Objectives: This study aimed to develop a root cause analysis (RCA) model for test overutilization, applying it to transferrin overordering at our institution.
Methods: A comprehensive review was undertaken to establish a systematic RCA model. Upon implementation, the questionnaire identifying the root causes of transferrin overordering with infographic intervention was distributed to clinicians and nurses.
Results: The RCA model comprises 5 steps: (1) problem identification, (2) causal factor determination, (3) data collection, (4) significant factor identification, and (5) corrective action development and outcome measurement. The major causes of transferrin overutilization were confusion between transferrin and transferrin saturation, as well as unfamiliarity with the laboratory handbook. An infographic reduced postintervention transferrin ordering among clinicians (84.9%, P < .001) and nurses (46.8%, P < .001).
Conclusions: This study presents a 5-step RCA model that offers a customized method to identify the causes of test overutilization. Applying this model to transferrin at our institution revealed 22 leading root causes. Laboratories are encouraged to adopt this RCA model as it can contribute to optimized patient care and more efficient resource allocation.
{"title":"A 5-step root cause analysis model for test overutilization: A study on its application to plasma transferrin testing.","authors":"Jiracha Jittapranerat, Wimol Chinswangwatanakul","doi":"10.1093/ajcp/aqae015","DOIUrl":"10.1093/ajcp/aqae015","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop a root cause analysis (RCA) model for test overutilization, applying it to transferrin overordering at our institution.</p><p><strong>Methods: </strong>A comprehensive review was undertaken to establish a systematic RCA model. Upon implementation, the questionnaire identifying the root causes of transferrin overordering with infographic intervention was distributed to clinicians and nurses.</p><p><strong>Results: </strong>The RCA model comprises 5 steps: (1) problem identification, (2) causal factor determination, (3) data collection, (4) significant factor identification, and (5) corrective action development and outcome measurement. The major causes of transferrin overutilization were confusion between transferrin and transferrin saturation, as well as unfamiliarity with the laboratory handbook. An infographic reduced postintervention transferrin ordering among clinicians (84.9%, P < .001) and nurses (46.8%, P < .001).</p><p><strong>Conclusions: </strong>This study presents a 5-step RCA model that offers a customized method to identify the causes of test overutilization. Applying this model to transferrin at our institution revealed 22 leading root causes. Laboratories are encouraged to adopt this RCA model as it can contribute to optimized patient care and more efficient resource allocation.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140048482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra E Tunkel, Emily R Youner, Hayk Barseghyan, Yulong Fu, Surajit Bhattacharya, Miriam Bornhorst, Ashkan S Monfared
Objectives: Distinguishing between sporadic and germline/mosaic NF2-related schwannomatosis is important to ensure that patients have appropriate long-term care. With this report, we describe a unique case of a patient with 4 ipsilateral schwannomas and identify a combination of sequencing modalities that can accurately diagnose mosaic NF2-related schwannomatosis.
Methods: We present a 32-year-old woman with a familial history of vestibular schwannoma in her father and right-sided schwannomas involving the apical and basal turns of cochlea, lateral semicircular canal, and internal auditory canal (IAC). Genetic analysis of blood and frozen tissue from 2 tumors (intralabyrinthine and IAC tumors) was performed using next-generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA), and optical genome mapping (OGM).
Results: Germline testing for NF2, LZTR1, and SMARCB1 was negative. Tumor genetic testing revealed a shared NF2 pathogenic variant between the 2 tumors ("first hit") but distinct "second hit" NF2 variants, including mosaic loss of chromosome 22 in the IAC tumor seen only with OGM, consistent with mosaic NF2-related schwannomatosis.
Conclusions: Multimodality sequencing, including NGS, MLPA, and OGM, was required to ensure appropriate diagnosis of mosaic NF2-related schwannomatosis in this patient. A similar approach can be used for other patients with multiple ipsilateral tumors and suspected tumor predisposition.
