American journal of clinical pathology
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Am. J. Clin. Pathol. · Jun 2006
Review Comparative StudyManagement issues in breast lesions diagnosed by fine-needle aspiration and percutaneous core breast biopsy.
The use offine-needle aspiration biopsy or percutaneous core needle biopsy to diagnose breast lesions has increased during the past few decades. Although the benefits of these procedures are well known, controversies remain about the management of certain categories of breast lesions detected by these methods. This article discusses the management issues in categories of breast lesions, including papillary lesions, atypical lobular hyperplasia and lobular carcinoma in situ, and mucinous lesions diagnosed by the preoperative techniques of aspiration or core biopsy.
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Am. J. Clin. Pathol. · Jun 2006
Correlation of workload with disagreement and amendment rates in surgical pathology and nongynecologic cytology.
In gynecologic cytology, workload limits are imposed as a surrogate to limit error rates. Whether workload correlates with error rates in surgical pathology and nongynecologic cytology is not known. We reviewed and compared the disagreement and amendment rates based on blinded review for 5 pathologists with the number of cases reviewed during that same period. ⋯ There is no correlation between workload and disagreement or amendment rates. Workload seems to be a poor surrogate for error rates in the range of workload examined in this study. Such data suggest that workload limits would have no effect at limiting or reducing error rates in surgical pathology or nongynecologic cytology.
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Am. J. Clin. Pathol. · May 2006
Total laboratory automation can help eliminate the laboratory as a factor in emergency department length of stay.
We obtained data on laboratory turnaround time (TAT) and emergency department (ED) length of stay (LOS). We correlated potassium test TAT outlier percentage (TAT-OP) with ED LOS and found that for each outlier percentage (potassium result > 40 minutes), a projected impact on ED LOS was approximately 2.8 additional minutes (ED LOS = 2.79 TAT-OP + 78.77). To address this issue, we began implementation of a totally automated chemistry system to decrease TAT-OPs. ⋯ The postautomation ED LOS correlated best with ED patient volume (r(2) = 0.88; P = .06). Although laboratories have focused on TAT means for performance assessment, our study suggests TAT-OPs are more clinically relevant benchmarks. Furthermore, our findings suggest that total laboratory automation can effectively improve overall laboratory service reliability and help eliminate the laboratory as a factor in ED LOS.
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Am. J. Clin. Pathol. · Nov 2005
Reducing laboratory turnaround time outliers can reduce emergency department patient length of stay: an 11-hospital study.
Poor core laboratory performance that causes delays in diagnosis and treatment is an impediment to optimal patient care, particularly in high-volume patient care areas such as the emergency department (ED). To evaluate the impact of laboratory performance on patient care outcomes, we obtained data from 11 hospitals related to laboratory test turnaround time (TAT) parameters and ED patient throughput. ⋯ Furthermore, improvements in laboratory performance during the study were associated with concurrent decreases in ED LOS. Although in the past, laboratories have focused on TAT means for performance assessment, our observations suggest that a more appropriate method of benchmarking might be to aggressively set clinically driven TAT targets and assess performance as the percentage of results achieving this goal.
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Am. J. Clin. Pathol. · Oct 2005
Presence of direct thrombin inhibitors can affect the results and interpretation of lupus anticoagulant testing.
In vitro experiments were conducted to determine whether the direct thrombin inhibitors argatroban and lepirudin can interfere with the results of lupus anticoagulant (LA) testing. Concentration-response curves were generated to calculate the concentration of anticoagulant that prolongs the activated partial thromboplastin time (aPTT) to 75 seconds (2.5 times the baseline average). Corresponding concentrations of anticoagulant were added to plasma samples before running dilute Russell viper venom tests (DRVVTs) and LA-sensitive aPTTs (PTT-LAs). ⋯ With argatroban added to normal plasma samples, neither the DRVVT percent correction of ratio nor the DRVVT test/confirm ratio were elevated, but when added to LA-positive plasma, some false-negative results were observed. Lepirudin increased the DRVVT percent correction of ratio and the DRVVT test/confirm ratio into a range that could lead to false-positive identifications of LAs. In sharp contrast to the DRVVT test system, distinction between LA-positive and LA-negative plasma samples was maintained and possibly even enhanced in the platelet neutralization procedure correction phase of the PTT-LA test system.