

“You get to know the person, even if the family are unable to get to Newcastle and we’re just talking over the phone. I’ll talk to them about the leaves, and ask what sort of leaves do you think they’d like? They might say, ‘well he was a mad Rabbitohs fan’, and we’ll find them a leaf with those colours.

“There might be a leaf design with a particular number of circles, matching the number of siblings that person had, or styles and patterns that fit with where they and their mob are from, what their totem is. Each leaf is as unique and precious as the person who painted it and the person who the leaf finds,” he said.

The leaves provide an important connection for grieving First Nations families but are also respectfully accepted by non-Indigenous families.

For one of the women at the Nikinpa art group, the leaves were a welcome sight when she was confronted with the sudden death of a relative and visited the Newcastle forensic medicine facility.

“Not long ago I had to go into forensics as a personal experience myself, and we had to say our goodbyes,” said Bonny Roberts, a Moandik woman from South Australia.

“I went into the family room and here was a basket of our leaves all painted up. Just the warmth of the whole experience of that, it didn’t feel so clinical.

“We had leaves to place with Pop and it was amazing to pick them out. It was just really personal. I’ve seen it from both sides now, and I couldn’t thank the ladies enough when I came back to Nikinpa.”

The art group is now providing art workshops at schools in the Lake Macquarie area, teaching students to paint their own leaves.

“The kids get involved and we explain to them what the leaves mean and where they go,” said Bonny.

“We ask them at the end would you like to keep your leaf? Or would you like to donate it? And 90 per cent of them want to donate it, they say, ‘no we want to give it’ and it goes in the forensic box.”

NSW Health Pathology’s Forensic & Analytical Science Service Director Michael Symonds (pictured below – back row, far right) expressed his heartfelt thanks to members of the Nikinpa art group for sharing their stories and their artwork.

“The leaves offer comfort and meaning to bereaved families at Forensic Medicine, and we’re honoured to have this important connection to the local Indigenous community,” Mr Symonds said.

A group of men and women outside a building with a Forensic Medicine sign. — Members of the Nikinpa Art Group visit staff at Newcastle Forensic Medicine, where their painted leaves provide comfort to grieving families.

Dominic Dwyer calls time on 40+ year career in virology and public health pathology

December 15, 2023 by Liz Farquhar Leave a Comment

He became the public face of our pathology services during the COVID-19 pandemic, but now Professor Dominic Dwyer PSM is retiring after more than four decades dedicated to researching, diagnosing, and treating infectious diseases.

Professor Dominic Dwyer PSM is a world-renowned medical virologist and infectious diseases physician at NSW Health Pathology’s Institute of Clinical Pathology and Medical Research (ICPMR) at Westmead Hospital.

His long and distinguished career spans nearly 42 years and has taken him all over the globe to investigate viral outbreaks that threaten the safety of communities.

When he’s not consulting with international experts or sharing his insight and experience at health conferences, he has been a trusted spokesperson on public health and emerging infections.

A man wearing a white lab coat and face mask swabbing the nose of a woman seated in front of him. — Professor Dwyer on the front lines of COVID testing while on sabbatical in Paris.

We’ve lost count of how many media interviews he has enthusiastically given during the COVID-19 pandemic and he is a globally renowned researcher with over 500 published papers.

Dominic undertook postgraduate research in HIV/AIDS at the Institute Pasteur in Paris, France, before going on to the lead the World Health Organization (WHO) National Influenza Centre in Westmead.

He has extensive experience in pandemic responses, even prior to COVID-19. His work in molecular testing for HIV spans three decades and he assisted the WHO to manage the SARS outbreak in China nearly 20 years ago.

“Dominic has been an exemplary public servant and a role model for collaborative leadership and innovative ideas,” NSW Health Pathology Chief Executive Vanessa Janissen said.

“He’s a trusted voice in the laboratory, in the clinic and the media, but perhaps his biggest test came with the devastating global COVID-19 pandemic.

“Working around the clock, he marshalled our expert ICPMR-Westmead team, developing scientific breakthroughs to advance the health response to the COVID-19 pandemic.”

In 2020 Dominic was selected by the WHO to be part of an international team of physicians, scientists and researchers to explore the origins of the coronavirus in Wuhan, China.

A man wearing a surgical face mask leans on a balcony railing in a high-rise brick building. — Dominic Dwyer in Wuhan, China. (Photo credit: Rhett Whyman, SMH)

Dominic’s contribution to the pandemic response earned him an Honourable Mention in the 2021 NSW Public Servant of the Year award.

He was awarded the Public Service Medal in the 2022 Australia Day Honours List for outstanding public service as an infectious disease expert and public health advisor in NSW, and the French Government’s ‘Chevalier de l’Ordre National du Mérite’ in 2021 for COVID-19 services.

