首页期刊导航|American journal of clinical pathology.
期刊信息/Journal information
American journal of clinical pathology.
Lippincott [etc.]
American journal of clinical pathology.

Lippincott [etc.]

0002-9173

American journal of clinical pathology./Journal American journal of clinical pathology.
正式出版
收录年代

    Implementation and Evaluation of Virtual Laboratory Tours for Laboratory Diagnosis of Hematologic Disease

    Scordino, Teresa A.Darden, Alix G.
    4页
    查看更多>>摘要：Objectives There is often limited time allocated to teaching laboratory medicine to medical students. Without adequate time and context, it can be difficult for students to learn appropriate uses and limitations of laboratory tests. Introducing students to the laboratories and test methods may help them learn these concepts, but physical laboratory tours are difficult to organize for large groups, especially during the coronavirus disease 2019 pandemic. Methods We created virtual laboratory tours consisting of short video clips and voiceover PowerPoint slides to teach students about the laboratory tests used to diagnose hematologic malignancies. We assessed the impact on student performance on laboratory medicine-themed quiz questions and surveyed the students to determine their attitudes about the activity. Results In total, 129 first-year medical students participated in the study. The average score on the preactivity quiz was 59.8%, and the average score on the postactivity quiz was 92.2%. Students were more confident in their ability to answer quiz questions after completing the activity. Postactivity survey data indicated that the students enjoyed the activity and felt it was an effective way to learn the material. Conclusions Virtual laboratory tours show promise as a method of incorporating more laboratory medicine content into medical school curricula.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Temperature Optimization Within 2 Uniquely Designed Courier Lockboxes During Extreme Summer Temperatures

    Hart, StephanieWiencek, Joesph R.
    4页
    查看更多>>摘要：Objectives To determine optimal temperature profiles for 2 uniquely designed courier lockboxes (steel vs polymer) by standardizing daily ice (-20oC) and cold (4-8oC) pack placement. Methods Paired courier lockboxes were placed outside in direct sunlight. Ambient outdoor and lockbox temperatures were monitored during 2 4-day cycles, and temperature mean and range were determined daily (time frame, 4:00-10:00 pm). Control lockboxes without packs were compared with experimental paired lockboxes with either 2 cold packs placed at 4:00 pm or 4 ice packs placed at 8:00 am and replaced with 4 cold packs at 4:00 pm daily. Results Cycle 1 mean temperatures within control steel and polymer lockboxes were 31.8oC (range, 18.4-44.1oC) and 37.2oC (range, 27.1-46.7oC), respectively. The addition of 2 cold packs at 4:00 pm reduced mean temperatures to 29.1oC (range, 19.1-37.2oC) and 25.3oC (range, 20.0-31.6oC) in steel and polymer boxes, respectively. Cycle 2 mean temperatures within control steel and polymer lockboxes were 28.3oC (range, 22.4-40.8oC) and 31.6oC (range, 23.8-41.0oC), respectively. The addition of 4 ice packs at 8:00 am and replacement with 4 cold packs at 4:00 pm reduced mean temperatures to 24.3oC (range, 17.4-27.9oC) and 13.4oC (range, 6.6-18.1oC) in steel and polymer boxes, respectively. Conclusions Standardizing instructions for ice and cold packs can decrease internal courier lockbox temperatures.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Hemolysis Index and Potassium Reporting Contextual Evidence-Based Reporting Criteria