{"title":"Four distinct ipsilateral vestibular schwannomas: A case of mosaic NF2-related schwannomatosis.","authors":"Alexandra E Tunkel, Emily R Youner, Hayk Barseghyan, Yulong Fu, Surajit Bhattacharya, Miriam Bornhorst, Ashkan S Monfared","doi":"10.1093/ajcp/aqae027","DOIUrl":"10.1093/ajcp/aqae027","url":null,"abstract":"<p><strong>Objectives: </strong>Distinguishing between sporadic and germline/mosaic NF2-related schwannomatosis is important to ensure that patients have appropriate long-term care. With this report, we describe a unique case of a patient with 4 ipsilateral schwannomas and identify a combination of sequencing modalities that can accurately diagnose mosaic NF2-related schwannomatosis.</p><p><strong>Methods: </strong>We present a 32-year-old woman with a familial history of vestibular schwannoma in her father and right-sided schwannomas involving the apical and basal turns of cochlea, lateral semicircular canal, and internal auditory canal (IAC). Genetic analysis of blood and frozen tissue from 2 tumors (intralabyrinthine and IAC tumors) was performed using next-generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA), and optical genome mapping (OGM).</p><p><strong>Results: </strong>Germline testing for NF2, LZTR1, and SMARCB1 was negative. Tumor genetic testing revealed a shared NF2 pathogenic variant between the 2 tumors (\"first hit\") but distinct \"second hit\" NF2 variants, including mosaic loss of chromosome 22 in the IAC tumor seen only with OGM, consistent with mosaic NF2-related schwannomatosis.</p><p><strong>Conclusions: </strong>Multimodality sequencing, including NGS, MLPA, and OGM, was required to ensure appropriate diagnosis of mosaic NF2-related schwannomatosis in this patient. A similar approach can be used for other patients with multiple ipsilateral tumors and suspected tumor predisposition.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irina Demina, Ekaterina Mikhailova, Elena Zerkalenkova, Alexandra Semchenkova, Julia Roumiantseva, Alexandra Borkovskaya, Evgeny Matveev, Dmitry Abramov, Dmitry Konovalov, Natalia Miakova, Natalia Ponomareva, Julia Belkina, Konstantin Kondratchik, Yulia Olshanskaya, Galina Novichkova, Alexander Karachunskiy, Alexander Popov
Objectives: Mixed-phenotype acute leukemia (MPAL) is a rare disease associated with difficulties in the correct lineage assignment of leukemic cells. One of the least common subtypes within this category is characterized by the simultaneous presence of B- and T-lineage-defining antigens. Each case of suspected B/T MPAL should be considered in light of all available laboratory and clinical data to avoid misdiagnosis.
Methods: In this study, we describe 6 pediatric patients who presented with leukemic blasts bearing B- and T-lineage antigens at diagnosis, including their clinical, immunophenotypic, morphologic, and cytogenetic characteristics.
Results: In 3 patients, more or less distinct populations of B- and T-lymphoid origin were found; the other 3 patients had a single mixed-phenotype blast population. All cases fulfilled the World Health Organization criteria, but not all of them turned out to be bona fide cases of B/T MPAL according to the available clinical and laboratory data. Found genetic lesions were helpful for the confirmation of MPAL instead of 2 concomitant tumors, but for a general B/T MPAL diagnosis, genetic studies provided the only descriptive data.
Conclusions: The accurate diagnosis of B/T MPAL requires a multidisciplinary approach combining high-tech laboratory methods and close cooperation between treating physicians and pathologists.
