bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transforming Healthcare Means Zero Harm: Laboratory Testing Matters
Authors: Mina A 
Published: October 2021

Abstract

Introduction/Objective
My role model when I was a medical technologist intern was a chief pathologist who taught me to speak up when something is unsafe and to serve willingly, do what is right, be fair and excellent in work. His character impacted my whole life and career. Every moment matters; life is precious and something to protect. The patient and their care teams depend upon accurate, safe and high-quality clinical laboratory tests result to achieve positive patient outcomes.

Methods/Case Report
Clinical Practice

Results (if a Case Study enter NA)
We can do better. Everybody can be surveyors with greater understanding of pathophysiologic processes in disease, extensive experience working in laboratories and in-depth knowledge about complaince, quality, mistake-proofing care, patient-focused and laboratory management.
Diagnostic testing would be the method to screen for disease, confirm disease, and monitor disease in hopes of secondary prevention - to identify latent disease to “catch it early.” The screening tests could be anything from newborn screening for inborn metabolism errors, adult screening tests (like mammograms, pap smears, and colonoscopies), to high-risk population screenings to detect HIV, RPR, and gonorrhea. The disease must have a high prevalence to justify the expense of therapy and should be detectable before symptoms arise. The test must not have many false positives but extremely high sensitivity. The results of these tests could lead to the three different methods of prevention.
Primary prevention would reduce the risk of developing cardiovascular disease or stroke. Secondary prevention would detect the disease early to prevent progression of the disease. Tertiary prevention would reduce disabilty and promotion of rehabilitation from the disease like strokes or rehab programs.

Conclusion
In conclusion, this information provides clinicians with a laboratory test menu guidelines to improve clinical practice. We can all learn well to focus on what really matters. Together, we can make healthcare better, more patient-centered, less costly, and safer.
Utilization of Short Tandem Repeat Analysis to Resolve Specimen Mislabeling in the Anatomic Pathology Laboratory
Authors: Tenney T , Robinson B , Sullivan H C 
Published: October 2021

Abstract

Introduction/Objective
A mislabeled specimen is an example of preanalytical error that can have significant consequences on patient care. These errors can be difficult to detect and resolve. One method to confirm genetic identity is short tandem repeat (STR) analysis, which is utilized in forensic investigations, paternity studies, and post- hematopoietic stem cell transplantation monitoring. Herein we present application of STR analysis to resolve a suspected specimen mislabeling prior to receipt in our anatomic pathology laboratory.

Methods/Case Report
DNA was extracted from paraffin embedded tissues. Chimerism testing was performed by STR analysis using the Globalfiler (ThermoFisher Scientific) and analyzed by Chimermarker (Softgenetics) automated chimerism software.

Results (if a Case Study enter NA)
Colon biopsies were received for a single patient (#1) with two requisition forms. Each specimen (A-F) was labeled with the patient’s name, with specimens A-D noted on first page of requisition and specimens E-F on the second requisition page. After the case was signed out, the lab was contacted looking for biopsy results on another patient (#2) who was seen on the same day as patient #1. Review of all the patients seen in the endoscopy suite on the given date raised suspicion that specimens E-F from the second page of the requisition actually pertained to patient #2. STR analysis performed on specimens confirmed that specimens E-F were genetically distinct from those labelled A-D. Tissue from a subsequent biopsy on patient #2 was analyzed by STR testing, which was identical to STR results performed on specimens E-F.

