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June 2017

Diagnostics anchor freestanding ED

June 2017—To the business world, “appropriate technology” may evoke the era of tie-dyed shirts, bead curtains, and Mother Earth News. But the term, coined by Small Is Beautiful author E.F. Schumacher in 1973, comes close to describing the goal of health care systems as they opt to expand their facility footprint with freestanding emergency departments (FSEDs).

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New scope for trial drives FDA verdict

June 2017—The new FDA-enabled milestone in pathology—approval in April of whole slide imaging for primary diagnosis—allows pathology to dip its toe into the technological revolution that has already transformed other fields. Widespread adoption will take time, training, and money, but it no longer awaits breakthrough approval.

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From the President’s Desk: Speaking of optics, 6/17

June 2017—We typically define “normal” or “true” from the perspective of our local communities and social circles. This reliance on the familiar can compromise communication effectiveness when we don’t appropriately consider the audience. And as the exchange of information continues to accelerate, the impact on what constitutes an authoritative assessment evolves similarly. Sometimes we don’t stop to think.

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Kevin B. Dole, MD | 1948–2017

June 2017—Kevin B. Dole, MD, 68, a member of the CAP Board of Governors from 2001 to 2007, died April 23 of metastatic pancreatic cancer. He had served as a member of the Councils on Government and Professional Affairs and on Public Affairs and as chair of the Council on Membership and Professional Development. He was a member of more than a dozen committees, among them Credentials, CLIA Implementation, Practice Guidelines, and Federal and State Affairs (which he chaired). He was named Pathologist of the Year in 2009.

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Book surveys patient safety from AP, CP standpoint

June 2017—CAP Press released in May Patient Safety in Anatomic & Clinical Pathology Laboratories. Editor Deborah Sesok-Pizzini, MD, MBA, and 11 additional contributors cover handoff communications, technology, tools and methods, human factors, a patient safety curriculum, and more. Dr. Pizzini is chief of blood bank and transfusion medicine in, and vice-chief of, the Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia. She is the department safety officer for CHOP Pathology and Laboratory Medicine, and she is a professor of clinical pathology and laboratory medicine, Perelman School of Medicine, University of Pennsylvania. We asked her about the new book. Here is what she told us.

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Pathologist Cognition

June 2017—In the chapter “Diagnostic Errors and Cognitive Bias” in Patient Safety in Anatomic & Clinical Pathology Laboratories, Stephen S. Raab, MD, writes about pathology work process and cognitive failures, pattern recognition and cognitive strategies, interpretive error, and mitigation and improving safety. Here is his section on pathologist cognition. Dr. Raab is a professor of pathology at the University of Mississippi Medical Center, Jackson.

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Helping phlebotomists ease pediatric patient anxiety

June 2017—“It’s the most talked about pain kids experience, even more so than post-op surgical pain.” Julie Piazza, a certified child life specialist, is referring to needlestick pain from pediatric blood draws. As project manager for patient and family-centered care at C.S. Mott Children’s Hospital in the University of Michigan health system, now known as Michigan Medicine, Ann Arbor, Piazza has observed anxiety at both ends of the needle.

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Life-threatening bleeding—what’s the right call?

June 2017—In the CAP16 session, “Your Turn: Management of the Bleeding Patient,” Theresa Nester, MD, reminded attendees who provide transfusion medicine consultation to assess the available information before calling the clinical team: patient history, drugs, coagulation test results, and products administered so far. “Your main role is to help determine why the patient is bleeding and the most appropriate treatment,” said Dr. Nester, medical director of integrated transfusion services at Bloodworks Northwest in Seattle.

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Emergency hemorrhage panel gives surgeons what they need

June 2017—As an alternative to point-of-care testing, Wayne Chandler, MD, and colleagues developed and implemented a rapid emergency hemorrhage panel, or EHP, for trauma patients (Chandler WL, et al. Transfusion. 2010;50[12]:2547–2552). The panel tests are prothrombin time, hematocrit, fibrinogen, and platelet count. “By limiting EHPs to patients that were actively bleeding, EHPs accounted for only 8 of 243 coagulation samples per day,” he and colleagues wrote in their 2010 article.

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Anatomic Pathology Abstracts, 6/17

June 2017—Fallopian tube involvement in uterine serous carcinomas: The authors investigated the frequency and histopathologic and immunohistochemical characteristics of tubal involvement in uterine serous carcinoma to clarify the relationship between serous tubal intraepithelial carcinoma (STIC) and uterine serous carcinoma. They prospectively collected and reviewed, for the presence of tubal involvement, cases of the latter with complete tubal examination.

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Clinical Pathology Abstracts, 6/17

June 2017—Stem cell divisions, somatic mutations, cancer etiology, and cancer prevention: Cancers are caused by mutations that may be inherited or induced by environmental factors or that may result from DNA replication errors. The mutations due to random mistakes made during normal DNA replication may explain why cancers occur much more commonly in some tissues than others. Approximately three mutations occur every time a normal human stem cell divides.

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Molecular Pathology Abstracts, 6/17

June 2017—Whole genome single-cell copy number profiling on FFPE tissue samples Single-cell genomic methods take the concept of analyzing intratumor genetic heterogeneity to its logical conclusion. Traditionally, however, single-cell methods can only be used to analyze fresh or rapidly frozen tissue because formalin fixation and paraffin embedding degrades tumor DNA and cross-links proteins.

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Q&A column, 6/17

June 2017—Our analyzer reported nucleated red blood cells of six, with no cellular interference flag. The technologist missed that the automated NRBC was six. When he performed the manual differential, he noted more than five NRBCs and performed a corrected count and certified it. Is it acceptable to report out the automated white blood cell value as well as the corrected WBC?

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Newsbytes, 6/17

June 2017—Making the most of classroom technologies to train residents: Google the phrase “millennials killed” and you’ll discover a genre of Internet clickbait claiming the generation in question has rejected a lengthy assortment of previously popular items, from “the suit” to “napkins” to the “hangout sitcom.”

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Put It on the Board, 6/17

June 2016—CMS grants Qualified Clinical Data Registry status to Pathologists Quality Registry: The Centers for Medicare and Medicaid Services has approved the CAP’s Pathologists Quality Registry as a Qualified Clinical Data Registry, or QCDR. This makes it a reporting option for pathologists in fulfilling reporting requirements under Medicare’s Quality Payment Program.

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