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AMT test yourself answers, February 2017

March 2017—In the February 2017 issue was a report, “An unusual BRAF mutation in a patient with melanoma,” written by members of the Association for Molecular Pathology. Here are answers (in bold) to the three “test yourself ” questions that followed that case report.

Hopes, fears as users switch to new troponin

December 2017—The questions that arise over the use of highly sensitive cardiac troponin are as riveting as, if less historically fraught than, the Jefferson-Hamilton debates over the shape of their newborn country. Who should lead—the states or a strong central government? Cardiologists or the emergency department? What cutoffs represent the right balance between admissions, referrals, and sending patients home? And will Lin-Manuel Miranda ever write a smash musical about this cardiac assay?

In hemostasis, two hot-button testing issues

December 2017—Having validation data to support the use of age-adjusted D-dimer cutoffs with the D-dimer assay your laboratory uses is a must, and know well the limitations of point-of-care prothrombin time/INR testing. That advice and more was shared in a “Hot Topics in Hemostasis” session at CAP17, presented by Russell Higgins, MD, and Karen Moser, MD.

‘Connectathon’ opens door to interoperability in digital pathology

December 2017—With the FDA having approved whole slide imaging for primary diagnosis this year, one obstacle to full acceptance of digital pathology remains: lack of interoperability. To topple that barrier, the Digital Pathology Association, the CAP through its Digital Pathology Committee, and DICOM Working Group 26 convened in October, during the Pathology Visions conference, the first Connect­athon for digital pathology.

HbA1c shows its mettle in predicting diabetes risk

December 2017—The longitudinal Framingham Heart Study, which first identified the concept of risk factors and made serum LDL cholesterol a household name, could help increase the celebrity status of HbA1c, with the Oct. 26 publication of a new study in Diabetes Care. International and national organizations since 2010 have recognized HbA1c as a valid way to diagnose abnormalities in glycemia and diabetes mellitus. But there has been less consensus on its use as a screen for elevated diabetes risk.

Higher pay for therapeutic apheresis, bone marrow aspiration

December 2017—For 2018, CMS estimates a one percent overall decrease in pathology reimbursement. Pathologists will receive payment increases for therapeutic apheresis and diagnostic bone marrow aspiration services in 2018. At the same time, reimbursement for flow cytometry services will continue to decrease following phased-in reductions set by the Medicare program last year, but the CAP was successful in lessening the impact of cuts to those services in 2018.

Automation, standardization lead the way in urinalysis

December 2017—Smaller-scale technology and standardization are just some of what laboratories need, and it’s where the companies that make urinalysis analyzers are in part focusing their work. CAP Today spoke with three of the five whose analyzers are profiled on the following pages.

Targeted NGS or exome? Consider the clinical context

December 2017—American writer Maile Meloy published a short story collection in 2009 titled Both Ways Is the Only Way I Want It. Molecular pathology laboratory directors faced with the variety of next-generation sequencing diagnostic panels might feel similarly. As the main character in Meloy’s title story asks, “What kind of fool wanted it only one way?”

Are point-of-care PT/INR devices safe and effective?

December 2017—Safety issues related to point-of-care PT/INR testing surfaced in recent years, among them a 2016 voluntary class 1 recall of Alere’s INRatio and INRatio2 monitor systems. “Prior to that, the company that manufactured the device had received thousands of complaints about it,” says Russell Higgins, MD, of the University of Texas Health Science Center at San Antonio.

Class act in Ohio expands pool of phlebotomists

December 2017—After two rounds of a new program to train high schoolers in phlebotomy, OhioHealth is seeing the fruits of its efforts. It has hired 19 of its trainees and a third course, set to begin next month, has 20 high school seniors enrolled. Just when OhioHealth’s phlebotomy staffing needs were expanding, laboratory services leaders were growing increasingly dissatisfied with the quality of the training students were receiving at most of the phlebotomy programs in the Columbus area.

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