Conclusion
Here we utilized STR testing to resolve a suspected mislabeled specimen, allowing the appropriate diagnosis to be attributed to the correct patient. This is a unique application of a common method, which could be implemented in anatomic pathology laboratories to resolve cases of specimen mix-ups.
Ensuring Standardization, Quality Management And Improvement Of Point-Of-Care Testing In The Municipal Public Health System Based Ambulatory Care And School Health Clinics In New York City
Authors: Sherpa T , Choesang T , Ahmad S , Huq Ronny F M 
Published: October 2021

Abstract

Introduction/Objective
Operated under different acute care hospital clinical laboratory limited-service laboratory (LSL) licenses, our New York City five borough spanning multisite ambulatory clinics and school-based clinics have been offering various waived point-of-care tests (POCTs) and provider-performed microscopy (PPM) to the local communities. A wide range of variability existed among the clinics concerning regulatory compliance, test performance, quality control and training. To ensure standardization and quality of POCT across the health system, our laboratory service adopted and implemented a plan for systemwide LSL transfer from the acute care hospitals to ambulatory care laboratory service for centralized implementation, monitoring, and oversight of the POCT operations.

Methods/Case Report
Having over 60 clinics, while transferring the LSLs, we chose multi-site license with ten or more sites on each license and by phase transfer from NYSDOH. Since the commencement of the transfer, system wide our qualified laboratory personnel have been updating and providing standard operating procedures (SOP), performing quality assurance and validation of new tests/devices, providing competency assessments and helping clinical staffs maintain compliance with state and other regulatory agencies.

Results (if a Case Study enter NA)
After the final phase of the transfer and POCT standardization implementation in 63 clinics, currently the clinical staffs performing POCT, get expeditious training and troubleshooting in more timely manner and the providers get the results of the ordered POCTs much faster and more efficiently and overall the quality metrics get improved markedly, indicated by internal audit team.

Conclusion
Even though Implementation of the planned POCT standardization was initially challenging due to the vastness and complexity of our multisite ambulatory care network and later confounded by the COVID -19 pandemic effect but eventually, it helped improve patient care delivery significantly and very effectively. Expectedly, our planned transfer implementation provided standardization and ensured improved quality of POC testing across our health system.
Challenges of Conducting Point-Of-Care Testing Operations During The COVID-19 Pandemic In The Municipal Public Health System Based Ambulatory Care And School Health Clinics In New York City
Authors: Sherpa T , Choesang T , Ahmad S , Huq Ronny F M 
Published: October 2021

Abstract

Introduction/Objective
Our New York City Municipal Public Health System based multisite ambulatory clinics and school-based clinics, offer various waived POCT (point of care tests) and provider performed microscopy (PPM). To ensure standardization and quality of POC testing across our health system, our laboratory service conducts system wide centralized implementation, monitoring and oversight of the POCT operations in regard to regulatory compliance, test performance, quality control and training. With the emergence of the COVID-19 infection in the New York City, like all other clinical laboratories, our ambulatory care clinics encountered numerous hurdles and challenges. Here we elaborated the issues that we encountered and how we managed to overcome during the COVID-19 Pandemic.

Methods/Case Report
We categorized the challenges that affected our managers as well as field level laboratory operations and have devised a plane to deal with COVID-19 related predicaments.

Results (if a Case Study enter NA)
Among the staffing issues, staff relocation to the acute care hospital laboratories during the peak of the pandemic caused massive delay or cessation of POCT operations in our ambulatory care clinics. Manual result entry, for COVID-19 testing, at the patient portals due to lack of interface with the reference testing labs, staff shortages and frequent absences due to illness and fatigue were primary issues noted at technical level. Furthermore, there were notable delays in the processing of paper works and new staff recruitments. The lack of and significant delays in the critical laboratory supplies was another major management issue.

Conclusion
Given the vastness and complexity of our multisite ambulatory care network, the COVID -19 pandemic impacted our ambulatory care clinic POCT operation in a very challenging way. However, our timeliness, coordinated interventions, close communications and initiatives handled the obstacles that arose very effectively to the ensure quality of POC testing, patient safety and quality care across our health system.
Utilization of 2D Barcode Technology to Create Surgical Pathology Reports
Authors: Qu Z , Qu E , Huang J , Micale M A , Li E 
Published: October 2021

Abstract

Introduction/Objective
After professional transcription service is eliminated, pathologists inevitably undertake the task of diagnostic data entry into pathology repot by adapting a variety of methods such as speech recognition, manual typing, and pre-texted command. Errors and inefficiency in reporting remain common problems, especially for information with unusual syntax such as genotype or nucleotide sequences. To overcome these shortcomings, we introduce here a novel application of a well-established technology as a complementary method, namely 2- dimensional (2D) barcode symbology.

