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At least 703 records · Page 39Linked to original sources
PubMed1996

Quality assurance of autopsy face sheet reporting, final autopsy report turnaround time, and autopsy rates: a College of American Pathologists Q-Probes study of 10003 autopsies from 418 institutions.

OBJECTIVE: To develop a multi-institutional reference database of autopsy practice and performance for quality improvement purposes. DESIGN: In 1990, participants in the Q-Probes quality improvement program of the College of American Pathologists (CAP) each retrospectively evaluated the 25 most recently completed consecutive autopsy reports and determined the number of deaths and autopsies that occurred in their institutions during 1989. SETTING: Hospital-based autopsies excluding forensic cases and stillborn infants. PARTICIPANTS: Four hundred ten institutions in the United States and eight institutions in Canada. MAIN OUTCOME MEASURES: Completeness of face sheet information contained in final autopsy reports, turnaround time for completion of final reports, and institutional autopsy rates. RESULTS: In the aggregate database of 10003 autopsies, the following six data items (from a total of 21) were present in 95% to 100% of the final autopsy reports in at least 85% of the participating institutions: institution where autopsy was performed, patient's name, patient's sex, autopsy number, autopsy date, and prosecter's name. The turnaround times for the final autopsy reports were as follows: 30 days or less in 47.6% of the cases, 31 to 60 days in 28.8%, and more than 60 days in 23.7%. A higher median percentage of autopsy final reports were completed in 30 days or less in institutions with the following characteristics: nonteaching (P < .004), no pathology residency program (P < .002), and rural location (P < .027). A lower number of autopsies performed in 1989 was associated with a higher median percentage of final reports completed in 30 days or less (P < .007). The aggregate autopsy rate for all participating institutions was 12.4%, and the median rate was 8.3%. Median autopsy rates for teaching institutions and institutions with pathology residency training programs were 15% and 19%, respectively. CONCLUSIONS: This multi-institutional study identified a core group of face sheet data items that were consistently present on final autopsy reports. However, the majority of the face sheet data items examined were inconsistently recorded. Approximately 75% of final autopsy report turnaround times were within the standard established by the Joint Commission on Accreditation of Healthcare Organizations. Nearly two thirds of the institutions reported autopsy rates for 1989 of 0% to 10%.

Autopsy↗
PubMed1996

Extraneous tissue in surgical pathology: a College of American Pathologists Q-Probes study of 275 laboratories.