目的:混合表型急性白血病(MPAL)是一种罕见的疾病,与白血病细胞难以正确分系有关。该亚型中最不常见的一种亚型的特点是同时存在 B 系和 T 系界定抗原。每个疑似 B/T MPAL 的病例都应根据所有可用的实验室和临床数据进行考虑,以避免误诊:在本研究中,我们描述了6例诊断时出现带有B系和T系抗原的白血病胚泡的儿科患者,包括他们的临床、免疫表型、形态学和细胞遗传学特征:结果:在3名患者中,发现了或多或少不同的B淋巴细胞和T淋巴细胞;另外3名患者有单一的混合表型囊泡。所有病例都符合世界卫生组织的标准,但根据现有的临床和实验室数据,并非所有病例都是真正的 B/T MPAL。发现的基因病变有助于确诊为MPAL而非两种并发肿瘤,但对于一般的B/T MPAL诊断,基因研究只能提供描述性数据:结论:B/T MPAL的准确诊断需要多学科方法,结合高科技实验室方法以及主治医生和病理学家之间的密切合作。
{"title":"Laboratory characterization of the pediatric B/T subtype of mixed-phenotype acute leukemia: Report of a case series.","authors":"Irina Demina, Ekaterina Mikhailova, Elena Zerkalenkova, Alexandra Semchenkova, Julia Roumiantseva, Alexandra Borkovskaya, Evgeny Matveev, Dmitry Abramov, Dmitry Konovalov, Natalia Miakova, Natalia Ponomareva, Julia Belkina, Konstantin Kondratchik, Yulia Olshanskaya, Galina Novichkova, Alexander Karachunskiy, Alexander Popov","doi":"10.1093/ajcp/aqae020","DOIUrl":"10.1093/ajcp/aqae020","url":null,"abstract":"<p><strong>Objectives: </strong>Mixed-phenotype acute leukemia (MPAL) is a rare disease associated with difficulties in the correct lineage assignment of leukemic cells. One of the least common subtypes within this category is characterized by the simultaneous presence of B- and T-lineage-defining antigens. Each case of suspected B/T MPAL should be considered in light of all available laboratory and clinical data to avoid misdiagnosis.</p><p><strong>Methods: </strong>In this study, we describe 6 pediatric patients who presented with leukemic blasts bearing B- and T-lineage antigens at diagnosis, including their clinical, immunophenotypic, morphologic, and cytogenetic characteristics.</p><p><strong>Results: </strong>In 3 patients, more or less distinct populations of B- and T-lymphoid origin were found; the other 3 patients had a single mixed-phenotype blast population. All cases fulfilled the World Health Organization criteria, but not all of them turned out to be bona fide cases of B/T MPAL according to the available clinical and laboratory data. Found genetic lesions were helpful for the confirmation of MPAL instead of 2 concomitant tumors, but for a general B/T MPAL diagnosis, genetic studies provided the only descriptive data.</p><p><strong>Conclusions: </strong>The accurate diagnosis of B/T MPAL requires a multidisciplinary approach combining high-tech laboratory methods and close cooperation between treating physicians and pathologists.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140183460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Low board pass rates in Blood Banking/Transfusion Medicine.","authors":"Gary W Procop, Tyler Sandersfeld, Mark K Fung","doi":"10.1093/ajcp/aqae028","DOIUrl":"10.1093/ajcp/aqae028","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140317560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy L Austin, Russell R Broaddus, Rhona J Souers, Megan E Kane, Ravindra Kolhe, Dylan V Miller, Joel T Moncur, Shakti Ramkissoon, Laura J Tafe, Dimitri G Trembath, Rondell P Graham
Objectives: To describe mismatch repair (MMR) and microsatellite instability (MSI) testing practices in laboratories using the College of American Pathologists (CAP) MSI/MMR proficiency testing programs prior to the 2022 publication of the MSI/MMR practice guidelines copublished by CAP and the Association of Molecular Pathology (AMP).
Methods: Data from supplemental questionnaires provided with the 2020-B MSI/MMR programs to 542 laboratories across different practice settings were reviewed. Questionnaires contained 21 questions regarding the type of testing performed, specimen/tumor types used for testing, and clinical practices for checkpoint blockade therapy.
Results: Domestic laboratories test for MSI/MMR more often than international laboratories (P = .04) and academic hospitals/medical centers test more frequently than nonhospital sites/clinics (P = .03). The most commonly used testing modality is immunohistochemistry, followed by polymerase chain reaction, then next-generation sequencing. Most laboratories (72.6%; 347/478) reported awareness of the use of immune checkpoint inhibitor therapy for patients with high MSI or MMR-deficient results.
