Inpatient Test Utilization and Test Volume Benchmarking: A Q-Probes Study.

Context.—: Test-ordering practices vary widely between and within health care organizations, and methods used to benchmark test utilization data are unstandardized.

Objective.

Adapting ChatGPT for Color Blindness in Medical Education.

Color vision deficiency (CVD) affects a significant portion of the population, yet its impact is often overlooked in medical education, especially in visually demanding specialties like dermatology, pathology, and radiology. In this study, we investigated the potential of ChatGPT to comprehend CVD-simulated images in image-based diagnostic tasks. Notably, the model successfully adapted its diagnostic reasoning to match CVD-modified color perception while preserving high prediction accuracy.

Red Blood Cell Transfusion Practices.

Context.—: Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes.

Archived Cytogenetic Cell Pellets Used to Detect a BCR::ABL1 Driver Mutation Eight Years before Disease Presentation.

Evidence suggests that the earliest genetic events in the evolution of a cancer can predate diagnosis by several years or decades. In chronic myeloid leukemia (CML), the BCR::ABL1 fusion driver mutation can be present for an extended period before clinical disease manifests. The time between the BCR::ABL1 occurrence and symptom onset is referred to as the latency period.

A treatment-refractory aggressive MDS-MLD with multiple highly complex chromosome 5 intrachromosomal rearrangements: a case report.

Background: A patient with a myelodysplastic neoplasm exhibited a karyotype with multiple complex chromosome 5 rearrangements. This patient appeared to have a catastrophic cytogenetic event that manifested as a treatment-refractory aggressive form of disease, which lead to patient demise within one year. Both the clinical presentation and disease course were unusual based on the medical history and morphologic findings.

Persistence and Protective Potential of SARS-CoV-2 Antibody Levels After COVID-19 Vaccination in a West Virginia Nursing Home Cohort.

Importance: West Virginia prioritized SARS-CoV-2 vaccine delivery to nursing home facilities because of increased risk of severe illness in elderly populations. However, the persistence and protective role of antibody levels remain unclear.

Objective: To examine the persistence of humoral immunity after COVID-19 vaccination and the association of SARS-CoV-2 antibody levels and subsequent infection among nursing home residents and staff.

Serial Convalescent Plasma Infusions for the Initial COVID-19 Infections in the Appalachian Region of West Virginia.

Purpose: The rapid spread of SARS-CoV-2, the virus that is responsible for causing COVID-19, has presented the medical community with another example of when convalescent plasma (CP) is still used today. The ability to standardize CP at the onset of a pandemic is unlikely to exist in a reliable and uniformly reproducible way. We hypothesized that CP of unknown strength given in a serial manner will promote health and reduce mortality in those inflicted with COVID-19.

A Tertiary Academic Medical Center Blood Bank's Experience With Four-Factor Prothrombin Complex Concentrate.

Objectives: The role of transfusion medicine consultative services in prospectively auditing (PA) orders for four-factor prothrombin complex concentrate (4F-PCC) was evaluated at an academic medical center.

Methods: Data from 4 years of 4F-PCC orders were obtained from the laboratory information system, and electronic health records of patients receiving concentrate were reviewed.

Results: 4F-PCC was ordered for 427 patients with warfarin-, apixaban-, or rivaroxaban-associated hemorrhage.

Interplay of Antibody and Cytokine Production Reveals CXCL13 as a Potential Novel Biomarker of Lethal SARS-CoV-2 Infection.

The SARS-CoV-2 pandemic is impacting the global population. This study was designed to assess the interplay of antibodies with the cytokine response in SARS-CoV-2 patients. We demonstrate that significant levels of anti-SARS-CoV-2 antibody to receptor binding domain (RBD), nucleocapsid, and spike S1 subunit of SARS-CoV-2 develop over the first 10 to 20 days of infection.

Double Robertsonian translocations in an infertile patient with macrocytic anemia: a case report.

Background: Constitutional heterologous double Robertsonian translocations (DRT) between chromosomes 13/14 and chromosomes 14/15 with 44 chromosomes are extremely rare. In this case report, we present the karyotype analysis of metaphases prepared from bone marrow, peripheral blood and cultured skin tissue cells. These showed only 44 chromosomes with DRT involving chromosomes 13, 14 and 15.

Laboratory Staff Turnover: A College of American Pathologists Q-Probes Study of 23 Clinical Laboratories.

Context.—: Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown.

Single versus double-unit transfusion: Safety and efficacy for patients with hematologic malignancies.

Objectives: Although hemoglobin thresholds for red blood cell (RBC) transfusion have decreased, double-unit RBC transfusion practices persist. We studied the effects switching from predominantly double-unit to single-unit RBC transfusions had on utilization and clinical outcomes for malignant hematology patients.

Methods: Retrospective chart review compared malignant hematology patients before and after implementing single-unit RBC transfusion policy.

A Q-Probes Study Involving Utilization of Free Prostate-Specific Antigen, Factor V Leiden, and Hepatitis A Serology Tests.

Context.—: Managing the utilization of laboratory tests is an important quality improvement activity that adds value to health care.

Objective.

Quality Improvement Intervention for Reduction of Redundant Testing.

