May 2014—A tipping point implies a point of no return, a monumental change in the status quo, a transformation that leads to a new paradigm. Malcolm Gladwell, in The Tipping Point: How Little Things Can Make a Big Difference, popularized the term and defined it as “the moment of critical mass, the threshold, the boiling point.” Tipping points bring both positive and negative consequences; they are a time of change and opportunity. Such is the position that cytopathology finds itself in today.
Read More »May 2014
Cytopathology and More | Cytopathology letter: Ignoring recommendations?
May 2014—Recently I received the 2014 CAP PAPM-A (gynecologic pathology) slide set and was surprised to see case No. 5: a Pap test from an 82-year-old woman with a clinical history of “routine exam.” The cervical cancer screening recommendations from the U.S. Preventive Services Task Force recommend against screening women over the age of 65 who have had adequate prior screening and are not at high risk for cervical cancer, while the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology guidelines recommend no screening for women over age 65 with evidence of adequate negative prior screening and no history of CIN2+ within the past 20 years.
Read More »Checklist changes put out fire (drills), for starters
May 2014—Gerald Hoeltge, MD, chair of the CAP Checklists Committee, is pretty sure he knows exactly the way many laboratories will react to a particular change in the latest edition of the Laboratory Accreditation Program checklists, which launch this month.
Read More »From the President’s Desk: Connect to colleagues, ideas at CAP ’14, 5/14
May 2014—The CAP annual meeting is the place to find top-drawer educational opportunities, network with peers, and become a more effective advocate for your practice and your specialty. I’m intent on persuading you to come.
Read More »Second act for HER2, in gastric cancers
May 2014—If one were to map out a “family tree” of tumors, breast and gastric cancers might end up looking like second cousins. One is common, the other is not, but it’s rapidly becoming known that they share a kinship of sorts with HER2 testing and the targeted therapy trastuzumab.
Read More »Pressure’s on to halt nosocomial infections
May 2014—Modern health care is more advanced than ever, but institutions continue to battle one problem that refuses to go away: hospital-acquired infections. They should be preventable, yet a recent CDC report estimates that one in 25 U.S. patients acquired at least one infection during a hospital stay in 2011. The most pervasive nosocomial pathogens, by far, are Clostridium difficile and Staphylococcus aureus.
Read More »Billing vendors adopt and adapt to boost clients’ revenue
May 2014—From federal requirements to voluntary standards to back-office activities and business tools, vendors of billing/AR/RCM systems share how they are helping their clients. Beginning on page 16 is CAP TODAY’s 2014 guide to lab billing/accounts receivable/revenue cycle management systems.
Read More »Sin of omissions: When tests fly under the radar
May 2014—“There are known knowns; there are things that we know that we know,” then-defense secretary Donald Rumsfeld famously said in response to a question at a 2002 news briefing. “We also know there are known unknowns. . . .” he added. “But there are also unknown unknowns, the ones we don’t know we don’t know.”
Read More »Unraveling metastasis with circulating tumor cells
May 2014—Some diseases have clear origins and unfold in predictable ways, but cancer isn’t one of them. Despite legions of studies over the decades, cancer tumorigenesis and its deadly sequel, metastasis, essentially remain a riddle, wrapped in a mystery, inside an enigma, as Winston Churchill once described Russia.
Read More »Molecular assays in HIV-1 Dx and therapeutic monitoring
May 2014—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. Here, this month, is the fourth such case. (See the February, August, and September 2013 issues for the first three.) AMP members write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, treatment, and more. Case report No. 4 comes from the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania.
Read More »Cytopathology and More | FNA cytology: Rapid on-site evaluation—how practice varies
May 2014—Rapid on-site evaluation, or ROSE, is a service that pathologists and cytotechnologists commonly perform to check the cellular content and adequacy of fine-needle aspiration smears and biopsy touch imprints. ROSE can inform the operator of the need to obtain additional samples and, in this cost-conscious age, make it possible to avoid having to repeat the procedure. ROSE allows for preliminary diagnosis so that additional material can be requested for ancillary studies such as flow cytometry, microbiology cultures, or molecular studies.
Read More »Put It on the Board, 5/14
May 2014—FDA clears FilmArray GI Panel: BioMérieux affiliate BioFire received Food and Drug Administration 510(k) clearance for the FilmArray Gastrointestinal Panel. The 22-target panel allows a syndromic approach to the diagnosis of infectious diarrhea, the company says, as it includes bacteria, viruses, and parasites in one test.
Read More »Q & A Column, 5/14
May 2014—Checklist requirement HEM.23050 regarding reference intervals includes a note that if absolute cell counts are reported with their reference ranges, then percent cell count reference ranges should not be reported because they can lead to misinterpretation of CBC data. I understand that many laboratories, like ours, have been reporting reference ranges for both absolute and percent cell counts, and I would like to clarify whether this is permissible.
Read More »Newsbytes, 5/14
May 2014—How to avoid becoming a ‘legacy system junkyard: The constant churn of information technology applications is creating new security and financial risks that health care organizations—including laboratories—must systematically address, IT experts say.
Read More »Clinical Pathology Selected Abstracts, 5/14
May 2014—Real-time clinical decision support systems for platelet and cryoprecipitate orders: Platelet and cryoprecipitate transfusions are often used to treat patients who are bleeding. However, many clinicians use non-evidence–based approaches to ordering and transfusing these products. Cost and such adverse effects as transfusion-transmitted diseases and transfusion reactions make it desirable to reduce the unnecessary transfusion of these products.
Read More »Anatomic Pathology Selected Abstracts, 5/14
May 2014—Impact of operator techniques and specimen-preparation checklist on bone marrow assessment: Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The authors conducted a study to determine whether specific operator techniques or use of a specimen-preparation checklist, or both, could impact the quality of bone marrow assessment by reducing the frequency of obtaining nonspicular aspirates, small cores, and nondiagnostic samples.
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