OBJECTIVE: To develop a multi-institutional reference database of extraneous tissue (contaminants) in surgical pathology. DESIGN: In 1994, participants in the College of American Pathologists Q-Probes quality improvement program performed prospective and retrospective evaluations of extraneous tissue found in surgical pathology microscopic sections for a period of 4 weeks or until 1000 slides were reviewed in each participating laboratory. PARTICIPANTS: Two hundred seventy-five surgical pathology laboratories institutions, predominantly from North America. MAIN OUTCOME MEASURES: Extraneous tissue contamination rate for slides in prospective and retrospective reviews; staffing and practice procedures; location of extraneous tissue on slides; type of extraneous tissue (normal, abnormal, nonneoplastic, neoplasm, microorganisms, etc); class of extraneous tissue (slide or block contaminants); source of extraneous tissue (different or same case); origin of extraneous tissue (pathology laboratory, physician's office or operating room); and degree of diagnostic difficulty caused by extraneous tissue. RESULTS: Three hundred twenty-one thousand seven hundred fifty-seven slides were reviewed in the prospective study and 57083 slides in the retrospective study. There was an overall extraneous tissue rate of 0.6% of slides (2074/321757) in the prospective study and 2.9% of slides (1653/57083) in the retrospective study. Of those slides with extraneous tissue, the extraneous tissue was located near diagnostic tissue sections in 59.5% of the slides reviewed prospectively and in 25.3% of slides reviewed retrospectively; deeper sections were performed to evaluate extraneous tissue in 12.2% of prospective cases and in 3.1% of retrospective cases. Of the laboratories, 98% had written guidelines for changing solution in tissue processors, and 64.9% had guidelines for maintaining water baths free of extraneous tissue. A total of 98.9% used lens paper, filter bags, or sponges for processing fragmented and small specimens. Written protocols for documentation of extraneous tissue in surgical pathology reports were established in 6.1% of laboratories, for removal of extraneous tissue from blocks in 5.7%, and for removal of extraneous tissue from microscopic slides in 4.7%. In 24% of laboratories no comment or record was kept to document extraneous tissue. Extraneous tissue consisted of neoplasm in 12.7% of the prospectively reviewed slides and in 6.0% of the retrospectively reviewed slides. For the prospective study, 59.4% of extraneous tissue was classified as slide contaminants, and 28.4% was found to be contaminants within the paraffin block; for the retrospective study, 72.9% was classified as slide contaminants and 15.9% as block contaminants. For the prospective study, 63.2% of extraneous tissue was presumed to be from a different case, and in the retrospective study, 48.5% was presumed to be from a different case. Over 90% of extraneous tissue was thought to originate from the pathology laboratory. The degree of diagnostic difficulty caused by extraneous tissue was judged to be severe in 0.4% of slides in the prospective study and 0.1% of slides in the retrospective study. In the prospective study, it could not be determined whether the tissue in the diagnostic sections was extraneous in 0.6% of slides, and in the retrospective study, it could not be determined whether tissue in the diagnostic sections was extraneous in 0.1%. CONCLUSIONS: This study has documented the frequency, type, origin, source, and diagnostic difficulty of extraneous tissue and presents benchmarks of extraneous tissue experienced in the general practice of surgical pathology.

Databases, Factual↗
PubMed1996

Blood culture quality improvement: a College of American Pathologists Q-Probes study involving 909 institutions and 289 572 blood culture sets.

OBJECTIVE: To evaluate solitary blood culture (SBC) collections as a preanalytic quality indicator of blood culture practice. DESIGN AND SETTING: Two College of American Pathologists Q-Probes laboratory quality improvement studies involving prospective evaluation of the proportion of and reasons for SBC collections in 909 institutions. OUTCOME: Reduction in the proportion of SBCs. RESULTS: Of 289572 blood culture sets studied, the median proportion of SBCs per institution was 10.1% and 12.1% among adult inpatients, 25.4% and 33.3% among adult outpatients, and 89.0% and 100% among pediatric/infant patients in the first and second (follow-up) studies, respectively. The two most common reasons for not performing a second culture in adults were (1) test not indicated and (2) physician believed one was sufficient. When compared with inpatient cultures, a significantly higher proportion of outpatient SBCs were classified as not indicated (P < .0001). Among 198 institutions participating in both studies, a significant decline in SBC rates was observed in the subgroup (n = 50) that continued to monitor SBCs (P = .004). CONCLUSIONS: Interinstitutional evaluation of solitary blood cultures provides a benchmark for quality assessment and an opportunity for performance improvement in blood culture specimen collections.

Bacteremia↗
PubMed1977

Diagnostic laparoscopy from the pathologist's viewpoint.

In conclusion, laparoscopy provides an easy approach to the diagnosis of various intraabdominal diseases. Because biopsy specimens are often small, adequate sampling is essential for accurate diagnosis. It is important for the laparoscopist to understand the basic pathologic anatomy of the diseases under consideration in order to provide the pathologist with adequate diagnostic material. The use of special techniques, including electron microscopy, may be helpful in establishing specific diagnosis in selected difficult cases.

Aged↗
PubMed1992

Interinstitutional assessment of colorectal carcinoma surgical pathology report adequacy. A College of American Pathologists Q-Probes study of practice patterns from 532 laboratories and 15,940 reports.

