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January 2014

Cytopathology and More | Effectiveness of the HPV vaccine in Australia

January 2014—A school-based quadrivalent human papillomavirus vaccine program was introduced in Australia in April 2007 for 12- to 13-year-old girls. This program was also extended to 14- to 17-year-old girls in schools and to 18- to 26-year-old women in the community. The vaccination program has been highly successful, with uptake rates of 86 percent, 82 percent, and 75 percent for doses one, two, and three, respectively. Australia also has an established National Cervical Screening Program. Screening is recommended at age 18, or two years after the onset of sexual activity.

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Coagulation analyzers:
New analyzers, assays, controls, and PEP

January 2014—With the new year come fresh offerings from coagulation analyzer manufacturers, of which at least two have launched entirely new testing systems. Instrumentation Laboratory’s ACL AcuStar hemostasis system has been “met with great enthusiasm for its speed, accuracy, and comprehensive line of high performance chemiluminescent assays,” says Venita C. Shirley, director of marketing for commercial operations in North America.

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Clinical Pathology Selected Abstracts, 1/14

January 2014—Predictive factors for blood transfusion in living donor pediatric liver transplantation: Patients undergoing liver transplantation, in particular pediatric liver transplantation, may receive massive transfusion. However, technical surgical improvements over the years have made it possible for many patients undergoing pediatric living donor liver transplantation (LDLT) to avoid transfusion.

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Anatomic Pathology Selected Abstracts, 1/14

January 2014—Flat pattern of nephrogenic adenoma unveiled using PAX2 and PAX8 immunohistochemistry; Managing borderline atypical ductal hyperplasia/ductal carcinoma in situ on breast needle core biopsy; Classic lobular neoplasia on core biopsy: a clinical and radiopathologic study with followup excision biopsy; Intestinal-type endocervical adenocarcinoma in situ: a subset of AIS affecting older women; Oncotype DX recurrence score: use of pathology-generated equations from linear regression analysis; Neuroendocrine carcinoma of the stomach: characteristics and prognosis; Interobserver reproducibility in diagnosis of high-grade endometrial carcinoma; Features associated with metastatic potential in invasive adenocarcinomas of the lung

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Introducing patients to their pathology reports

January 2014—Meaningful use standards are fostering increasing patient access to medical records, including pathology reports. Yet pathology reports can be challenging even for clinicians, much less for patients, to understand. Nonetheless, it is typically left to the treating non-pathologist clinician to explain the findings to the patient, even when the clinician lacks detailed knowledge of pathologic features.

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Labs weighing pros, cons of micro TLA

January 2014—Sleek specimen processing instruments, often with sophisticated robotics, are features of many larger microbiology laboratories, despite the longstanding belief that microbiology is too complex to automate. But total laboratory automation (TLA) has not yet gained a foothold in the U.S., even though there are several installations in microbiology laboratories in Europe. Could 2014 be the year that total microbiology laboratory automation comes into its own?

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Getting to the point in fragile X syndrome

January 2014—Can one equal 600? Is it possible for a mutation in a single nucleotide base in the FMR1 gene to be as potent as a run of more than 200 triplet repeats in causing fragile X-like symptoms? That was the question Stephen T. Warren, PhD, FACMG, raised in his keynote lecture at the 2013 meeting of the Association for Molecular Pathology. Two decades ago Dr. Warren and others showed that expansion of CGG triplet runs in the FMR1 gene is responsible for fragile X syndrome, or FXS. At the AMP meeting, Dr. Warren, who received the AMP Award for Excellence in Molecular Diagnostics, presented evidence that a point mutation in an FMR1 gene with a normal CGG repeat number can also cause intellectual disability and developmental delay, just as triplet repeats do, accompanied by other, non-FXS manifestations. In at least one case, a point mutation caused the full fragile X syndrome.

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The perils of overlooking lesser-known STIs

January 2014—When it comes to sexually transmitted infections, most clinicians and laboratories are well versed in diagnosing those caused by chlamydia, gonorrhea, HIV, and syphilis. But a host of lesser-known STIs often go undiagnosed, despite their surprising prevalence. Many of these STIs receive little publicity because they’re not considered reportable by the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists—a requirement that depends on a variety of factors, including whether an intervention is available and a public health response is indicated, and whether the disease or condition represents a threat to public health.

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From the President’s Desk: In policy matters, no pause in the cause, 1/14

January 2014—The landscape for physician payment is changing and all of medicine is feeling a persistent downward pressure on reimbursement, so this month’s column is a reality check and a call to arms. The reality check piece is that we’re not just talking about the shift from volume to value, the growing influence of coordinated care, or a new approach to Medicare physician payment updates.

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Lab’s respiratory panel found to curb antibiotic use

January 2014—Fewer children with respiratory disease symptoms hospitalized from the ED without a diagnosis, less antibiotic use, and a favorable ratio of reimbursement to expense. That’s what the laboratory at Children’s Healthcare of Atlanta is seeing, said Beverly B. Rogers, MD, chief of pathology, in a Nov. 5 webinar, “Focus on FilmArray: One New Technology Applied to Classic Clinical Problems.” Presented by CAP TODAY and made possible by an educational grant from BioFire Diagnostics, the webinar centered on the multiplex PCR system from BioFire that tests for viruses, bacteria, yeast, and antimicrobial resistance genes.

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Q & A Column , 1/14

January 2014—I read a question and answer in the April 2001 CAP TODAY about platelet clumping on EDTA and whether vortexing is an acceptable procedure. A common solution suggested was to redraw the specimen into sodium citrate or acid citrate dextrose (ACD). How do you calculate the correction factor for blood drawn in an ACD tube? Our lab has an old procedure for ACD correction, and it is to divide the RBC of the EDTA tube by the RBC count of the ACD tube. I don’t have any reference for this and would appreciate information.

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Newsbytes, 1/14

January 2014—Why one pathologist champions social media—In an era when one angry tweet or provocative selfie can crash a career, the potential pitfalls of social media might be more obvious than their professional benefits. But one Arkansas dermatopathologist, an enthusiastic user of Facebook, Twitter, and YouTube, urges pathologists to consider the many opportunities social media offer, particularly for networking and education.

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