Biomedical subjects

Molly Walsh

Publications and source records attributed to Molly Walsh.

8 recordsLinked to original sources

PubMed2007

Assessment monitoring of laboratory critical values: a College of American Pathologists Q-Tracks study of 180 institutions.

CONTEXT: Critical laboratory value reporting is a highly visible and essential key activity for clinical laboratories. OBJECTIVE: To measure critical laboratory value reporting in multiple institutions over time and to examine the practice patterns and demographic factors associated with sustained improvement in critical value reporting. DESIGN: A longitudinal cohort study of 180 clinical laboratories that provided quarterly critical values reporting data for 2 to 16 quarters was conducted using a uniform definition of successful caregiver notification. Mixed linear model analysis of the 2001 through 2004 dataset was performed. RESULTS: A decrease in total and inpatient rates of undocumented critical values per 1000 results was associated with (1) the American Association of Blood Banks inspection within the past 2 years (P = .01, for both total and inpatient rates); (2) unit secretary/clerical staff not authorized to accept inpatient critical value notification (P = .004 [total] and .001 [inpatient]); and (3) the mandatory practice of requiring notification of health care providers when handling inpatients known to have results repeatedly in the critical range (P = .01, for both total and inpatient rates). Continued participation in the Q-Tracks monitoring program was associated with significant and progressive improvement in total, inpatient, and outpatient critical value reporting (P = .02, .01, and .003, respectively). CONCLUSIONS: Critical value reporting improved as the duration of participation in the Q-Tracks monitoring program increased. Improved total and inpatient critical value reporting was associated with factors that may be markers for institutions with priorities of quality management and enhanced communication with responsible caregivers.

Benchmarking↗

PubMed2006

Inhibition of cell proliferation by mitomycin C incorporated into P(HEMA) hydrogels.

OBJECTIVES: The technique of mitomycin C (MMC) drug delivery and its application in glaucoma surgery are not standardized with resultant inconsistencies in the results. Also, one time application of MMC does not seem to have the same efficacy after glaucoma drainage device surgeries compared with trabeculectomies. This preliminary study examined the efficacy of a slow release form of MMC for its ability to inhibit cell proliferation in vitro. METHODS: MMC was incorporated into 1% P(HEMA) hydrogels using a redox polymerization method. For some experiments, unreacted low molecular weight components were removed from the hydrogels before the MMC was incorporated. Sterile disks (8 mm) of each polymer sample were affixed to 60 mm tissue culture dishes, and the dishes were inoculated with COS-1 cells or early passage human conjunctival fibroblasts. After 7 days in culture, the number of cells in each dish was determined. Cell morphology was assessed in replicate cultures after fixation and staining. RESULTS: Hydrogels with unreacted low molecular weight components slowed cell proliferation and induced morphologic changes. Early passage human conjunctival fibroblasts were more sensitive than COS-1 cells both to intrinsic contaminants in the hydrogels and to incorporated MMC. Once contaminants had been removed, MMC-loaded hydrogels inhibited conjunctival fibroblast proliferation in a dose-dependent fashion, with an IC50 of approximately 0.15 mg/g polymer. CONCLUSIONS: This study demonstrates that a slow release form of MMC can inhibit cell proliferation in vitro. Future experiments will focus upon the efficacy of this polymer-bound form during in vivo wound healing.

Adult↗

PubMed2006

The significance of certification in liquid-based cytology and performance in the college of american pathologists interlaboratory comparison program in cervicovaginal cytopathology.

CONTEXT: Morphology training and certification provided by the manufacturer is required before laboratories are allowed to prepare and interpret liquid-based cytology (LBC) gynecologic slides. Whether this certification is associated with improved LBC interpretation performance is not known. OBJECTIVE: To determine whether LBC certification correlates with performance. DESIGN: The results of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytopathology for the year 2004 were reviewed. During this year a question on the answer form asked participants whether they were certified in LBC preparations. Participant responses were analyzed at 2 levels of agreement with the reference diagnosis of unknown glass slides mailed quarterly. RESULTS: For cytotechnologists and pathologists, participants who were LBC certified had a significantly lower total discordant rate to series than participants who were not certified for validated LBC ThinPrep (Cytyc Corp, Marlborough, Mass) preparations (P < .001 for both groups). The results were similar for validated conventional preparations for pathologists but not for cytotechnologists. The differences were present across most individual diagnostic series. Differences were most striking for low-grade squamous intraepithelial lesions. In addition, cytotechnologists and pathologists who were certified had a significantly lower total discordant rate to the exact diagnosis for validated LBC ThinPrep slides than those who were not certified (discordant rates for cytotechnologists, 14.14% and 23.36%, respectively, P < .001; for pathologists, 15.99% and 24.07%, respectively, P < .001). CONCLUSION: Although not all confounding factors were excluded in this study, LBC certification is associated with a significantly lower discordant rate to both series and exact diagnosis for validated LBC ThinPrep preparations.

