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Uhlman K, Bonert M, Murphy J, Duku E, Naqvi A, Thoma A. Routine Pathological Examination of Clinically Presumed Dupuytren Disease: Does It Add Value? Hand (N Y) 2022:15589447221128982. [PMID: 36314350 DOI: 10.1177/15589447221128982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND In surgery for Dupuytren disease (DD), palmar fascia specimens are routinely submitted for pathological evaluation. The purpose of this study was to determine the rate of discordant diagnosis and the value of, and costs associated with, routine pathological analysis of palmar fascia tissue extracted in surgery for clinically diagnosed DD. METHODS All pathology reports for in-house palmar fascia specimens obtained in surgery for clinically diagnosed DD (time period: January 2001 to December 2020) were retrieved from one academic institution. All specimens were classified by a hierarchical free-text string matching algorithm (HFTSMA) and searched for evidence of malignancy. The primary outcome was percentage of concordant, discrepant, and discordant diagnoses. Secondary outcomes included anatomical location and costs. The HFTSMA was used to capture the anatomical location. Costs included professional, laboratory processing, and ancillary fees based on the Ontario Schedule of Benefits. RESULTS The search retrieved 1323 pathology reports, with 1480 palmar fascia specimens, from 1078 individual patients. By diagnosis, 96.1% of specimens (1422/1480) were concordant (fibromatosis), 3.9% (58/1480) were discrepant (scarring/fibrosis, benign fascia/connective tissue, or other benign findings), and 0% (0/1480) were discordant. The most common location was ring finger (n = 381, 48.7%). Ancillary testing was minimal. The cost per palmar fascia specimen was estimated to be CAD $34.57. The institutional costs were approximately CAD $2558.18/year. CONCLUSIONS Routine pathological examination of specimens in cases of clinically diagnosed DD does not yield additional clinically important findings and may not warrant their costs.
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Affiliation(s)
| | - Michael Bonert
- McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, ON, Canada
| | - Asghar Naqvi
- McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
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White TE, Wong WB, Janowiak D, Hilborne LH. Strategies for laboratory professionals to drive laboratory stewardship. Pract Lab Med 2021; 26:e00249. [PMID: 34381860 PMCID: PMC8339222 DOI: 10.1016/j.plabm.2021.e00249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
Appropriate laboratory testing is critical in today's healthcare environment that aims to improve patient care while reducing cost. In recent years, laboratory stewardship has emerged as a strategy for assuring quality in laboratory medicine with the goal of providing the right test, for the right patient, at the right time. Implementing a laboratory stewardship program now presents a valuable opportunity for laboratory professionals to exercise leadership within health systems and to drive change toward realizing aims in healthcare. The proposed framework for program implementation includes 5 key elements: 1) a clear vision and organizational alignment; 2) appropriate skills for program execution and management; 3) resources to support the program; 4) incentives to motivate participation; and, 5) a plan of action that articulates program objectives and metrics. This framework builds upon principles of change management, with emphasis on engagement with clinical and administrative stakeholders and the use of clinical data as the basis for change. These strategies enable laboratory professionals to cultivate organizational support for improving laboratory use and take a leading role in providing high-quality patient care.
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Affiliation(s)
- Terra E. White
- Quest Diagnostics, 500 Plaza Dr, Secaucus, NJ, 07094, USA
| | - Wesley B. Wong
- Hc1, 6100 Technology Center Dr, Indianapolis, IN, 46278, USA
| | - Diane Janowiak
- Hc1, 6100 Technology Center Dr, Indianapolis, IN, 46278, USA
| | - Lee H. Hilborne
- Quest Diagnostics, 500 Plaza Dr, Secaucus, NJ, 07094, USA
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, 757 UCLA Medical Plaza, Room B788, Los Angeles, CA, 90095, USA
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Crowe EP, Goel R, Andrews J, Meyer EK, Wong TE, Sloan SR, Delaney M, Lieberman L, Cushing MM. Survey of newborn direct antiglobulin testing practice in United States and Canadian transfusion services. Transfusion 2021; 61:1080-1092. [PMID: 33629748 DOI: 10.1111/trf.16335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We hypothesized that variability in practice exists for newborn immunohematology testing due to lack of consensus guidelines. We report the results of a survey assessing that variability at hospitals in the United States and Canada. STUDY DESIGN AND METHODS An AABB Pediatric Subsection working party developed and validated a survey of newborn immunohematology testing practice. The survey was sent electronically to transfusion service leadership at teaching institutions. RESULTS The response rate was 67% (61/91); 56 surveys meeting inclusion criteria were analyzed. Approximately 90% (50/56) were from birth hospitals and 16.1% (9/56) were from pediatric hospitals. Newborn immunohematology testing is ordered as a panel by 66.0% (33/50) of birth hospitals. ABO group and DAT is mandated before discharge in 14/56 (25.0%) and 13/56 (23.2%), respectively. About 76.8% (43/56) selectively perform a DAT according to blood blank or clinical parameters. The most common DAT practices include anti-IgG only testing by 73.2% (41/56) and use of umbilical cord specimen type by 67.9% (38/56). A positive DAT is a critical value for 26.8% (15/56) and followed with eluate testing when a maternal antibody screen is positive for 48.2% (27/56). In the setting of a non-ABO maternal red cell antibody, 55.4% (31/56), phenotype neonatal red cells when the DAT is positive. Group O RBC are transfused irrespective of the DAT result for 82.1%, (46/56). CONCLUSION There is variability in newborn immunohematology testing and transfusion practice and potential overutilization of the DAT. Evidence-based consensus guidelines should be developed to standardize practice and to improve safety.