Conclusions: The results demonstrate the state of MMR and MSI testing in laboratories prior to the publication of the CAP/AMP best practice guidelines, highlighting differences between various laboratory types. The findings indicate the importance of consensus guidelines and provide a baseline for comparison after their implementation.
{"title":"Current laboratory testing practices for mismatch repair deficiency and microsatellite instability testing: A survey-based review of current laboratory practices.","authors":"Amy L Austin, Russell R Broaddus, Rhona J Souers, Megan E Kane, Ravindra Kolhe, Dylan V Miller, Joel T Moncur, Shakti Ramkissoon, Laura J Tafe, Dimitri G Trembath, Rondell P Graham","doi":"10.1093/ajcp/aqae094","DOIUrl":"https://doi.org/10.1093/ajcp/aqae094","url":null,"abstract":"<p><strong>Objectives: </strong>To describe mismatch repair (MMR) and microsatellite instability (MSI) testing practices in laboratories using the College of American Pathologists (CAP) MSI/MMR proficiency testing programs prior to the 2022 publication of the MSI/MMR practice guidelines copublished by CAP and the Association of Molecular Pathology (AMP).</p><p><strong>Methods: </strong>Data from supplemental questionnaires provided with the 2020-B MSI/MMR programs to 542 laboratories across different practice settings were reviewed. Questionnaires contained 21 questions regarding the type of testing performed, specimen/tumor types used for testing, and clinical practices for checkpoint blockade therapy.</p><p><strong>Results: </strong>Domestic laboratories test for MSI/MMR more often than international laboratories (P = .04) and academic hospitals/medical centers test more frequently than nonhospital sites/clinics (P = .03). The most commonly used testing modality is immunohistochemistry, followed by polymerase chain reaction, then next-generation sequencing. Most laboratories (72.6%; 347/478) reported awareness of the use of immune checkpoint inhibitor therapy for patients with high MSI or MMR-deficient results.</p><p><strong>Conclusions: </strong>The results demonstrate the state of MMR and MSI testing in laboratories prior to the publication of the CAP/AMP best practice guidelines, highlighting differences between various laboratory types. The findings indicate the importance of consensus guidelines and provide a baseline for comparison after their implementation.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thiyaphat Laohawetwanit, Daniel Gomes Pinto, Andrey Bychkov
Objectives: We sought to investigate the adoption and perception of large language model (LLM) applications among pathologists.
Methods: A cross-sectional survey was conducted, gathering data from pathologists on their usage and views concerning LLM tools. The survey, distributed globally through various digital platforms, included quantitative and qualitative questions. Patterns in the respondents' adoption and perspectives on these artificial intelligence tools were analyzed.
Results: Of 215 respondents, 100 (46.5%) reported using LLMs, particularly ChatGPT (OpenAI), for professional purposes, predominantly for information retrieval, proofreading, academic writing, and drafting pathology reports, highlighting a significant time-saving benefit. Academic pathologists demonstrated a better level of understanding of LLMs than their peers. Although chatbots sometimes provided incorrect general domain information, they were considered moderately proficient concerning pathology-specific knowledge. The technology was mainly used for drafting educational materials and programming tasks. The most sought-after feature in LLMs was their image analysis capabilities. Participants expressed concerns about information accuracy, privacy, and the need for regulatory approval.
Conclusions: Large language model applications are gaining notable acceptance among pathologists, with nearly half of respondents indicating adoption less than a year after the tools' introduction to the market. They see the benefits but are also worried about these tools' reliability, ethical implications, and security.