Congratulations on a stellar career Dominic, and we wish you a long and enjoyable retirement!

A close up of a man's face above a row of test tubes. — Hanging up the lab coat after more than 40 years.

New Cooma pathology laboratory opens

December 13, 2023 by Liz Farquhar Leave a Comment

We’re excited to show off our brand-new pathology laboratory at Cooma Hospital. It features the latest technology and will bring enormous benefits for patients, staff and the wider Cooma community.

The pathology laboratory has been completed as part of the NSW Government’s $26.5 million investment in the Cooma Hospital redevelopment that also includes an expanded emergency department, ambulatory care centre and a new maternity department.

The laboratory features new equipment and the latest technology, including new chemical pathology analysers which NSW Health Pathology is rolling out in regional locations across the state as part of a $29 million investment.

The chemical analysers can carry out a range of common pathology tests, including liver and kidney function tests and monitoring for diabetes.

Senior Hospital Scientist in Charge at Cooma, Jo-Anne Hagger, says the refurbished laboratory will deliver significant benefits for both patients and pathology staff at Cooma Hospital.

“We have a new collections room on Level B at the Cooma Hospital where people can go for blood tests,” she said.

“We bulk bill and accept all referrals, and you don’t need an appointment.

“There are also on-site, lifesaving blood transfusion services available.”

The Cooma pathology laboratory operates 7 days a week and performs more than 40,000 pathology tests each year.

A big thank you to Jo-Anne Hagger for leading this redevelopment with the support of Local Pathology Director Matthew Watts, Operations Manager Peter Tomlinson, and the entire Cooma team.

Our Planning team has also been there every step of the way, and a huge thanks goes to Geoff Channels who was involved in the design and Pankaj Gaur who project managed the laboratory decant and was on-site to help with all the logistics for relocating equipment between hospital floors.

We’re proud to be serving the Cooma community!

Will Japanese encephalitis return this summer?

December 5, 2023 by Liz Farquhar Leave a Comment

The last two summers have been swarming with mosquitoes thanks to near constant rain and flooding brought on by La Niña.

With the return of El Niño, and a hot, dry summer in store, what’s the outlook for Japanese encephalitis and other mosquito-borne diseases?

First, let’s look back at the last two summers

The boom in mosquitoes over the last two springs and summers didn’t just bring an increased annoyance of buzzing and bites but also outbreaks of potentially fatal mosquito-borne disease.

The first outbreak of Japanese encephalitis virus was first detected in southern regions of mainland Australia in February 2022.

This was followed by the return of Murray Valley encephalitis in early 2023, which turned out to be the biggest outbreak in the southern states since 1974.

These outbreaks were the result of more than just more mosquitoes. Floodwaters provided ideal breeding conditions for waterbirds, the key “reservoirs” of these viruses.

Mosquitoes pick up the infection after feeding on the birds and then subsequently spread the viruses to people when they bite.

What’s different about Japanese encephalitis?

Outbreaks of Japanese encephalitis virus in temperate regions of Australia in 2022 came as a surprise. There had been activity in northern Australia and the Torres Strait, but it was generally only considered a risk to overseas travellers.

In India, Southeast Asia, and the Western Pacific, Japanese encephalitis is considered one of the most dangerous mosquito-borne diseases, with tens of thousands of cases of severe infection each year.

While the majority of people infected suffer no or very mild symptoms, some will experience neck stiffness, fever, headache and, in the most severe cases, permanent neurological complications or death.

However, a vaccine is available that can significantly limit serious illness.

The discovery of Japanese encephalitis virus in Australia’s southern states triggered a declaration of a “communicable disease incident of national significance”. This was in place from March 2022 through June 2023. A total of 45 people were infected, seven of whom sadly died.

It wasn’t just people who were at risk. The impact on commercial piggeries, which farm pigs for pork production, was devastating and required urgent strategies to control mosquitoes.

Piggeries weren’t the source of the outbreak, they were the “canaries in the coalmine” – signalling the spread of the virus early on and the need to protect the broader community.

What caused outbreaks in piggeries?

Our research investigated how different landscapes and weather patterns influence interactions between wildlife, mosquitoes, and outbreaks of Japanese encephalitis virus.

We looked at 62 piggeries where the virus had been detected and some locations where the virus had also been detected in mosquitoes, along with waterbird and feral pig habitats, rainfall and temperature.

Some of the results were unexpected. Piggeries were at highest risk of an outbreak when the number of different waterbird species in their location was “just right”. If there were too few or too many, the risk of an outbreak was reduced.