In 1991, the College of American Pathologist's Q-Probes Quality Improvement Program evaluated practices in 532 institutions for pathologic information provided in surgical pathology reports of 15,940 resected primary colorectal carcinomas. Participating institutions studied their last 30 completed cases and were from the United States (98%), Canada (1.5%), and Australia (0.4%). The influence of various institutional differences and other practice patterns were analyzed to determine factors associated with an increased institutional likelihood of providing information on pathology reports. The one practice significantly associated with increased likelihood of providing complete oncologic pathology information on eight of 11 gross and microscopic information items surveyed was the use of a standard report form or checklist. Other institutional differences bearing inconsistent associations included teaching institution status, presence of pathology residency, use of microscopic descriptions, institution bedsize category, and performance of DNA ploidy analysis. The development and adoption of a standardized report form or checklist for each case is a simple but effective means to assure report adequacy and consistent communication of oncologic pathology information. In conjunction with accompanying criteria for its accurate use, this process can be considered a practice guideline or practice parameter that can be extended to the surgical pathology examination of all resected malignant neoplasms.

Colorectal Neoplasms↗
PubMedDate not supplied

Speech-language pathologists in the schools.

This data page profiles speech-language pathologists working in school facilities. Of particular interest is an examination of differences between those employed in preschools versus other school facilities. Andrea K. Blake is coordinator of ASHA's research division.

Adolescent↗
PubMed1992

The pathologist's role in the diagnosis of cancer.

This brief overview of the activities of the pathologist for cancer patients has shown the primary care physician not only what is involved for the office patient, but also procedures that are out of the scope of office practice. It is intended that this review lead to better patient care through communication and cooperation.

Biopsy, Needle↗
PubMed1992

Quantification of errors in laboratory reports. A quality improvement study of the College of American Pathologists' Q-Probes program.

Over a 3-month period, 61,496 errors were detected in clinical laboratory reports by 631 participants in the College of American Pathologists' 1990 Q-Probes program. Each error detected was defined as an opportunity for improvement. Almost 4% of the detected errors were attributed to nonlaboratory personnel and approximately 4% (A errors) had a major impact on patient care. Rates of B (serious errors, but unlikely to affect patient care) and C errors (minor clerical errors) were approximately equal. When expressed in terms of measures of laboratory work loads, four of six measures of mean errors were lowest in blood banking, intermediate in chemistry and microbiology, and highest in hematology. Thirteen percent of participants did not have an error detection system in place. We conclude that many errors go undetected, and we recommend that an effective system for error detection in patient reports should be employed in all laboratories.

Blood Banks↗
PubMed2003

[Management of ductal carcinoma in situ by the pathologist: current questions].

As a consequence of increased screening mammography, ductal carcinoma in situ represents a growing percentage of breast cancer diagnoses. The management of per-cutaneous biopsies as well as wire-localized surgical biopsies is a difficult task for pathologists. In this Article, we describe the diagnostic criteria of these lesions as well as the histopathological characteristics of their two principal differential diagnoses: atypical ductal hyperplasia and micro-infiltrating carcinoma. We also detail the utility of immunohistochemistry in the diagnosis of these lesions. This paper reviews the accepted prognostic factors for ductal carcinoma in situ and describes the important techniques needed to characterize them (grade and extent, status of margins and exclusion of microinvasion). Correct handling of pathological specimens, as detailed here, is one of the main keys for therapeutic success with ductal carcinomas in situ. Indeed, if dealt with adequately, such lesions should almost never affect the patient's long-term survival.

Adult↗
PubMed2003

[Roles of the pathologist in neoadjuvant chemotherapy: evaluation of response, prognostic and predictive factors].

Induction chemotherapy is a therapeutic option for women presenting with invasive tumors over 3cm. This management is aimed to reduced tumor size in order to avoid mammectomy and to test the in vivo chemo sensitivity of the tumor cells. The pathologist plays a key role in optimal management of patients enrolled in induction chemotherapy trials. Evaluation of pretreatment biopsies contributes to establishment of key management parameters such as tumor type, SBR grade immunohistochemical parameters. This evaluation gives predictive parameters of drug response such as hormonal status, proliferation rate, HER2. The evaluation of the post treatment tumor residue helps in determinating tumor response to treatment, establishing prognosis and adjusting adjuvant regimens. Standard histopathological procedures are mandatory.