    DiToro, Daniel F.Conrad, Michael J.Jarolim, Petr
    5页
    查看更多>>摘要：Objectives In vitro hemolysis generates a spurious increase in potassium. Roche Diagnostics recently revised its recommended guidelines for potassium reporting on cobas analyzers. By dramatically reducing the allowable degree of hemolysis, these guidelines would increase specimen rejection rates. We attempted to balance the desire to avoid inaccurate results with the clinical implications of increased specimen rejection rates. Methods We downloaded hemolytic indices (HI) for 80,795 specimens tested at our institution on cobas chemistry analyzers in 1 month and evaluated potential specimen rejection rates based on the new criteria. We also spiked nonhemolyzed samples with hemolyzed blood to assess the influence of HI values on potassium measurements. Results The new recommendations would lead to specimen rejection rates of 76% in the neonatal intensive care unit (NICU), 41% in the emergency department (ED), 16% in inpatient specimens, and 9% in outpatient samples. Our current criteria of reporting potassium concentrations in inpatient and outpatient specimens with HI <= 100 and in NICU and ED specimens with HI <= 300 and additional interpretive guidance for HI values between 100 and 300 reduce unnecessary specimen rejections to 3% in NICU, 2% in ED and inpatients, and less than 1% in outpatients without significantly increasing the number of clinically consequential incorrect results. Conclusions The new recommendations would lead to unacceptably high specimen rejection rates. Laboratories should develop context-specific, evidence-based reporting criteria that minimize reporting of inaccurate results without disrupting delivery of care.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Anatomy of a Cyberattack Part 3: Coordination in Crisis, Development of an Incident Command Team, and Resident Education During Downtime

    Wilburn, ClaytonBryant, BronwynFrisch, NoraKalof, Alexandra N....
    9页
    查看更多>>摘要：Objectives Our institution was subject to a multi-institutional, systemwide cyberattack that led to a complete shutdown of multiple major patient care, operational, and communication systems for more than 25 days. The electronic health record computer system was taken offline, as was the hospital email and authentication systems, internet access, and the laboratory information system. The impact on the hospital and patient care was substantial, and our laboratories were crippled. Methods Our laboratory endured challenges in communication because of the loss of connectivity and difficulties in laboratory management, and we recognized a need to restructure leadership to maintain operations during the crisis. As an academic institution, residents and trainees were also significantly affected by the disaster. Results We developed an incident command team (ICT), alternative methods of communication, and innovative management strategies to remain operational. Trainees were incorporated into the disaster-relief efforts, with negative impacts on resident education. Conclusions This paper focuses on the challenges in communication and lab management as well as the need for an alternative leadership structure during the crisis. We also highlight the unique experience of our trainees during this prolonged downtime, underscoring the importance of incorporating resident trainees into the daily ICT's administrative activities as an invaluable lab management experience.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Morphologic Markers of Acute and Chronic Stress in Child Abuse

    Flomenbaum, Mark A.Warner, Ryan C.
    13页
    查看更多>>摘要：Objectives To elucidate pathologic markers of acute and chronic stress found but rarely reported in chronic child abuse. Methods Autopsies of 3 cases of fatal child abuse with well-documented chronic maltreatment are reported, with an emphasis on the nontraumatic findings of acute and chronic stress. Results Besides the overwhelming physical injuries, all 3 children and 1 additional case obtained for consultation had telogen effluvium, a form of alopecia well known to be associated with stress in adults and some children but never reported in chronic abuse. All 3 had the microscopic findings of markedly involuted thymus, a well-known marker of physiologic stress in children but only occasionally referred to in child abuse. All 3 also had microscopic findings of myocardial necrosis associated with supraphysiologic levels of catecholamine, a well-documented finding associated with stress but rarely reported in fatalities associated with child abuse. Two of the 3 children also had Anitschkow-like nuclear changes in cardiac tissue, markers associated with prior, nonischemic myocardial pathologies that may be associated with prior episodes of acute stress. Conclusions Pathologists are urged to explore these markers as supportive evidence in their own investigations of possible child abuse fatalities, especially when associated with stress.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Challenges and Opportunities in Using Twitter as a Pedagogical Tool in Pathology and Laboratory Medicine Education