Methods/Case Report
Commonly used diagnostic wordings of pathology reports including specimen type, surgical procedure, diagnosis, and test results are collated and organized by organ (specimen type) and by their frequency of usage/occurrence. Next, 2D data matrix barcodes are created for these diagnostic wordings using a on-line tool (www.free-barcode-generator.net/datamatrix/). The 2D barcodes along with their text are displayed on the computer screen (or printed out as a booklet). A 2D barcode scanner (Symbol LS2208, Motorola) was used to retrieve the text information from the barcodes and transfer into the pathology report. To assess the efficacy of this barcode method, we evaluated the time of data entry into reports for 117 routine cases using an on-line stopwatch and compared with those by other data entry methods.

Results (if a Case Study enter NA)
Unlike manual typing or speech recognition, the barcode method did not introduce typographic or phonosemantic errors since the method simply transferred pre-texted and proof-read text content to report. It was also faster than manual typing or speech recognition, and its speed was comparable to that of the pre-text method integrated in LIS but did not require human memorization of innumerable text commands to retrieve desired diagnosis wordings.

Conclusion
Our preliminary results demonstrated that the diagnostic data entry time was reduced from 28.5% by other methods to 22.1% by the barcode method although due to the small sample size, statistical analysis was not conclusive.
Laboratory Testing Patterns by Day of Hospital Stay for Medical and Surgical Hospitalizations
Authors: Brimhall B , Whitted M , Windham A , Fernandez J 
Published: October 2021

Abstract

Introduction/Objective
Studies of laboratory test utilization and costs by specific hospital day of stay (DOS) have yet to be widely published. Evaluation of laboratory test use by DOS would be helpful to better predict laboratory test reduction as hospital length of stay (LOS) is shortened, since testing on the final day of hospitalization is likely to differ from the average daily figures.

Methods/Case Report
Using an internal cost accounting database, we evaluated laboratory tests and costs by hospital DOS over one year (2017) at a large health system (N=133,139 hospital days). To evaluate changes over the first days of hospitalization, we set day 1 of hospitalization as a baseline and determined subsequent days as a percentage of day 1 figures. We also calculated laboratory variable cost as a percent of aggregate variable costs per DOS. We limited our analysis to the first week of hospitalization. We employed Medicare Severity Diagnosis Related Groups (MSDRG), used by the US Centers for Medicare and Medicaid Services (CMS), to aggregate hospital encounters into medical or surgical hospitalizations using MSDRG grouping methods.

Results (if a Case Study enter NA)
For medical inpatient stays, average laboratory tests (variable costs) were 10.8 ($74.11) on day 1, 7.7 ($38.53) on day 2, and 5.8 ($23.75) on day 3, with little change over the next four hospital DOS. Laboratory testing, as a percent of day 1 testing, for days 2-7 was: 70.7%, 53.4%, 54.3%, 54.5%, 55.1%, and 54.0%. Laboratory variable costs represented 7.8% of aggregate variable costs on hospital day 1 and declined sequentially over days 2-7: 5.6%, 4.3%, 3.9%, 3.8%, 3.8%, and 3.5%. For surgical hospitalizations, average laboratory tests (variable costs) were 18.2 ($130.02) on day 1, 11.9 ($57.38) on day 2, and 8.4 ($35.32) on day 3. As with medical stays, there was little change over the next four hospital DOS. Laboratory testing, as a percent of day 1 testing, for days 2-7 was: 65.6%, 46.1%, 44.6%, 46.3%, 45.9%, and 44.9%. Laboratory variable costs represented 3.2% of aggregate variable costs on hospital day 1 and remained essentially unchanged over the following days (range 3.3%-3.7%).