{"title":"A survey analysis of the adoption of large language models among pathologists.","authors":"Thiyaphat Laohawetwanit, Daniel Gomes Pinto, Andrey Bychkov","doi":"10.1093/ajcp/aqae093","DOIUrl":"https://doi.org/10.1093/ajcp/aqae093","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to investigate the adoption and perception of large language model (LLM) applications among pathologists.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted, gathering data from pathologists on their usage and views concerning LLM tools. The survey, distributed globally through various digital platforms, included quantitative and qualitative questions. Patterns in the respondents' adoption and perspectives on these artificial intelligence tools were analyzed.</p><p><strong>Results: </strong>Of 215 respondents, 100 (46.5%) reported using LLMs, particularly ChatGPT (OpenAI), for professional purposes, predominantly for information retrieval, proofreading, academic writing, and drafting pathology reports, highlighting a significant time-saving benefit. Academic pathologists demonstrated a better level of understanding of LLMs than their peers. Although chatbots sometimes provided incorrect general domain information, they were considered moderately proficient concerning pathology-specific knowledge. The technology was mainly used for drafting educational materials and programming tasks. The most sought-after feature in LLMs was their image analysis capabilities. Participants expressed concerns about information accuracy, privacy, and the need for regulatory approval.</p><p><strong>Conclusions: </strong>Large language model applications are gaining notable acceptance among pathologists, with nearly half of respondents indicating adoption less than a year after the tools' introduction to the market. They see the benefits but are also worried about these tools' reliability, ethical implications, and security.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan Hartmann, Joao Dias, Alexandra Shilo, Yamini Bynagari, Brandon Garrett, Walter Jeske, Zorayr Manukyan, Karen Mkhitaryan, Dieter Adelmann, Kathirvel Subramaniam, Tetsuro Sakai
Objectives: We sought to establish normal reference ranges (NRRs) for a novel TEG 6s cartridge (TEG 6s Citrated: K, KH, RTH, FFH [Global Hemostasis]) (Haemonetics Corporation, Boston, MA, US).
Methods: Healthy volunteers (≥18 years of age) included in this single-arm study provided single samples of whole blood. Primary end points included TEG parameters in the citrated kaolin (CK), CK with heparinase (CKH), RapidTEG with heparinase (CRTH), and functional fibrinogen with heparinase (CFFH) assays.
Results: Evaluable data were contributed by 164 volunteers (48.8% female; 62% White/Caucasian). The following NRRs were established: CK maximum amplitude (MA), 51.0 to 67.6 mm; CKH-MA, 51.8 to 67.9 mm; CRTH-MA, 53.0 to 68.9 mm; CFFH-MA, 15.3 to 34.4 mm; CK reaction time, 5.0 to 9.1 minutes; CKH reaction time, 4.9 to 9.4 minutes; CKH lysis 30 minutes after MA, 0% to 3.2%. Duplicate measurements demonstrated high reproducibility. CFFH-MA correlated with Clauss fibrinogen concentration (Pearson correlation coefficient, 0.74). Laboratory-based studies demonstrated maintenance of the relationship between CFFH-MA and fibrinogen up to 1344 mg/dL (hyperfibrinogenemic samples) and acceptability of heparin neutralization up to concentrations of low molecular weight and unfractionated heparin of 1.3 IU/mL and 5 IU/mL, respectively.
Conclusions: This study established NRRs for the Global Hemostasis cartridge and serves as a proof of concept for the validity of results obtained using this cartridge.
