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Skirting the pitfalls of merging lab results

May 2018—“One of these things is not like the others” is a fun puzzle for kids in the context of Sesame Street. But it can be a vexing informatics challenge when you are managing data entered in fields in a database. For anyone charged with merging outside laboratory results into an institution’s electronic health record alongside results from an in-house laboratory, the differences can generate no end of headaches.

New contender speeds ID with susceptibility testing

May 2018—If a seismic shift were to happen in microbiology, the technology behind the Accelerate Pheno system and PhenoTest BC test kit, which won FDA approval last year as a rapid pathogen identification and antimicrobial susceptibility testing (AST) system for blood cultures, could well be the cause.

Teaming up: how one site is managing its complex liver cases

May 2018—It didn’t take long for Heather Stevenson-Lerner, MD, PhD, to grasp one key fact about the liver biopsy cases she was seeing at the University of Texas Medical Branch, Galveston: They were often complicated. UTMB sees plenty of challenging liver cases of its own, says Dr. Stevenson-Lerner, assistant professor of medicine and liver and transplantation pathologist, Department of Pathology.

Pharmacogenomics advocates make case for wider use

May 2018—Use of pharmacogenomic testing is still limited, despite ample research, the existence of guidelines, and the emerging evidence it can help patients. Panels can be costly and insurance coverage variable, and providers need guidance—from pharmacists, the lab, decision support alerts—in knowing what and when to order and in understanding the results. Plus, patients move.

Clearing the air for electronic cancer checklists

May 2018—Length, cost, variability in vendor support, and lack of consistency have cast a cloud for pathologist users over the CAP’s cancer protocols and the electronic version of those protocols, the electronic cancer checklists. Work is underway to improve the user experience (Nakhleh RE, et al. Arch Pathol Lab Med. 2017;141[9]:1153–1154). Behind that effort is the undeniable: “Structured discrete data, using a controlled vocabulary, can be captured, stored, and reviewed much more readily than data in other formats,” says Mary Edgerton, MD, PhD, vice chair of the CAP’s Pathology Electronic Reporting (PERT) Committee and associate professor of pathology, University of Texas MD Anderson Cancer Center.

With hemolysis, tackling the rush with the reasoning

May 2018—First a journey. Then sometimes a vigorous shake. Little wonder that red blood cells hemolyze. “Red blood cells don’t like to be stressed,” says Kathleen Finnegan, MT(ASCP)SH, phlebotomy training program director at Stony Brook University School of Technology and Management, New York. She instructs her students to avoid stressing the RBCs by skipping what she calls the “martini shake” (CLSI recommends five to 10 tube inversions), using a needle that is the right size, and not using a syringe for transfer but instead a transfer device. “So it’s gentle,” she says.

Cytopathology and More: Reporting salivary gland cytopathology—New user-friendly milan system consists of six diagnostic categories

May 2018—The Milan System for Reporting Salivary Gland Cytopathology was published Jan. 31 and is an important step toward standardizing the reporting of salivary gland fine needle aspiration. A large body of literature has demonstrated that FNA is an effective method for the initial evaluation of salivary gland masses, but until this year there was no uniform, widely accepted reporting system. The complexity of salivary gland cytology poses unique challenges that demand a standardized approach to communication of diagnostic information between pathologists and treating clinicians.

Cytopathology and More: For thyroid cytopathology, the 2017 Bethesda System

May 2018—Surgical pathologists take their tumor nomenclature from the WHO Classification of Tumours, but cytopathologists take their terminology from where the consensus groups convened—Bethesda, Paris, Milan, and Yokohama—to formulate terminology recommendations. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)1 is now in its second edition.

TB testing: new approaches to old scourge

April 2018—Scratch the surface of TB testing, and things quickly get interesting. The standard skin reaction test, widely adopted by the early 1940s, is still in use today. The goal has remained steady as well: break the transmission cycle. “From the clinician perspective and the laboratory perspective, because of its infectious nature, we want to identify people with latent tuberculosis,” says Elitza Theel, PhD, lab director for the infectious disease serology laboratory, Mayo Clinic and Mayo Medical Laboratories. “The ultimate goal is to treat them, so they don’t progress to active TB.”

HBsAg tests, mutation in public health spotlight

April 2018—If you were asked to pick a place on the map where problems with detecting a mutant strain of an infectious disease would likely come to light, the capital of Nebraska might not be your first guess. But in Lincoln, in 2017, a hemodialysis patient who was vaccinated against hepatitis B virus in 2010 and had repeatedly tested negative for HBV surface antigen was found to have had undiagnosed chronic hepatitis B. The case led state and local public health officials to investigate and find evidence that some hepatitis B surface antigen (HBsAg) assays were not picking up particular HBV mutant strains.