A group of pigs in a muddy yard. — Feral and domestic pigs can be infected with Japanese encephalitis virus and also infect mosquitoes that feed on them. Cameron Webb (NSW Health Pathology)

High rainfall and flooding provided excellent conditions for mosquitoes, with temporary wetlands and flooded areas posing a greater risk than permanent wetlands.

Temporary wetlands may have provided habitat for waterbirds whose normal habitat and movement patterns were disrupted due to the extensive La Niña flooding.

Or perhaps permanent wetlands support a greater diversity of aquatic life (including animals that eat mosquitoes) that helped keep mosquito numbers lower than temporary waterbodies.

So what might happen this summer?

The return of El Niño is expected to bring below average rainfall and above average temperatures. But that can be unpredictable. Wetlands are already drying up. Bushfires have replaced floods.

Mosquito populations are expected to decline sharply. Surveillance programs of state and territory health authorities, such as New South Wales and Victoria, are already reporting mosquito populations far lower than previous seasons.

So we may not see as much Japanese encephalitis this season. But that doesn’t mean it will disappear completely.

It doesn’t matter how hot and dry it gets, mosquitoes are resilient and will persist. They’ll seek out the same environments where water remains. So too will waterbirds and feral pigs.

Authorities are also on alert for the return of Ross River virus along the coast. Despite the lower rainfall, the mosquitoes that live in saltwater wetlands will thrive following flooding by high tides, especially “king tides”.

Combined with extreme weather, even during hot and dry summers, outbreaks of Ross River virus can occur.

How can you reduce your chance of getting these viruses?

To protect yourself and family from mosquito bites and mosquito-borne disease:

keep following the advice of health authorities
try to avoid bushland and wetland areas in late afternoon and early evening
cover up with long-sleeved shirts, long pants and covered shoes
apply a recommended insect repellent
check your eligibility for a Japanese encephalitis vaccination.

Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; Michael Walsh, Senior Lecturer of Infectious Disease Epidemiology, University of Sydney, and Victoria Brookes, Lecturer in Epidemiology and One Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The important work of a dissection scientist in a pathology laboratory

November 22, 2023 by Liz Farquhar Leave a Comment

Kajaal Prasad is the team leader in dissection at our Nepean laboratory, playing a key role in the diagnosis and treatment of patients.

Kajaal has been working as a Hospital Scientist (Dissection Scientist) at NSW Health Pathology for just over four years and prior to that was working in pathology in the private sector.

She worked at Westmead Hospital in Anatomical Pathology as a dissection technician before progressing to work as a Dissection Scientist at Nepean.

“Pathology is most definitely the ‘hidden’ part of medicine,” she says.

“When most people hear I work in pathology – they automatically think blood collection. Pathology has so many sub-fields and anatomical pathology is just one of them. We work collectively behind the scenes to provide patients with crucial details regarding their diagnosis and best treatment options.”

As the team leader in dissection, Kajaal oversees the safe and efficient daily operation of cut-up including the triage of specimens.

“I also conduct macroscopic dissection (cut-up) and analysis of non-complex specimens such as biopsies, small organs as well as complex specimens including partial and/or whole organs – basically I cut up organs!

“The work I do in dissection plays a significant role in the diagnosis and treatment of patients as it provides crucial information required for pathology diagnosis. For example, in cancer cases we assess tumours in any given organ and map the tumour to crucial anatomical landmarks to identify whether the tumour is confined within the organ or has potentially spread – which then assists in cancer staging and treatment for patients.”

Kajaal also provides dissection training and support to the laboratory’s dissection technician, scientist and pathology trainees.

She is passionate about anatomy, healthcare, and education.

“This role combines all these components together as I get to use my anatomical knowledge, play a role in many individuals diagnostic journey and share my knowledge to other members of the team during training sessions. It’s the perfect role for me.

“There’s always something new – no one day looks the same. We definitely get some interesting cases that come along which always provides an opportunity to learn. For me, the most rewarding part of my role is being able to help patients with their pathology diagnosis. The next rewarding aspect of my role would be teaching our pathology trainees – they are our future pathologists.”

A woman works at a laboratory bench wearing a white lab coat. — Kajaal says pathology is the “hidden” part of medicine but is a very rewarding career.

In addition to her work at NSW Health Pathology, Kajaal is also a PhD candidate.

“My research is looking at developing high-fidelity 3D printed breast specimens for dissection training for pathology trainees.”

Kajaal says she would definitely recommend a career in anatomical pathology, saying it provides great flexibility to work independently and within a team.

“It’s a place for continuous learning – if you aren’t afraid of organs or other bodily fluids,” she said.

“I also get to work with a wide range of people in the medical field who share insights about cases. We often get to discuss complex cases with surgeons who complete the surgery of the specimens we receive, working together to provide patients with the best possible outcome.”