    Tushir, AbhimanyuTung Duy NguyenBiehl, ColtonMirza, Kamran M....
    8页
    查看更多>>摘要：Objectives Even though the benefits of using Twitter for teaching and information exchange within the pathology community are primarily undisputed, a fair number of users refrain from sharing educational content on this social media platform. The survey aims to identify challenges in using Twitter as a pedagogical tool and discuss ways of converting those challenges into opportunities. Methods We performed a cross-sectional survey-based study involving 174 participants from the pathology community on Twitter. Results The results demonstrated that procurement of content was the major challenge faced by 36.2% of the participants, with most participants being concerned or very concerned regarding institutional policies and Health Insurance Portability and Accountability Act issues. Content procurement concerns were followed by social media inertia, stated by 23% of the participants as an obstacle to posting educational content on Twitter. Conclusions The report helps elicit some common obstacles faced by the pathology and laboratory medicine community and allows us to recommend solutions to overcome these obstacles.
      原文链接:
    • NSTL
    • Oxford Univ Press

    COVID-19 and Immune-Mediated RBC Destruction A Systematic Review

    Jacobs, Jeremy W.Booth, Garrett S.
    8页
    查看更多>>摘要：Objectives To summarize the epidemiologic, clinical, and laboratory characteristics of autoimmune hemolytic anemia (AIHA) secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination. Methods We conducted a systematic review using standardized keyword search to identify all reports of SARS-CoV-2 infection or vaccination and AIHA across PubMed, Web of Science, Scopus, and Google Scholar through September 24, 2021. Results Fifty patients (mean [SD] age, 50.8 [21.6] years) diagnosed with coronavirus disease 2019 (COVID-19) and AIHA were identified. AIHA subtypes and number of patients were as follows: cold AIHA (n = 18), warm AIHA (n = 14), mixed-type AIHA (n = 3), direct antiglobulin test (DAT)-negative AIHA (n = 1), DAT-negative Evans syndrome (n = 1), Evans syndrome (n = 3), and subtype not reported (n = 10). Mean (SD) hemoglobin at AIHA diagnosis was 6.5 [2.8] g/dL (95% confidence interval, 5.7-7.3 g/dL). Median time from COVID-19 symptom onset to AIHA diagnosis was 7 days. In total, 19% (8/42) of patients with COVID-19-associated AIHA with reported outcomes were deceased. Four patients (mean [SD] age, 73.5 [16.9] years) developed AIHA following SARS-CoV-2 vaccination: Pfizer-BioNTech BNT162b2 vaccine (n = 2); Moderna mRNA-1273 vaccine (n = 1); undisclosed mRNA vaccine (n = 1). AIHA occurred after 1 dose in 3 patients (median, 5 days). Conclusions SARS-CoV-2 infection and vaccination are associated with multiple AIHA subtypes, beginning approximately 7 days after infectious symptoms and 5 days after vaccination.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Identification of Hemoglobin Variants Prevalent in China and Their Effects on Hemoglobin A(1c) Measurements

    Xu, AnpingChen, WeidongXu, MiaoXie, Weijie...
    6页
    查看更多>>摘要：Objectives We aimed to evaluate the effects of hemoglobin (Hb) variants prevalent in China on HbA(1c) measurements and to identify them during HbA(1c) measurements. Methods We evaluated a cation-exchange high-performance liquid chromatography (HPLC) method (Bio-Rad D-100), a capillary electrophoresis (CE) method (Capillarys 3 TERA), an immunoassay (Cobas c501), and a boronate affinity method (Premier Hb9210, as a comparative method) for HbA(1c) measurements in the presence of Hb variants prevalent in China. Results The Bio-Rad D-100 and Capillarys 3 TERA gave specific retention times and numeric migration positions for each Hb variant, respectively, showing excellent interindividual reproducibility. All methods showed statistically significant differences (P < .01) for several variants. Clinically significant effects were observed for the Bio-Rad D-100 (Hb New York and Hb J-Bangkok), Capillarys 3 TERA (Hb New York and Hb J-Bangkok), and Cobas c501 (Hb New York). Among 297 samples with Hb variants, there were 75 (25.3%) unacceptable results for Bio-Rad D-100, 28 (9.4%) for Capillarys 3 TERA, and 19 (6.4%) for Cobas c501 compared with the results from Premier Hb9210. Conclusions Some Hb variants prevalent in China affect HbA(1c) measurements. The HPLC retention time and CE migration position can aid in the presumptive identification of Hb variants.
      原文链接:
    • NSTL
    • Oxford Univ Press