Laboratory data are critical to analyzing and improving clinical quality. In the setting of residual use of creatine kinase M and B isoenzyme testing for myocardial infarction, we assessed disease outcomes of discordant creatine kinase M and B isoenzyme +/troponin I (-) test pairs in order to address anticipated clinician concerns about potential loss of case-finding sensitivity following proposed discontinuation of routine creatine kinase and creatine kinase M and B isoenzyme testing. Time-sequenced interventions were introduced.

Quality Monitoring Approach for Optimizing Antinuclear Antibody Screening Cutoffs and Testing Work Flow.

Background: An antinuclear antibody (ANA) testing strategy involving enzyme immunoassay (EIA) screening that reflexed to immunofluorescence assay (IFA) was implemented, monitored, and optimized for clinical utility.

Methods: The clinical utility, test performance, and workload implications of various ANA testing strategies were compared during the following study phases: (a) Preimplementation (n = 469) when IFA was used for all ANA screening, (b) Verification (n = 58) when EIA performance was confirmed, (c) Implementation (n = 433) when a reflexive strategy (EIA screen/IFA confirmation) was implemented, and (d) Postimplementation (n = 528) after the reflexive strategy was optimized. Sequential samples were captured in the Preimplementation, Implementation, and Postimplementation phases for clinical performance evaluation.

Validating Laboratory Results in Electronic Health Records: A College of American Pathologists Q-Probes Study.

Context: -Laboratories must ensure that the test results and pathology reports they transmit to a patient's electronic health record (EHR) are accurate, complete, and presented in a useable format.

Objective: -To determine the accuracy, completeness, and formatting of laboratory test results and pathology reports transmitted from the laboratory to the EHR.

Design: -Participants from 45 institutions retrospectively reviewed results from 16 different laboratory tests, including clinical and anatomic pathology results, within the EHR used by their providers to view laboratory results.

Test Cancellation: A College of American Pathologists Q-Probes Study.

Context: Requests for laboratory testing are canceled after a specimen has already been collected from the patient for many reasons. Regardless of the cause, test cancellation represents a significant resource expenditure for laboratories, and many cancellation events impact patient care by delaying the reporting of test results.

Objective: To survey a wide variety of hospitals to determine the rate, causes, and circumstances surrounding laboratory test cancellation events.

Trends in Lung Cancer Molecular Testing.

Molecular testing of non-small cell lung carcinomas (NSCLCC) with adenocarcinoma features has become commonplace with the development and use of targeted treatments for these malignancies. Prior to treating these tumors with targeted drug regimens, testing for specific mutations is usually required to determine the potential response of the tumor to the therapeutic agents. This case review describes a patient with lung cancer showing a specific gene mutation who benefitted from targeted treatment.

Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011.

Context: Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring.

Objective: To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors.

Workflow analysis comparing manual and automated specimen processing for mass spectrometry-based vitamin D testing.

Objective: To quantify the benefits of automating specimen extraction in terms of specimen-preparation times and labor usage.

Methods: We used workflow modeling and time-motion studies to compare manual and automated solid-phase extraction methods to prepare specimens for a mass spectrometry-based vitamin D assay. We processed 20 batches, that included 5 to 90 specimens each, with both methods in parallel and randomly over a 4-week period.

Twenty-five years of accomplishments of the College of American Pathologists Q-probes program for clinical pathology.

Context: During the past 25 years, the College of American Pathologists' (CAP) Q-Probes program has been available as a subscription program to teach laboratorians how to improve the quality of clinical laboratory services.

Objective: To determine the accomplishments of the CAP Q-Probes program.

Design: We reviewed Q-Probes participant information, study data and conclusions, author information, and program accomplishments.

Frequency monitoring of hemoglobin A1c, low-density lipoprotein, and urine protein laboratory testing: a College of American Pathologists Q-Probes study.

Context: Ensuring laboratory tests are performed at intervals consistent with established, evidence-based guidelines in diabetic patients is an important aspect of laboratory utilization.

Objectives: To measure how frequently diabetes mellitus patients are tested for hemoglobin A1c (HbA1c), low-density lipoprotein, and urine protein and to determine whether the frequencies with which these analytes are tested are consistent with recognized guidelines.

Design: Participants prospectively identified up to 40 patients with a current HbA1c result and at least 2 previous measurements within the past 24 months.

Abbott ARCHITECT iPhenytoin assay versus similar assays for measuring free phenytoin concentrations.

Objective: To measure free phenytoin (FP) concentrations in filtered specimens using the Abbott ARCHITECT iPhenytoin assay and to compare results from this method with results from the Abbott TDx/FLx assays.

Methods: We verified accuracy, analytic measurement range, and precision for FP measurements. For correlation and therapeutic interval studies, we used filtered calibrators, controls, proficiency-testing materials, and surplus clinical samples.

Quantitative fecal lactoferrin in toxin-positive and toxin-negative Clostridium difficile specimens.

Quantitative fecal lactoferrin was measured in 112 patients tested for toxigenic Clostridium difficile using glutamate dehydrogenase (GDH) and toxin immunoassays combined with tcdB PCR. Lactoferrin levels were higher in the GDH-positive/toxin-positive group (79 μg/ml) than in the GDH-positive/toxin-negative/PCR-positive (21 μg/ml) and the GDH-negative groups (13 μg/ml). Differences in fecal lactoferrin levels suggest variable presence or severity of C.