December 2022

December 2022—Ask Leonard Weiss, MD, what his favorite part of his schedule is, and he’s quick to answer that it’s the fieldwork: the helicopter and ambulance dispatches he accompanies once or twice a month as associate medical director of emergency medical services at the University of Pittsburgh Medical Center. Dr. Weiss, who is also assistant professor of emergency medicine and assistant medical director of Pittsburgh’s Stat Medevac service, says one of the UPMC emergency services he strongly supports is the prehospital transfusion of blood products. “Until recently, there wasn’t a lot of evidence to deploy its use on the ground as it is in the air, but thanks to extensive use by the military and scientific evidence of the value of prehospital transfusion,” he says, it is more likely to become part of some hospitals’ emergency medicine programs. The 911 ground-based transfusion program at UPMC and city of Pittsburgh EMS began in 2020. As Dr. Weiss and his UPMC colleagues acknowledge, however, myriad complexities come into play.

December 2022—Reflex urine culture algorithms have become common and have been shown to reduce urine culture utilization, but efforts to sharpen clinical decision support continue.

December 2022—The Centers for Medicare and Medicaid Services published on Nov. 1 its final 2023 Medicare physician fee schedule with payment rates and new policies set to take effect next year.

Nearly 800 registrants were at the Digital Pathology Association’s Pathology Visions meeting this fall, and 54 companies exhibited. “There was a great vibe at the meeting. People were mingling, collaborative. Digital pathology is picking up,” says DPA president Esther Abels. Her term as president will end this month and Liron Pantanowitz, MD, PhD, MHA, of the University of Michigan, will step in as president on Jan. 1.

December 2022—In toxicology testing, cross-reactive compounds, incomplete medical records, immunoassay performance, calibrator drift, and human error all play into unexpected positives.

December 2022—Laboratories that provide only waived testing will now have a CAP accreditation program laboratory general (GEN) checklist tailored to waived test procedures, beginning with the 2022 checklist edition released in October.

December 2022—In September, when CAP TODAY publisher Bob McGonnagle met with pathologists and representatives of companies to talk about laboratory information systems (“Lab information systems—where the needs are greatest,” https://bit.ly/LIS_112022), they talked also about artificial intelligence—innovations, clinical impact, how much interest there is. That part of their conversation follows.

December 2022—Atsushi Ohtsu, MD, PhD, director of Japan’s prestigious National Cancer Center Hospital East, reached a groundbreaking decision with his management team in February 2020: They decided to pursue CAP accreditation. While the CAP has accredited more than 40 laboratories in Japan, this was to be a first for a Japanese hospital. And it was: In September 2022, the CAP advised the cancer center (NCCE) of its success in achieving accreditation and congratulated the team for the excellence of its laboratory services.

December 2022—Many of us were raised on alluring stories of the good old days in medicine, when physicians enjoyed long-term, respectful relationships with their patients. I grew up hearing from my father, an obstetrician/gynecologist, and my mother, a nurse, about their frustrating transition from this to a modern reality in which these relationships were strained by a seemingly impenetrable health care bureaucracy. Like so many pathologists, I have felt intimidated by such behemoths as the CMS, the FDA, and insurance companies, as well as smaller monoliths like the C-suites or dean’s office at health systems and medical schools where I have practiced. But what I have realized by working with the CAP is that dealing with these entities can be more manageable when we create positive and productive relationships with the people who work in them.

December 2022—Tranexamic acid is an antifibrinolytic drug that improves survival in adults with traumatic hemorrhage. To the authors’ knowledge, it has not been evaluated in a trial of injured children.

December 2022—Prostatic duct adenocarcinoma, which is characterized by pseudostratified columnar epithelium, has historically been considered invasive carcinoma, although it may have an intraductal component.

December 2022—Infantile-onset epilepsy has a variety of underlying etiologies, including brain injury, metabolic disorders, and genetic factors. Refractory epileptic conditions in infants can result in developmental delays, poor quality of life, and increased mortality rates.

December 2022 Q. What is the appropriate way to measure or identify microcytosis or macrocytosis? Read answer. Q. A six-year-old female with B-cell acute lymphoblastic leukemia and Rh-negative blood is being treated with myeloablative chemotherapy to achieve durable remission or as a bridge to stem cell transplantation, during which supportive transfusions will include repeated platelet transfusions over many weeks. Clinicians are concerned that the patient could become alloimmunized to the D antigen, which, in turn, could affect her ability to eventually bear children. Apheresis platelets contain a small but finite amount of RBC contaminants, which are not usually quantitated. An optimal strategy to prevent anti-D alloimmunization is to use Rh-negative platelets, but they are often in short supply and cannot be ordered stat in a timely enough manner to ensure every platelet transfusion episode is Rh-negative. We considered using Rh immune globulin (RhIg). However, we recognize that commercial RhIg is designed to prevent D alloimmunization in the setting of obstetric fetal-maternal bleeding. Is there an optimal dose for RhIg or suggested timing of administration to prevent anti-D alloimmunization in this setting? Read answer.

December 2022—To safely and effectively extend the process of conducting point-of-care testing to staff from various hospital departments is no easy feat. That’s why four full-time employees at Children’s Hospital Los Angeles oversee POC testing, relying heavily on middleware, analytics, and exception-management tools.

December 2022—The Food and Drug Administration has approved the Ventana FOLR1 (FOLR1-2.1) RxDx Assay, the first immunohistochemistry companion diagnostic test to aid in identifying epithelial ovarian cancer patients who are eligible for targeted treatment with Elahere (mirvetuximab soravtansine-gynx). Elahere is a first-in-class antibody-drug conjugate therapy developed by Immuno­Gen and approved under the FDA’s accelerated approval program for the treatment of FRα-positive platinum-resistant ovarian cancer.