Conclusion
Laboratory variable costs are highest on the first day of hospitalization and decline over subsequent days to flatten by day 3.
Lab Wisely in Canada: Enhancing and highlighting the role of all clinical laboratory professionals in reducing harm and waste
Authors: VanSpronsen A , Nielsen C , Djukic B , Villatoro V 
Published: October 2021

Abstract

Introduction/Objective
Stewardship initiatives are a key strategy for addressing inappropriate utilization of clinical laboratory resources. These approaches require engagement of multiple types of stakeholders. Some professional groups are historically underrepresented, such as those who perform specimen collection, testing, and quality processes. A specific campaign is needed to engage these groups and highlight their expertise.

Methods/Case Report
We surveyed Medical Laboratory Technologists and Medical Laboratory Assistants to understand the barriers they face to participating in laboratory stewardship initiatives. These survey findings helped shape tools and resources that we created for new campaign called Lab Wisely. We also identified that one-third of existing Choosing Wisely Canada recommendations relate to laboratory testing. We categorized and tagged each recommendation to create a publicly-available searchable database which was placed on the campaign website (LabWisely.ca).

Results (if a Case Study enter NA)
NA

Conclusion
Laboratory testing is featured in a significant proportion of all Choosing Wisely Canada recommendations, supporting the idea that the clinical laboratory should be heavily involved in reducing medical overuse in healthcare. In our survey, we found that laboratory professionals face time and workload constraints, but feel a professional responsibility for ensuring appropriate resource use by all users. There was also a lack of ‘know- how’ around tangible ways to become involved. The Lab Wisely website has become a one-stop-shop for highlighting the role of technical and scientific professionals in laboratory stewardship and providing concrete tools that can be used to develop capacity in these groups. Every level of staff can and should be involved in improving the utilization of clinical laboratory services.
What Makes Our Medical Laboratory Workforce Unique?
Authors: Arora K , Sharma G 
Published: October 2021

Abstract

Introduction/Objective
A career in the medical laboratory requires advanced education and technical training. To assist both employers and employees, several government organizations conduct demographic, education, and wage surveys for the general U.S. labor market. Through its workforce surveys, the American Society of Clinical Pathology (ASCP) does the same for the medical laboratory professions. Our aim was to compare the findings of these surveys and identify similarities and dissimilarities between the general labor pool and the medical laboratory workforce.

Methods/Case Report
Since the 2021 ASCP Wage survey is currently open, we reviewed the findings described in ASCP’s 2019 Wage Survey of Medical Laboratories in the United States (Am J Clin Pathol 2021;155:649-673) with the publicly available information (for 2019) on demographics, educational attainment, and average hourly earnings available on the websites of U.S. Bureau of Labor Statistics (www.bls.gov) as well as United States Census (www.census.gov).

Results (if a Case Study enter NA)
In 2019, the male: female ratio was 52.9:47.1 in general labor pool and 19.1:80.9 in the medical laboratory workforce. The average age of a worker in the general labor pool was 41.9 years and was 42 years in the medical laboratory workforce. The average hourly earnings were $27.99/hour in the general labor pool and ranged from $16.64/hour (phlebotomists) to $53.95/hour (pathologists assistants) in the medical laboratory workforce, with the MLS/MT/CLS earning $30.02/hour to $52.53/hour. While 33.1% adults in the U.S. have attained a bachelor’s degree or above, 73.79% have attained this in the medical laboratory workforce.