{"title":"TEG® 6s coagulation testing with a novel heparin neutralization cartridge: Technical validation and determination of normal reference ranges.","authors":"Jan Hartmann, Joao Dias, Alexandra Shilo, Yamini Bynagari, Brandon Garrett, Walter Jeske, Zorayr Manukyan, Karen Mkhitaryan, Dieter Adelmann, Kathirvel Subramaniam, Tetsuro Sakai","doi":"10.1093/ajcp/aqae088","DOIUrl":"https://doi.org/10.1093/ajcp/aqae088","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to establish normal reference ranges (NRRs) for a novel TEG 6s cartridge (TEG 6s Citrated: K, KH, RTH, FFH [Global Hemostasis]) (Haemonetics Corporation, Boston, MA, US).</p><p><strong>Methods: </strong>Healthy volunteers (≥18 years of age) included in this single-arm study provided single samples of whole blood. Primary end points included TEG parameters in the citrated kaolin (CK), CK with heparinase (CKH), RapidTEG with heparinase (CRTH), and functional fibrinogen with heparinase (CFFH) assays.</p><p><strong>Results: </strong>Evaluable data were contributed by 164 volunteers (48.8% female; 62% White/Caucasian). The following NRRs were established: CK maximum amplitude (MA), 51.0 to 67.6 mm; CKH-MA, 51.8 to 67.9 mm; CRTH-MA, 53.0 to 68.9 mm; CFFH-MA, 15.3 to 34.4 mm; CK reaction time, 5.0 to 9.1 minutes; CKH reaction time, 4.9 to 9.4 minutes; CKH lysis 30 minutes after MA, 0% to 3.2%. Duplicate measurements demonstrated high reproducibility. CFFH-MA correlated with Clauss fibrinogen concentration (Pearson correlation coefficient, 0.74). Laboratory-based studies demonstrated maintenance of the relationship between CFFH-MA and fibrinogen up to 1344 mg/dL (hyperfibrinogenemic samples) and acceptability of heparin neutralization up to concentrations of low molecular weight and unfractionated heparin of 1.3 IU/mL and 5 IU/mL, respectively.</p><p><strong>Conclusions: </strong>This study established NRRs for the Global Hemostasis cartridge and serves as a proof of concept for the validity of results obtained using this cartridge.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine L H Snozek, Claire I Yee, Janetta Bryksin, Rejwi Dahal, Benjamin Gerson, Carmen Gherasim, Kristin D Hauff, Nicholas Heger, Marilyn A Huestis, Kamisha L Johnson-Davis, Claire E Knezevic, Sara A Love, Stacy E F Melanson, Jaime H Noguez, Michael Pikulski, Stephen Roper, Manoj Tyagi, Jill S Warrington, He Sarina Yang, Yifei K Yang
Objectives: Urine drug testing (UDT) is a critical tool used in medical, forensic, and occupational settings, but interpreting results can be challenging. We performed a study to assess the ability of health care professionals to interpret UDT results accurately.
Methods: In total, 911 clinical and laboratory professionals in the United States and Canada responded to a survey with questions gauging expertise in UDT interpretation. Responses were analyzed to identify knowledge gaps.
Results: Toxicologists and laboratory PhD scientists performed well, with means of 4.82 and 4.63 questions answered correctly (out of 6 possible), respectively. Physicians specializing in pathology, emergency medicine, primary care, and internal medicine, however, displayed concerning knowledge gaps, as did laboratorians with nondoctoral degrees. Experience and training correlated with interpretation accuracy. Identification of simulated compliance as well as understanding opioid exposure, metabolism, and immunoassay cross-reactivity were among the most clinically significant knowledge gaps. More than 30% of survey respondents indicated that they would seek UDT information from the internet or peers rather than clinical or laboratory experts.
Conclusions: The study highlighted the need for targeted education and better collaboration between clinical and laboratory experts and other health care professionals to ensure that when physicians order UDT, they can accurately interpret results and reduce harm.
