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PubMed1994

Interlaboratory variation in DNA flow cytometry. Results of the College of American Pathologists' Survey.

The results of the DNA Analysis Module of the College of American Pathologists' Flow Cytometry Survey were analyzed to determine if participating laboratories could correctly identify aneuploid populations and estimate S-phase fraction reproducibly in proficiency specimens. Each survey contained three specimens: a diploid calibrator and two unknowns comprising cultured aneuploid tumor cells with DNA indexes of 1.2 to 2.0 admixed with normal lymphocytes. Results of ploidy analysis were obtained from a mean of 241 participants on 19 unknowns from 1990 to 1992. Most laboratories correctly reported the modal (and intended) number of aneuploid peaks; the proportion of correct responses ranged from 58% to 97%, with a mean of 86%. The lower percents of correct response were associated with near-diploid and tetraploid unknowns. Some laboratories showed consistent deviations from the mean for DNA index, indicating apparent instrument linearity problems. S-phase results on five specimens showed wide interlaboratory variability, although the means of participants' responses were close to the reference values obtained by the specimen provider.

DNA, Neoplasm↗

PubMed1993

Burnout: a smouldering problem amongst South African speech-language pathologists and audiologists?

The present study aimed to investigate the frequency of burnout occurring within the profession of speech-language pathology and audiology and to examine possible work situation factors unique to the profession, that may be correlated with burnout. A cross-sectional postal survey research design was used, including a standardised measure of burnout as well as a questionnaire inquiring about demographic and work situation variables. Subjects were randomly drawn from names obtained from the South African Medical and Dental Council. Results were analysed statistically using Pearsons correlations, Multivariate Analysis as well as Bonferroni T-tests. The main finding that emerged was that, as a group speech-language pathologists (SPLP's) and audiologists in South Africa are experiencing moderate levels of emotional exhaustion, low levels of depersonalisation as well as high levels of personal accomplishment. Therapists working in hospitals, mainly treating peripheral hearing disorders, working either as audiologists only or speech-language therapists and audiologists, with heavy caseloads and extensive paperwork, and perceiving themselves to be under large amounts of work pressure, appear to be the most susceptible to burnout.

Audiology↗

PubMed1975

The College of American Pathologists comprehensive blood bank survey program, 1973.

The 1973 Comprehensive Blood Bank Survey Program of the College of American Pathologists was administered to 2,200 laboratories and blood banks throughout the United States. The results showed a considerable increase in the accuracy of the testing and in the performance of reagents. Accuracy of ABO testing was 99.3%; Rh testing, 99%; crossmatching was 98.9% correct. Antibody detection was correct 96.3% of the time, with the exception of a cold-reacting anti-P1 which was found by only 62% of the participants. About the same number of laboratories also did not find the antibody during the crossmatch procedure. A sample from a donor with a positive antiglobulin test created much confusion and was misinterpreted in a number of ways. Reagents were found to be performing well with the exception of two, one [anti-hr'(C)] which produced a significant number of false positives, and another (anti-Kell) which produced numerous false negatives. The results seem to indicate that the anti-hr'(C) from several manufacturers is at fault for this error, while the anti-Kell errors showed no predilection for manufacturers and may represent erroneous testing by the laboratories or a failure to employ adequate quality control.

ABO Blood-Group System↗

PubMed1994

Current status of sweat testing in North America. Results of the College of American Pathologists needs assessment survey.

The College of American Pathologists surveyed 5096 laboratories for information concerning collection and analytic methodologies used in the performance of the sweat test. The test measures the concentration of electrolytes in sweat and is an essential criterion for the diagnosis of cystic fibrosis. An 83% response rate was achieved on the needs assessment survey, representing the first large-scale, national study of sweat testing practices. Nineteen percent of the respondents perform sweat testing in their laboratory, and the majority of the respondents analyze the sweat for chloride concentration. Fifty-nine percent of the laboratories performing sweat testing indicated an interest in participating in proficiency testing for sweat analysis. The information gathered from the needs assessment survey will be used to develop a comprehensive proficiency testing program to provide feedback and education to laboratories performing this critical diagnostic test.

Chemistry, Clinical↗

PubMed1993

Wegener's granulomatosis in the 1990s--a pulmonary pathologist's perspective.