    The Gallbladder and Vermiform Appendix as Quality Assurance Indicators in Autopsy Pathology A 10-Year Community Teaching Hospital Experience

    Williams, NathanVidhun, RamapriyaStroever, StephanieDodge, Jessica L....
    5页
    查看更多>>摘要：Objectives We investigate the number of autopsy reports that did or did not document the presence or absence of the gallbladder or appendix or document abdominal scars in patients following cholecystectomy or appendectomy. We also report gallbladder and appendix pathology at autopsy. Methods Autopsy reports from patients 18 years or older autopsied at a community teaching hospital between January 1, 2009, and December 31, 2018 were reviewed. Nonabdominal autopsies were excluded. Histopathologic examination of the gallbladder and appendix was only performed if gross pathology was seen. Results Of the 385 autopsies studied, 48 (12.5%) had cholecystectomies, of which 6 (12.5%) did not document abdominal scars. Sixty-two (16.1%) had appendectomies, of which 12 (19.4%) did not document abdominal scars. The presence or absence of the gallbladder and appendix was not documented in 6 (1.6%) and 16 (4.2%) of reports, respectively. Pathology was seen in 87 (25.8%) gallbladders and 4 (1.2%) appendixes. Conclusions Absence of the gallbladder or appendix is a relatively common autopsy finding. Auditing autopsy reports for documentation of their presence or absence, along with associated abdominal scars, are potential quality assurance indicators of autopsy reports. Documentation of these elements could be improved by changing the autopsy template or using synoptic reporting.
      原文链接:
    • NSTL
    • Oxford Univ Press

    Metastatic Neoplasms Involving the Stomach A Clinicopathologic Analysis of a Large Multi-Institutional Cohort

    Vyas, MonikaHissong, ErikaGonzalez, Raul S.Shia, Jinru...
    11页
    查看更多>>摘要：Objectives Metastatic neoplasms involving the stomach are rare and diagnostically challenging if clinical history of malignancy is absent or unavailable. This study was designed to identify the tumors that most frequently metastasize to the stomach and the morphologic features that can provide clues to investigate the possibility of metastasis and predict the primary sites. Methods All patients with metastatic neoplasms involving the stomach were included in the study. The H&E- and immunohistochemical-stained slides were reviewed, and all clinical, endoscopic, and radiologic information was recorded. Results One hundred fifty patients, including 84 (56%) women and 66 (44%) men (mean age, 64 years), were identified. Gastric metastases were the initial presentation in 15% cases. Epithelial tumors (73.3%) comprised the largest group, followed by melanoma (20.6%), sarcomas (4%), germ cell tumors (1.3%), and hematolymphoid neoplasms (0.7%). Lobular breast carcinoma was the most common neoplasm overall in women, while in men, it was melanoma. Solid/diffuse growth pattern (75%) was more common compared with glandular morphology. The solid/diffuse category included lobular breast carcinoma (21.3%), melanoma (20.6%), and renal cell carcinoma (10.6%), while the glandular category was dominated by gynecologic serous carcinomas (7.3%) with papillary/micropapillary architecture. Conclusions Metastatic neoplasms should be considered in the differential diagnosis of gastric neoplasms, particularly those with a diffuse/solid growth pattern. Glandular neoplasms are difficult to differentiate from gastric primaries except for Mullerian neoplasms, which frequently show a papillary/micropapillary architecture.
      原文链接:
    • NSTL
    • Oxford Univ Press