Conclusion
Compared to the general labor pool, the medical laboratory workforce is a highly educated workforce and has a higher participation by women. The average worker age and average hourly wage are comparable. We encourage laboratorians to participate in ASCP surveys since such surveys reveal data that can drive better prospects for the medical laboratory workforce.
Standardizing Instructions for Ice and Cold Pack Use Can Mitigate Summer Temperatures on Two Commercially Available Outdoor Courier Lockboxes
Authors: Hart S A , Wiencek J R 
Published: October 2021

Abstract

Introduction/Objective
Clinical and Laboratory Standards Institute document GP44 recommends samples avoid temperatures &gt;22°C during sample transport and storage. Outdoor courier lockboxes used in external sample transport can experience extreme temperatures (&gt;40°C) in the summer. Ice (frozen at -20°C) and cold (refrigerated at 4-8°C) packs can be used to reduce internal lockbox temperatures during hot summer days. Unfortunately, there are no universally accepted instructions to maintain internal lockbox temperatures during these conditions. Therefore, our goal was to elucidate the impact of placing ice and cold packs at two specific time points to mitigate external summer temperatures in two commercially available outdoor courier lockboxes used at our institution.

Methods/Case Report
Two pairs of uniquely manufactured courier lockboxes (steel vs. urethane polymer) were placed outside in direct sunlight in Nashville, Tennessee during the second week of June 2021. Ambient outdoor and lockbox temperatures were monitored using data loggers during a four-day cycle. Each type of lockbox design had a control with no ice or cold packs. These controls were then compared to each experimental, paired lockbox with four ice packs placed at 8am and replaced with four cold packs at 4pm.

Results (if a Case Study enter NA)
The mean ambient outdoor temperature over these four days was 27.7°C (range: 22.2-39.8°C). Temperatures within the steel and urethane polymer lockboxes without ice or cold packs was 28.3°C (range: 22.4-40.8°C) and 31.6°C (range: 23.8-41.0°C), respectively. The addition of four ice packs at 8am and replaced with four cold packs at 4pm reduced temperatures in the steel box to 24.3°C (range: 17.4-27.9°C) whereas in the urethane polymer box temperatures were reduced to 13.4°C (range: 6.6-18.1°C).

Conclusion
Temperatures inside outdoor lockboxes can increase in summer commonly above the outdoor ambient temperature. Standardizing instructions for ice and cold packs can reduce internal outdoor courier lockbox temperatures during summer months, especially in urethane polymer lockboxes.
Diagnostic utility of flow cytometric immunophenotyping in cerebrospinal fluid specimen
Authors: Naiyer N , Lin H 
Published: October 2021

Abstract

Introduction/Objective
Flow cytometric immunophenotyping (FCI) of cerebrospinal fluids (CSF) has increasingly been used for diagnosing and monitoring hematologic malignancies. We reviewed CSF specimens sent for flow cytometry evaluation to identify the utility and limitations of FCI.

Methods/Case Report
We performed a retrospective review on CSF specimens received from July to October 2020. Samples were sent with requisition for unexplained neurologic signs or symptoms, to determine CNS involvement of neoplasm, or to stage a neoplasm. We reviewed specimen volume and cell count of flow cytometry samples and electronic medical records for possible diagnosis at time of specimen submission, final diagnosis, and concurrent cytology diagnosis.

Results (if a Case Study enter NA)
A total of 104 CSF samples from 59 patients were processed by the Flow Cytometry Laboratory during the review period. Of the 104 samples, 66% were from patients with a prior history of a hematologic malignancy, of which 20% had abnormal findings by FCI and cytomorphology. FCI was noncontributory for the cases in which patient did not have a previously diagnosed hematologic malignancy and underwent lumbar puncture for neurological abnormalities (n = 34). Concurrent cytology results were available in all but one case. Atypical or reactive findings by cytomorphology were seen in 21 cases (20%), for which flow cytometry studies showed no diagnostic immunophenotype in 12 cases. Abnormal FCI results occurred in 5 cases with history of hematologic malignancies, while concurrent cytomorphologic reports were negative.

Conclusion
Our findings suggest that CSF flow cytometry has low utility for screening patients with undifferentiated neurologic symptoms or without a prior hematologic malignancy history. Use as a screening tool for cases without clinical suspicion of hematolymphoid neoplasm is debatable. Flow cytometric and cytomorphologic analysis should be performed concurrently. While flow cytometric analysis in CSF may have higher sensitivity in hematologic malignancies, cytomorphology appears more favorable in identifying atypia or reactive conditions.