The diagnosis and classification of vasculitic syndromes in general requires a correlation of clinical histologic and serologic data. Classifications based solely on clinical or histologic features have proven unsatisfactory. WG is no exception, and proper diagnosis and management of patients with WG requires careful correlation of all available clinical, radiographic, serologic, and histologic data by experienced individuals. Active discourse between the clinician and pathologist frequently helps in the decision as to how to proceed in an individual case and whether or not further diagnostic tests are necessary.

Antibodies, Antineutrophil Cytoplasmic↗

PubMed1994

Outbreak of Hantavirus pulmonary syndrome in the southwestern United States. Response of pathologists and other laboratorians.

During late spring and early summer of 1993, national and international media called worldwide attention to a cluster of deaths in the southwestern United States. These patients succumbed to a rapidly progressive severe respiratory distress syndrome. After notification of state and national health agencies in mid-May, a major effort was launched to determine the cause of this often fatal respiratory distress syndrome, to advise the public on safety measures, and to determine the method of spread of this "mystery illness." Within weeks of recognition of the early cases, the Centers for Disease Control and Prevention announced the probable agent, a Hantavirus. This report details the response of pathologists, medical technologists, and other laboratory scientists to this new viral epidemic, with emphasis on activities that occurred within New Mexico.

Adolescent↗

PubMed1994

Inpatient phlebotomy practices. A College of American Pathologists Q-Probes quality improvement study of 2,351,643 phlebotomy requests.

We report outcomes of requests for inpatient phlebotomy procedures from 683 institutions participating in the College of American Pathologists Q-Probes programs. Of the 2,351,643 phlebotomy requests analyzed, 93.2% of venipunctures were successful, 1.6% were unsuccessful, 0.4% were partially successful, and 4.9% were not attempted by the assigned phlebotomist. Administrative inefficiencies prevented the assigned phlebotomist from attempting these venipunctures of which the most frequent reasons were patient unavailability (1.4%), patient transferred or discharged (0.9%), followed by the specimen already collected by someone else (0.7%). These results suggest that performance improvement of phlebotomy services, in general, would achieve the greatest gains by focusing attention to specific processes associated with administrative inefficiencies identified, rather than phlebotomists' technical skills.

Appointments and Schedules↗

PubMedDate not supplied

Malassezia furfur folliculitis in cancer patients. The need for interaction of microbiologist, surgical pathologist, and clinician in facilitating identification by the clinical microbiology laboratory.

Malassezia furfur (MF) is a lipophilic yeast which can be found as a member of the indigenous microbiota of human skin. In immunocompromised transplant patients, MF can cause a distinctive folliculitis which is a clinical look-alike to Candida folliculitis, the latter of more potentially devastating significance. Recovery of MF in culture is dependent upon the addition to culture media of an exogenous source of fatty acids, such as olive oil. The addition of an extra Sabourauds plate with an olive oil overlay to the routine set of media used to inoculate all skin biopsy specimens in order to detect MF is labor-intensive and not cost-effective. Thus, MF may not be isolated in cases of MF folliculitis unless the clinical microbiology laboratory is put on alert by the clinical suspicions of the attending physician, or by histopathologic findings suggestive of folliculitis revealed by review of surgical pathology slides. The clinical, pathological, and microbiological findings of two cases of MF folliculitis are presented where an interactive approach featuring communication between the microbiologist, the surgical pathologist, and the clinician guided the microbiology laboratory to the isolation and identification of isolates of MF that were clinically-relevant. These cases underscore how a combined approach which features communication between the laboratory and the clinical services always provides superior guidance in the diagnosis and therapy of infectious diseases.

Adult↗

PubMed1993

Bedside glucose monitoring. A College of American Pathologists Q-Probes study of the program characteristics and performance in 605 institutions.

In 1991, the College of American Pathologists' Q-Probes quality improvement program studied precision, accuracy, and program characteristics of bedside glucose monitoring (BGM) in 605 institutions. Precision measurements made in 569 institutions were based on 15,950 quality control results. Precision, expressed as a percentage coefficient of variation, was less than 10 in almost 90% of the institutions. For accuracy, 4517 BGM results from 181 institutions were compared with clinical laboratory glucose results. Approximately 58% of BGM results were within +/- 10% and 75% of BGM results were within +/- 15% of the corresponding clinical laboratory results. Program characteristics associated with better performance were (1) laboratorian program responsibility, laboratorian BGM test performance, and laboratorian involvement in training; (2) a policy requiring repeated scheduled operator training and/or performance review; (3) use of an internal comparison program; and (4) participation in an external proficiency testing program. We conclude that BGM frequently does not meet quality goals and provide recommendations on how BGM programs can be improved.