Antineoplastic Agents↗
PubMed2003

[Small but high throughput: how "tissue-microarrays" became a favorite tool for pathologists and scientists].

Progress in the knowledge of molecular genetics and availability of high-throughput technologies offer the opportunity to identify new diagnostic and prognostic markers and new therapeutic targets in human cancer. The recently developed "tIssue microarrays" (TMA) technology allows parallel molecular profiling of clinical samples. Using this technique and immunohistochemistry (IHC), fluorescence in situ hybridisation (FISH), or RNA in situ hybridisation (ISH), the pathologist is now able to perform unprecedented large-scale analyses. The advantages are significant: large number of cases assessed simultaneously for numerous markers, processed in identical conditions, from reduced amount of archival tIssues, with an excellent correlation with standard methods, and a reduction in cost and time. This Article provides a short review of this technology, and points out several aspects of the TMA construction and its applications for clinical research.

Biomarkers↗
PubMed2004

[Fifty years of creative work (Society of Lithuanian Pathologists, 1954-2004)].

The article deals with the activity stages and forms of Society of Lithuanian Pathologists (in 1954-1991--Republic Scientific Society of Pathologoanatomists, in 1991-1996--Society of Lithuanian Pathologoanatomists). Founder of the Society and the first President (in 1954-1976) was prof. Janina Mackevicaite-Lasiene, in 1976-1996--prof. Elena Stalioraityte and since 1996 up till now--prof. Dalia Pangonyte. Taking into account the needs of medical research and practice, its activities varied. According to the tasks there are 4 stages of Society activity. The first--establishment of pathological practice, introduction into clinic and pathological practice of pathogenetic and nosologic diagnosis; the second--consolidation and development of pathological practice, conveyance of pathology knowledge, optimization of pathology teaching and training of specialists; the third--reforming of Society and pathological practice, widening of international relations; the fourth--introduction of recent methods and information technologies in pathological practice and teaching. The Society has organized ten republic conference and two congresses, four school-seminars, its members published 19 monographs and collections of articles, 6 textbooks, 28 learning books, 26 methodical recommendations, more than fifty members acquired academic degree.

History, 20th Century↗
PubMed1992

Terminology and specimen adequacy in cervicovaginal cytology. The College of American Pathologists Interlaboratory Comparison Program experience.

The 600 participants in the College of American Pathologists 1991 Interlaboratory Comparison Program in Cervicovaginal Cytology were surveyed by mailed questionnaire in March 1991. The total annual gynecologic specimen volume of the 362 respondents was over 7 million. Nearly all participants (94%) used a descriptive diagnosis for cases not within normal limits. Most (87%) have implemented or plan to implement the Bethesda System. A Papanicolaou class system was not used by 66%. Terminology for reporting squamous lesions with premalignant potential was variable, with many laboratories using two or more sets of terms. Specimen adequacy was routinely reported by 66% of participants. Median rates of unsatisfactory and "less than optimal" specimens reported by participants in 1990 were 0.5% to 0.9% (range, 0% to greater than 20%) and 3.0% to 4.9% (range, 0% to greater than 40%), respectively. Leading reasons for both unsatisfactory and less than optimal smears included scant cellularity, obscuring inflammation, obscuring blood or menses, and poor preservation. Absent endocervical component was also a leading reason for less than optimal specimens. The largest number of respondents required endocervical columnar cells and/or metaplastic cells as the criteria for an endocervical component. In conclusion, nearly all laboratories use descriptive terminology for smears that are abnormal, and most laboratories routinely report specimen adequacy. Frequency and criteria for unsatisfactory and less than optimal smears vary significantly, supporting the need for consensus definitions of specimen adequacy.