Allied Health Personnel↗

PubMed2006

Laboratory productivity and the rate of manual peripheral blood smear review: a College of American Pathologists Q-Probes study of 95,141 complete blood count determinations performed in 263 institutions.

CONTEXT: Automated laboratory hematology analyzers are capable of performing differential counts on peripheral blood smears with greater precision and more accurate detection of distributional and morphologic abnormalities than those performed by manual examinations of blood smears. Manual determinations of blood morphology and leukocyte differential counts are time-consuming, expensive, and may not always be necessary. The frequency with which hematology laboratory workers perform manual screens despite the availability of labor-saving features of automated analyzers is unknown. OBJECTIVE: To determine the normative rates with which manual peripheral blood smears were performed in clinical laboratories, to examine laboratory practices associated with higher or lower manual review rates, and to measure the effects of manual smear review on the efficiency of generating complete blood count (CBC) determinations. DESIGN: From each of 3 traditional shifts per day, participants were asked to select serially, 10 automated CBC specimens, and to indicate whether manual scans and/or reviews with complete differential counts were performed on blood smears prepared from those specimens. Sampling continued until a total of 60 peripheral smears were reviewed manually. For each specimen on which a manual review was performed, participants indicated the patient's age, hemoglobin value, white blood cell count, platelet count, and the primary reason why the manual review was performed. Participants also submitted data concerning their institutions' demographic profiles and their laboratories' staffing, work volume, and practices regarding CBC determinations. The rates of manual reviews and estimations of efficiency in performing CBC determinations were obtained from the data. SETTING: A total of 263 hospitals and independent laboratories, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program. RESULTS: There were 95,141 CBC determinations examined in this study; participants reviewed 15,423 (16.2%) peripheral blood smears manually. In the median institution (50th percentile), manual reviews of peripheral smears were performed on 26.7% of specimens. Manual differential count review rates were inversely associated with the magnitude of platelet counts that were required by laboratory policy to trigger smear reviews and with the efficiency of generating CBC reports. Lower manual differential count review rates were associated with laboratory policies that allowed manual reviews solely on the basis of abnormal automated red cell parameters and that precluded performing repeat manual reviews within designated time intervals. The manual scan rate elevated with increased number of hospital beds. In more than one third (35.7%) of the peripheral smears reviewed manually, participants claimed to have learned additional information beyond what was available on automated hematology analyzer printouts alone. CONCLUSION: By adopting certain laboratory practices, it may be possible to reduce the rates of manual reviews of peripheral blood smears and increase the efficiency of generating CBC results.

Blood Cell Count↗

PubMed2003

Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.

CONTEXT: Numerous studies address the accuracy or positive predictive value of cytologic interpretations for defined histopathologic entities. The reproducibility (precision) of cytologic interpretation is less well defined. OBJECTIVE: To establish and compare the reproducibility (precision) of cytologic interpretation in gynecologic cytopathology, as reflected in the educational program of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology (PAP). METHODS: The pathologists' interpretations for both validated (25 745 responses) and educational conventional (14 353 responses) slides in the PAP program for 2001 were analyzed. The frequency of exact matches between the reference and pathologists' interpretation for each of the cytologic interpretative categories was identified, and the cumulative distributions of exact match rates were derived. chi2 Tests by reference interpretations were used for cytodiagnostic categories, least and most reproducible groupings, and high-grade (HSIL) versus low-grade (LSIL) squamous intraepithelial lesions. RESULTS: Pathologists' interpretations of negative, Candida, Trichomonas, herpes, and LSIL were characterized by a high degree of exact matching, while interpretations of repair, HSIL, adenocarcinoma, and squamous cell carcinomas were characterized by a lesser degree of exact matching (reproducibility). Pathologists' cytologic interpretations of HSIL were significantly less reproducible than those of LSIL. CONCLUSION: The cytologic interpretations of the most significant categories (HSIL, squamous cell carcinoma, and adenocarcinoma) are less precise than those of specific infection (Candida, Trichomonas, and yeast), negative, and LSIL categories. Cytologic interpretations of LSIL are made with greater precision than those of HSIL and may represent a more appropriate endpoint to measure the precision performance of gynecologic cytology laboratories.

Adenocarcinoma↗

PubMed2003

Five-year follow-up of routine outpatient test turnaround time: a College of American Pathologists Q-Probes study.