Australia↗

PubMed1994

Nosocomial infections. A college of American pathologists Q-probes study in 512 North American institutions.

We report nosocomial infection surveillance methods and hospital infection rates in 512 institutions obtained from a Q-Probes study of the College of American Pathologists, Northfield, Ill. The results showed that nosocomial infection surveillance procedures were well standardized. Use of microbiology reports was the most common case-finding method (97.3%), followed by review of the patient's medical record (86.1%). The median number of full-time equivalents per 100 occupied beds utilized for infection control services was 0.64, and these full-time equivalents spent 40% of their time on surveillance activities. A computer was used in 81% of institutions to assist in conducting surveillance, although this usage was not associated with decreased surveillance time or personnel required. This study provided data on total and site-specific infection rates for a wide range of small to large hospitals. When stratified into subgroups (based on teaching status and hospital size), infections rates in this study were comparable with those of the National Nosocomial Infection Surveillance program, and showed a trend of increasing rates of nosocomial bloodstream and surgical wound infections.

Computers↗

PubMed1994

Quality improvement approaches. Survey of pathologists serving the pediatric patient.

A questionnaire was circulated in 1990 by the Practice Committee of the Society for Pediatric Pathology to its membership to assess the involvement of pediatric pathology departments (PPDs) in quality improvement (QI) activities. Twenty-nine PPDs responded. Analysis of responses disclosed a wide variation in plans, although the majority (22 of 29) had developed or were in the process of developing (three of 29) a specific plan. The plans varied in sophistication and complexity. Pediatric pathologists (directors or designates) were heavily involved in assuming leadership roles for the QI activities in 25 of 28 PPDs. The PPDs with plans (25) had identified the QI indicators monitored either sporadically or on an ongoing basis. The respondents had several indicators in common, such as volume, technical, and clinical indicators, as well as indicators related to turnaround times, meetings, and internal and external consultations. The plurality of the monitors reported are related to indicators in the discipline of anatomic pathology. This review is therefore limited to QI issues in anatomic pediatric pathology. In conclusion, this survey functions to shed some light on the extent of involvement of PPDs in the management of QI. In addition, it provides a model for starting or improving the existing QI plans for PPDs.

Autopsy↗

PubMed1993

The pathologist as a clinical consultant for hemostasis in the community hospital.

Most of the clinically recognized disorders of hemostasis were described before the availability of today's sensitive and specific molecular assays. Even though many of these newer assays are not yet technically practical for the average community hospital, in certain situations they are indispensable to accurate diagnosis and treatment. The most significant advances, however, have come not from the tests themselves but from the new insights they have provided into the basic mechanisms of hemostasis, thereby extending the usefulness of the widely available older global clotting assays. Pathologists who are able to integrate this increased understanding of the pathophysiology of various disorders with the history and physical findings will be better able to assist their clinical counterparts in the most cost-effective approach to the care of their patients.

Blood Coagulation Disorders↗

PubMed1993

Digoxin therapeutic drug monitoring practices. A College of American Pathologists Q-Probes study of 666 institutions and 18,679 toxic levels.

We investigated digoxin therapeutic drug monitoring practices in 666 institutions participating in Q-Probes, a quality improvement program of the College of American Pathologists. Participants used 13 different lower and 16 different upper limits for their therapeutic range. More than 280,000 digoxin levels were studied, and 6.7% (n = 8679) of results were in the toxic range (> 2.6 nmol/L). For the 77% of patients with toxic levels, the last digoxin dose was given orally; for 23% of patients, it was given intravenously; and for less than 1%, it was given intramuscularly. Between 22% and 31% of specimens in the toxic range were obtained before steady state had occurred, depending on the criteria used. Small institutions (less than 150 beds), outpatients, stat specimens, and laboratory policies not requiring the time of the last dose before measurement were associated with higher percentages of specimens drawn before the recommended time had elapsed. We describe digoxin monitoring practice patterns and provide suggestions for improvement.

Digoxin↗

PubMed1993

Current status of mycobacterial testing in clinical laboratories. Results of a questionnaire completed by participants in the College of American Pathologists Mycobacteriology E survey.