Cytodiagnosis↗
PubMed2004

[A new role of pathologists in medical risk management].

Safety management is the prime issue for health professionals. How can we pathologists to improve their risk sense to prevent medical errors? Various autopsy cases such as drug adverse events, unexpected sudden deaths and/or multiple organ failures after operations have made us aware of faulty systems of health care. Thus, the scope of pathology must be extended from the traditional tissue and cell pathology to the implementation of preventive pathology, by participation in morbidity and mortality conferences.

Adult↗
PubMed1992

In vitro fertilization culture medium surveys. A College of American Pathologists pilot proficiency testing survey.

Two pilot surveys for in vitro fertilization culture medium were conducted by the Reproductive Biology Resource Committee of the College of American Pathologists. The first phase (February 1991) involved seven laboratories, all of them being members of the committee, while the second phase (April 1991) also included other laboratories that voluntarily participated in the survey. Questionnaires accompanied the media and included variables such as conditions of shipment and measurements of pH and osmolarity, along with quality control results obtained from mouse embryo culture studies. Of the two medium samples per shipment, one was adulterated with an embryotoxic substance. The results of these surveys revealed consistency in most laboratories, while some laboratories could be easily identified due to their out-of-range results. These surveys have described the first attempts to develop an intralaboratory testing system for clinical in vitro fertilization laboratories. Further studies will be required to achieve greater consistency among laboratories with respect to implementation of the survey and reporting of results. Additionally, other systems should be evaluated, particularly for those laboratories that use systems other than mouse embryo culture.

Animals↗
PubMed1992

Interinstitutional database for comparison of performance in lung fine-needle aspiration cytology. A College of American Pathologists Q-Probe Study of 5264 cases with histologic correlation.

In 1990, the College of American Pathologists Q-Probes Quality Assurance Program studied performance in fine-needle aspiration (FNA) of pulmonary lesions derived by retrospective analyses of cases accessioned throughout 1989 by 436 institutions in North America. The aggregate database consisted of 13,094 lung FNA cases with 11,922 (91%) judged as satisfactory for cytologic evaluation. Of these satisfactory aspirates, 5264 (40%) had corresponding histologic tissue biopsy preparations and FNA diagnoses available for further evaluation and formed the basis for determining diagnostic accuracy. There was no significant difference in overall performance results derived from the data provided by all participants compared with the median of those reporting a greater number of correlated FNA cases. In the diagnosis of lung cancer by FNA, the following performance results were derived using the aggregate database: 89% sensitivity of FNA procedure, 99% sensitivity of FNA diagnosis, 96% specificity, 99% positive predictive value, 70% negative predictive value, 91% efficiency, 0.8% false-positive FNA interpretation, and 8% false-negative rate. The aggregate value and median performance values of sensitivity and specificity derived from this Q-Probe study, which reflects the general practices of mostly non-university hospitals in North America, compare very favorably with study results of similar design in the literature reflecting practices from academic centers. This appears to validate published rates from academic centers as reproducible in the general practice of pathology and validates the use of these values derived from an aggregate database as a benchmark to measure performance improvement in lung FNA.

Biopsy, Needle↗
PubMed2000

[Morphology of severe mycoses. Role of the pathologist in the diagnosis].

Mycoses are diseases caused by fungi. To be regarded as pathogenic, a fungus has to be able to complete a number of steps in order to initiate infection. Although culture remains the gold standard to diagnose the causative agent, presumptive identification of these fungi in histologic slides is of great value because invasion is only demonstrated in tissue sections. When culture is not available, histopathologic examination may be the sole source of information about the nature of the infection. To make a diagnosis, the pathologist needs to be familiar with the morphologic appearance of the different types of fungi, and has also to be aware of the limitations in their identification. The purpose of this work is to review the current problems on this subject, specially referring to the most frequent severe mycoses of our environment.

English Abstract↗