CONTEXT: Timely reporting of outpatient tests can increase efficiency of care and improve customer satisfaction. OBJECTIVES: We conducted a survey in 2002 to determine how quickly hospital-based laboratories turned around routine requests for 3 common assays and compared the results with a similar survey conducted in 1997. DESIGN: One hundred eighteen laboratories prospectively recorded the collection-to-verification turnaround time for 9252 complete blood cell counts (CBCs), 8832 thyroid tests, and 9193 basic metabolic panels. RESULTS: The median facility reported all test results by 7:00 am of the weekday immediately after the date of specimen collection. The bottom 10% of institutions reported 99% of CBCs and basic metabolic panels within 1 day and 60% of thyroid tests within 1 day. The 65 institutions that participated in both the 1997 and 2002 surveys showed significant overall improvement in turnaround time for all 3 types of tests (P <.001). In 2002, federal institutions had significantly slower turnaround times than nonfederal institutions for CBC tests (P <.001), thyroid tests (P =.03), and basic metabolic panels (P <.001). Other demographic and practice variables were not associated with turnaround time. CONCLUSION: The turnaround time of routine outpatient tests appears to have improved between 1997 and 2002.

Blood Cell Count↗

PubMed2003

Six-year trends in laboratory computer availability.

CONTEXT: Failure of a clinical laboratory computer system can disrupt work flow and charge capture and affect patient care. The first comprehensive survey of computer downtime was conducted in 1995 and demonstrated significant interinstitutional variation in system availability. Despite numerous changes in the laboratory and computer industries since 1995, no follow-up study has been reported. OBJECTIVES: To quantify current laboratory computer availability and compare it with 1995 performance. DESIGN: Ninety-seven laboratories prospectively recorded the frequency and duration of computer downtime during 30 days in 2001. Results were compared with 1995 survey data. RESULTS: For the median facility, the number of downtime episodes decreased from 8 events per 30 days during 1995 to 3 events per 30 days during 2001 (P <.01). The frequency of unscheduled downtime also improved, from a median of 2 to 0.5 events per 30 days (P <.01). Reduced downtime events were paralleled by reduced cumulative downtime (14.3 vs 4.0 hours per 30 days; P <.01). Improvements were not restricted to the median facility; laboratories performing in the bottom quartile in 2001 recorded substantially less downtime than laboratories in the bottom quartile in 1995. When the comparison was restricted to the 37 institutions that participated in both the 1995 and 2001 surveys, a significant reduction in overall downtime and unscheduled downtime events was still evident (P <.01). More recent installation of vendor software patches was associated with a reduced frequency of downtime events in the 2001 data set. CONCLUSION: Laboratory computer downtime was less frequent in 2001 than in 1995; industry performance appears to be improving.

Clinical Laboratory Information Systems↗

PubMed2003

Customer satisfaction in anatomic pathology. A College of American Pathologists Q-Probes study of 3065 physician surveys from 94 laboratories.

CONTEXT: Measurement of physicians' and patients' satisfaction with laboratory services has recently become a requirement of health care accreditation agencies in the United States. To our knowledge, this is the first customer satisfaction survey of anatomic pathology services to provide a standardized tool and benchmarks for subsequent measures of satisfaction. OBJECTIVE: This Q-Probes study assessed physician satisfaction with anatomic pathology laboratory services and sought to determine characteristics that correlate with a high level of physician satisfaction. DESIGN: In January 2001, each laboratory used standardized survey forms to assess physician customer satisfaction with 10 specific elements of service in anatomic pathology and an overall satisfaction rating based on a scale of rankings from a 5 for excellent to a 1 for poor. Data from up to 50 surveys returned per laboratory were compiled and analyzed by the College of American Pathologists. A general questionnaire collected information about types of services offered and each laboratory's quality assurance initiatives to determine characteristics that correlate with a high level of physician satisfaction. SETTING: Hospital-based laboratories in the United States (95.8%), as well as others from Canada and Australia. PARTICIPANTS: Ninety-four voluntary subscriber laboratories in the College of American Pathologists Q-Probes quality improvement program participated in this survey. Roughly 70% of respondents were from hospitals with occupied bedsizes of 300 or less, 65% were private nonprofit institutions, just over half were located in cities, one third were teaching hospitals, and 19% had pathology residency training programs. MAIN OUTCOME MEASURES: Overall physician satisfaction with anatomic pathology and 10 selected aspects of the laboratory service (professional interaction, diagnostic accuracy, pathologist responsiveness to problems, pathologist accessibility for frozen section, tumor board presentations, courtesy of secretarial and technical staff, communication of relevant information, teaching conferences and courses, notification of significant abnormal results, and timeliness of reporting). RESULTS: The database of 3065 physician surveys was derived from 94 laboratories. An average of 32.6 surveys (median 30) was returned per institution, with a range of 5 to 50 surveys per institution. The mean response rate was 35.6% (median 32.5%). The median (50th percentile) laboratory had an overall median satisfaction score of 4.4. The lowest satisfaction scores that were obtained all related to poor communication, which included timeliness of reporting, communication of relevant information, and notification of significant abnormal results. Statistically significant associations of customer satisfaction with certain institutional characteristics and laboratory performance improvement activities were identified. CONCLUSIONS: The importance of this satisfaction survey lies not in its requirement as an exercise for accrediting agencies but in understanding the needs of the customer (in this case the physician) to direct performance improvement in the delivery of quality anatomic pathology laboratory services.

Consumer Behavior↗