To learn what methods are used in clinical microbiology laboratories for detection, identification, and susceptibility testing of mycobacteria, questions addressing these issues were added to the College of American Pathologists' Mycobacteriology E proficiency testing survey, and participants in the survey were asked to complete the questionnaire. Other questions related to numbers of mycobacteriology tests performed and the frequency with which drug-resistant Mycobacterium tuberculosis is isolated. Just over half of the respondents stained smears for acid-fast bacilli with the fluorochrome stain. Only 26% of respondents processed respiratory specimens daily, potentially providing results within 24 hours of receiving the specimen. The most rapid methods currently available for detection of mycobacteria and for identification of M tuberculosis, respectively, were used by 30% and 35% of the respondents. Half of the respondents who performed susceptibility testing on isolates of M tuberculosis used rapid methods. Approximately 26% of the respondents indicated that they usually provided a final identification of M tuberculosis within 21 days of receiving a specimen, and 11% indicated that identification and susceptibility test results were reported within 28 days. Participants' responses indicated that the mean number of specimens received for mycobacterial culture per month was higher during the first 5 months of 1992 than it had been in 1991. Moreover, the number of drug-resistant M tuberculosis isolated per month from January through May 1992 was about double the number isolated per month in 1991.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriological Techniques↗

PubMedDate not supplied

[Neonatal cholestasis: the viewpoint of the pathologist].

The authors make a review of paediatric-neonatal cholestasis, a troublesome field in clinical and hepatopathology. They focus the main topics and stress the differential aspects in extrahepatic biliary atresia, "neonatal hepatitis", cholestatic syndromes associated with paucity of interlobular biliary ducts and metabolic diseases. The "overlap" areas and differential diagnosis in these chapters are a challenge for the pathologist. The importance of a close collaboration with clinicians is stressed.

Biliary Atresia↗

PubMed1993

Research by pathologists in the United States: analysis of publications.

Academic pathology is a unique profession in which the ability to pursue almost any type of academic or scholarly endeavor can be supported. Although it is difficult to define methods of comparing individual achievements in medicine, for investigative activity, common measures of academic productivity are numbers of peer-reviewed publications and National Institute of Health support. Articles from pathology departments were randomly selected from MEDLINE. One hundred and five articles were examined for the following features: financial support, human subjects, the presence of a photomicrograph, molecular biology techniques, and the number of times each article was cited as determined using the Science Citation Index. The articles were assigned to one of the following categories: anatomical pathology, clinical pathology, or research. The following percentages of articles were federally funded: total, 43.8; anatomical pathology, 33.3; clinical pathology, 9.5 and research, 74.4. The citations per article for federally funded and not federally funded articles, respectively, for each as these categories was as follows: total, 18.7 and 5.3; anatomical pathology, 15.7 and 5.5; clinical pathology, 2.0 and 4.9; and research, 21.4 and 5.7. It can be concluded from the data presented that federally funded articles from departments of pathology are cited more often than articles that are not federally funded. The most impressive finding in reviewing the articles is the wide diversity of research conducted in pathology departments. The use of federal funding or citation analysis to evaluate the performance of an individual pathologist would be a mistake.

Efficiency↗

PubMed1993

Physician goals and laboratory test turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722 institutions.

Laboratory test turnaround times (TATs) for emergency department patients were studied in 722 institutions using Q-Probes, a quality improvement program of the College of American Pathologists. The medians of the TATs required by 2763 clinicians were 10 minutes for PO2, 20 minutes for hemoglobin, and 30 minutes for potassium and glucose measurements. Surgeons had the shortest TAT requirements for hemoglobin, potassium, and glucose measurements, whereas emergency department physicians had the shortest requirements for PO2. The measured TATs of most hemoglobin and potassium determinations did not meet clinician goals. In contrast to laboratorians, the majority of clinicians defined a TAT start time as test ordering, and a TAT ending time as result reporting. We recommend laboratorians and clinicians mutually agree on the definition of TAT, jointly develop timeliness goals, and together improve TAT performance to fulfill these goals.

Diagnostic Tests, Routine↗

PubMed1993

The 1990 Comprehensive Blood Bank Surveys of the College of American Pathologists.

The performance of participants on the 1990 Comprehensive Blood Bank Surveys of the College of American Pathologists was consistent with the high quality of past surveys. The surveys include challenges in ABO and Rh typing, crossmatching, transfusion decisions, unexpected antibody detection and identification, and supplemental questions to assess contemporary practices. As in previous years, a recurrent serologic problem has been the reporting of antibodies not present in serum (anti-E in Set J-B, and anti-K in Set J-D). Such overidentification of antibodies has little implication for transfusion safety and may, in fact, represent an artifact of the survey's samples and reporting practices.

Blood Banks↗