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Affiliation(s)
- Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jennifer Andrews
- Department of Pediatrics and Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Erin K Meyer
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Trisha E Wong
- Pathology and Pediatric Hematology Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven R Sloan
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine Division, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology & Pediatrics, The George Washington University Medical School, Washington, District of Columbia, USA
| | - Lani Lieberman
- University Health Network and Affiliated Hospitals, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa M Cushing
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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Roth CG, Huang WY, Caruso AC, Sekhon N, Kung DH, Greely JT, Du YB, Holder-Haynes JG, Little JE, Fielder EK, Ismail NJ. How to Teach Laboratory Stewardship in the Undergraduate Medical Curriculum? Am J Clin Pathol 2020; 153:66-73. [PMID: 31836880 DOI: 10.1093/ajcp/aqz102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Promotion of high-quality care at a lower cost requires educational initiatives across the continuum of medical education. A needs assessment was performed to inform the design of an educational tool with the goal of teaching laboratory stewardship to medical students. METHODS The needs assessment consisted of semistructured interviews with core clerkship directors and residency program directors at our institution, a national survey to the Undergraduate Medical Educators Section (UMEDS) of the Association of Pathology Chairs, and a review of existing online resources that teach high-value care. RESULTS Two major themes emerged regarding opportunities to enhance laboratory stewardship education: appropriate ordering (knowledge of test indications, pretest/posttest probability, appropriateness criteria, recognition of unnecessary testing) and correct interpretation (understanding test specifications, factors that affect the test result, recognizing inaccurate results). CONCLUSIONS The online educational tool will focus on the curricular needs identified, using a multidisciplinary approach for development and implementation.
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Affiliation(s)
- Christine G Roth
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
| | - William Y Huang
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Andrew C Caruso
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Navdeep Sekhon
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Doris H Kung
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Jocelyn T Greely
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Ye B Du
- Department of Psychiatry, Baylor College of Medicine, Houston, TX
| | | | - Jenelle E Little
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Elaine K Fielder
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Nadia J Ismail
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX
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Affiliation(s)
- Steven H Kroft
- Department of Pathology, Medical College of Wisconsin, Milwaukee
| | - Roger L Bertholf
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
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Shen JZ, Hill BC, Polhill SR, Evans P, Galloway DP, Johnson RB, Reddy VVB, Bosarge PL, Rice-Jennings LA, Lorenz RG. Optimization of Laboratory Ordering Practices for Complete Blood Count With Differential. Am J Clin Pathol 2019; 151:306-315. [PMID: 30357374 DOI: 10.1093/ajcp/aqy146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the utilization of CBC and CBC with differential (CBC w/diff) tests at University of Alabama at Birmingham Hospital, and to determine if a reduction in CBC w/diff tests could be achieved without negatively impacting patient care. Methods The quantity of testing and distribution of repeated tests before, during, and after an educational intervention were compared. Results CBC w/diff tests were ordered 10-fold more frequently than CBC tests. The trauma burn intensive care unit ordered the most CBC w/diff tests, with repeat tests done every 4 or 12 hours. The educational intervention reduced the number of CBC w/diff tests ordered and tests repeated every 12 hours. Conclusions The educational intervention changed the ordering practices of CBC w/diff and CBC tests. This was sustained after the intervention and no negative effects on patient care were noted. Similar interventions may lead to optimization of ordering practices of other laboratory tests.
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Affiliation(s)
- Jeffrey Z Shen
- Departments of Pathology, University of Alabama at Birmingham
| | - Benjamin C Hill
- Department of Pathology, Children’s Hospital of Alabama, Birmingham
| | | | | | - David P Galloway
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Alabama, Birmingham
| | - Robert B Johnson
- Department of Respiratory Care, University of Alabama at Birmingham Hospital
| | | | | | | | - Robin G Lorenz
- Departments of Pathology, University of Alabama at Birmingham
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