{"title":"Assessing knowledge gaps and educational needs in urine drug test interpretation among health care professionals.","authors":"Christine L H Snozek, Claire I Yee, Janetta Bryksin, Rejwi Dahal, Benjamin Gerson, Carmen Gherasim, Kristin D Hauff, Nicholas Heger, Marilyn A Huestis, Kamisha L Johnson-Davis, Claire E Knezevic, Sara A Love, Stacy E F Melanson, Jaime H Noguez, Michael Pikulski, Stephen Roper, Manoj Tyagi, Jill S Warrington, He Sarina Yang, Yifei K Yang","doi":"10.1093/ajcp/aqae095","DOIUrl":"10.1093/ajcp/aqae095","url":null,"abstract":"<p><strong>Objectives: </strong>Urine drug testing (UDT) is a critical tool used in medical, forensic, and occupational settings, but interpreting results can be challenging. We performed a study to assess the ability of health care professionals to interpret UDT results accurately.</p><p><strong>Methods: </strong>In total, 911 clinical and laboratory professionals in the United States and Canada responded to a survey with questions gauging expertise in UDT interpretation. Responses were analyzed to identify knowledge gaps.</p><p><strong>Results: </strong>Toxicologists and laboratory PhD scientists performed well, with means of 4.82 and 4.63 questions answered correctly (out of 6 possible), respectively. Physicians specializing in pathology, emergency medicine, primary care, and internal medicine, however, displayed concerning knowledge gaps, as did laboratorians with nondoctoral degrees. Experience and training correlated with interpretation accuracy. Identification of simulated compliance as well as understanding opioid exposure, metabolism, and immunoassay cross-reactivity were among the most clinically significant knowledge gaps. More than 30% of survey respondents indicated that they would seek UDT information from the internet or peers rather than clinical or laboratory experts.</p><p><strong>Conclusions: </strong>The study highlighted the need for targeted education and better collaboration between clinical and laboratory experts and other health care professionals to ensure that when physicians order UDT, they can accurately interpret results and reduce harm.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Do errors in requesting and interpreting drug screens harm patients?","authors":"Roger L Bertholf","doi":"10.1093/ajcp/aqae092","DOIUrl":"https://doi.org/10.1093/ajcp/aqae092","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: In this study, we investigated the clinical feasibility of using umbilical cord blood as an alternative to neonatal blood for measuring serum albumin and immunoglobulin G (IgG) levels in newborns, including preterm newborns.
Methods: Serum levels of albumin and IgG were measured in cord and neonatal blood from singleton newborns. We analyzed correlations and systematic errors between cord and neonatal blood measurements, stratifying the results for very preterm newborns (VPNs) born at a gestational age of less than 32 weeks and non-VPNs born at a gestational age of 32 weeks or later.
Results: Among all 494 newborns (78 VPNs and 416 non-VPNs), serum albumin and IgG levels were determined for 95.7% and 88.7% of them, respectively. Strong correlations between cord and neonatal blood were observed for the serum albumin and IgG levels (rs = 0.864 and 0.966, respectively). Moreover, the measurement errors between cord and neonatal blood were small for all newborns (0.2 g/dL and 65 mg/dL, respectively). These findings were consistent with both VPNs and non-VPNs.
Conclusions: Umbilical cord blood is a suitable substitute for neonatal blood in measuring serum albumin and IgG levels in newborns, even in premature newborns.
{"title":"Umbilical cord blood as a substitute for neonatal blood in measuring serum albumin and immunoglobulin G levels.","authors":"Toshihiko Ikuta, Sota Iwatani, Seiji Yoshimoto","doi":"10.1093/ajcp/aqae089","DOIUrl":"https://doi.org/10.1093/ajcp/aqae089","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we investigated the clinical feasibility of using umbilical cord blood as an alternative to neonatal blood for measuring serum albumin and immunoglobulin G (IgG) levels in newborns, including preterm newborns.</p><p><strong>Methods: </strong>Serum levels of albumin and IgG were measured in cord and neonatal blood from singleton newborns. We analyzed correlations and systematic errors between cord and neonatal blood measurements, stratifying the results for very preterm newborns (VPNs) born at a gestational age of less than 32 weeks and non-VPNs born at a gestational age of 32 weeks or later.</p><p><strong>Results: </strong>Among all 494 newborns (78 VPNs and 416 non-VPNs), serum albumin and IgG levels were determined for 95.7% and 88.7% of them, respectively. Strong correlations between cord and neonatal blood were observed for the serum albumin and IgG levels (rs = 0.864 and 0.966, respectively). Moreover, the measurement errors between cord and neonatal blood were small for all newborns (0.2 g/dL and 65 mg/dL, respectively). These findings were consistent with both VPNs and non-VPNs.</p><p><strong>Conclusions: </strong>Umbilical cord blood is a suitable substitute for neonatal blood in measuring serum albumin and IgG levels in newborns, even in premature newborns.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}