American journal of clinical pathology最新文献

Objective: To identify challenges, opportunities, and best practices for improving the communication of urgent and significant unexpected diagnoses in anatomic pathology, to enhance diagnostic excellence and patient safety.

Methods and results: The American Society for Clinical Pathology convened a group of eleven pathologists from diverse practice settings who discussed the challenges, opportunities, and best practices for improving communication of urgent and significant unexpected findings in anatomic pathology. Through structured discussions, the group identified the challenges such as variability in definitions of urgent and significant unexpected diagnoses and lack of standardized protocols. The group developed a set of best practices and strategies to support timely notification, clear documentation, and standardized communication processes within the healthcare teams to ensure appropriate patient management based on the communicated diagnoses.

Conclusions: Timely and effective communication of urgent and significant unexpected findings in anatomic pathology is essential for patient safety. Standardized definitions and protocols, combined with collaborative strategies, can improve diagnostic accuracy and clinical outcomes. Future research should focus on building an evidence base to support these practices and evaluate their impact on patient care.

Objective: To evaluate the potential of artificial intelligence (AI) to enhance urine cytopathology for detecting urothelial carcinoma (UC), emphasizing improvements in diagnostic sensitivity, accuracy, and efficiency, as well as potential reductions in pathologist workload.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Google Scholar, EMBASE, and ScienceDirect were searched (January 2018 to July 2025) for English-language studies applying AI to urine cytology for UC detection and reporting sensitivity and specificity.

Results: Eleven studies met the inclusion criteria, with sample sizes ranging from 116 to 2641 cases. The AI models, predominantly convolutional neural networks, achieved a sensitivity of 63% to 100% and a specificity of 61.8% to 100% for high-grade urothelial carcinoma (HGUC) detection. Artificial intelligence has the potential to improve detection and streamline workflows in clinical settings.

Conclusions: Artificial intelligence shows strong potential as a diagnostic aid in urine cytopathology, particularly for HGUC detection, by improving accuracy and efficiency. However, challenges such as standardizing its use in different settings remain, along with the need for further large-scale validation studies.

Objective: The prevalence of mistreatment in the laboratory workforce is concerning. This study aimed to develop an antibullying course for laboratories and to pilot-test its effectiveness in improving knowledge, readiness for organizational change, and coping self-efficacy. In addition, it used geographic information system mapping to explore the geospatial distribution of bullying and course participation and to describe the program for potential implementation by other institutions.

Methods: An 8-module online course was developed for laboratory management and nonsupervisory staff, focusing on best practices to address incivility at the organizational and individual levels. Participants completed a pre-course assessment, including the Short Negative Acts Questionnaire and a pretest, before taking the course. The program's effectiveness was evaluated by comparing pre-course and post-course scores using paired sample t tests and geospatial analysis.

Results: Of 127 laboratory professionals who completed the pre-course survey, 92 (72.4%) completed the bullying prevention course and post-course evaluation. More than half (55.1%) were classified as victims of workplace bullying, with regional analysis showing the highest bullying intensity in the West and Midwest regions that also showed contrasting course completion rates (85%-87% in the West vs <70% in the Midwest). Post-course assessment revealed statistically significant improvements in participants' knowledge (mean increase from 2.57 to 3.08, P < .001) and coping strategies (2.60-2.94, P < .001), supporting the course's efficacy. Most participants (77.2%) rated the course positively.

Conclusions: The issue is persistent and will require deliberate interventions. The piloted bullying prevention educational platform presented is promising and can be a foundation for future targeted educational interventions for pathology laboratories.

Objective: Toxoplasma gondii and human papillomavirus (HPV) can cause spontaneous abortus. This study aimed to investigate the prevalence of these pathogens in formalin-fixed, paraffin-embedded placenta samples from women diagnosed with spontaneous abortus.

Methods: A total of 288 formalin-fixed, paraffin-embedded placenta tissue blocks stored in the archives of Etlik City Hospital Pathology Laboratory were included in the study between October 1, 2022, and June 23, 2023. The presence of T gondii and HPV in formalin-fixed, paraffin-embedded placenta samples was investigated using real-time polymerase chain reaction.

Results: The T gondii DNA was not detected in the samples. However, anti-T gondii IgG antibody was positive in 10.4% (11/106) of the patients. Human papillomavirus DNA was positive in 5.4% of the samples, with HPV 18 and HPV 31/58/66 being the most frequently detected HPV types.

Conclusions: Our study revealed that HPV could infect the placenta by detecting high-risk HPV in placental samples. However, no relationship was found between HPV positivity and previous stillbirth or spontaneous abortus. Prospective studies with larger populations are needed to further understand the role of these factors in the cause of spontaneous abortus.

Objective: We sought to identify the challenges of paper-based documentation and quantify the benefits of transitioning to a digital platform for resident grossing competency evaluation.

Methods: We conducted a retrospective review of resident grossing competency documentation and administered surveys to assess satisfaction with an established paper-based system. Following implementation of a digital laboratory information system (LIS)-based process, we reassessed resident grossing documentation, with a 1-month crossover comparison of the 2 methods and a 6-month follow-up evaluation of the LIS-based method.

Results: Overall, resident grossing completion was 37% (745 total completed of 2016 total required) with the paper-based system. Residents forgot documentation "sometimes" (7/17 [41.2%]), "often" (4/17 [23.5%]), or "always" (2/17 [11.8%]); experienced delays in obtaining signatures from attending physicians (14/17 [82.4%]); and reported feeling neutral (6/17 [35.3%]) or dissatisfied (6/17 [35.3%]) with the paper-based system. In the 1-month crossover period, the paper-based system generated 21 competency completions with 3 constructive comments compared with 31 competency completions and 10 -constructive comments collected through the LIS-based process. Documentation levels further increased in the 6-month period following the switch to LIS alone, with means of 97 competencies and 14 constructive comments documented per month.

Conclusions: Transition to a LIS-based system led to greater competency completion capture and constructive feedback. The success of the digital LIS-based system was facilitated by using an easy and familiar system with routine clinical workflows.

Objective: Reliable diagnostic services and testing capacity are fundamental to quality health care delivery. Yet data on such testing and services are often sparse in low- and--middle-income countries. The objective of this study was to obtain these data from the African country of Malawi by surveying a range of clinical laboratories and diagnostic services.

Methods: We conducted a cross-sectional survey of clinical pathology services and infrastructure among laboratories across Malawi. Subject matter experts developed a structured instrument covering staffing, infrastructure, equipment, and test menus by discipline. Surveys were distributed through the American Society for Clinical Pathology international listserv (May-Oct 2022), with targeted follow-up to Malawian institutions (November 2022-July 2025).

Results: Nine laboratories from the northern, central, and southern regions of Malawi submitted complete responses: 6 public and 3 private (2 tertiary facilities and 7 district, secondary, or research centers). All sites reported point-of-care/rapid diagnostics, chemistry, microbiology, and hematology services. Blood bank/transfusion services were available at 7 sites, 2 of which had all 5 queried products available (red blood cells, plasma, platelets, cryoprecipitate, and whole blood). Coagulation testing (2 sites), flow cytometry (2 sites), and cytogenetics (0 sites) were limited. Infrastructure gaps included inconsistent electricity or lack of backup generators (3 sites), limited internet access (5 sites), and need for more trained staff (4 sites).

Conclusions: Basic diagnostic services were widely available among this sample of Malawian laboratories, whereas advanced modalities and infrastructure were constrained outside tertiary centers. The baseline data obtained from this study could inform national planning and partner investments as external funding landscapes evolve.