Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center.

This case study over time describes five years of experience with interventions to improve laboratory test utilization at an academic medical center. The high-frequency laboratory tests showing the biggest declines in order volume post intervention were serum albumin (36%) and erythrocyte sedimentation rate (17%). Introduction of restrictions for 170 high-cost send-out tests resulted in a 23% decline in order volume. Targeted interventions reduced mis-orders involving several "look-alike" tests: 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D; manganese, magnesium; beta-2-glycoprotein, beta-2-microglobulin. Lastly, targeted alerts reduced duplicate orders of germline genetic testing and orders of hepatitis B surface antigen within 2 weeks of hepatitis B vaccination.

Biofilm Producing Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Humans: Clinical Implications and Management.

Since its initial description in the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has developed multiple mechanisms for antimicrobial resistance and evading the immune system, including biofilm production. MRSA is now a widespread pathogen, causing a spectrum of infections ranging from superficial skin issues to severe conditions like osteoarticular infections and endocarditis, leading to high morbidity and mortality. Biofilm production is a key aspect of MRSA's ability to invade, spread, and resist antimicrobial treatments. Environmental factors, such as suboptimal antibiotics, pH, temperature, and tissue oxygen levels, enhance biofilm formation. Biofilms are intricate bacterial structures with dense organisms embedded in polysaccharides, promoting their resilience. The process involves stages of attachment, expansion, maturation, and eventually disassembly or dispersion. MRSA's biofilm formation has a complex molecular foundation, involving genes like icaADBC, fnbA, fnbB, clfA, clfB, atl, agr, sarA, sarZ, sigB, sarX, psm, icaR, and srtA. Recognizing pivotal genes for biofilm formation has led to potential therapeutic strategies targeting elemental and enzymatic properties to combat MRSA biofilms. This review provides a practical approach for healthcare practitioners, addressing biofilm pathogenesis, disease spectrum, and management guidelines, including advances in treatment. Effective management involves appropriate antimicrobial therapy, surgical interventions, foreign body removal, and robust infection control practices to curtail spread within healthcare environments.

Smart and connected devices in point-of-care molecular diagnostics: what role can they play in the response to COVID-19?

INTRODUCTION: Coronavirus disease-2019 (COVID-19) has been a huge public health challenge that has led to significant morbidity and mortality across the globe. Given the high prevalence and continued circulation of SARS-CoV-2 infection globally, accurate and rapid point-of-care testing is critical. AREAS COVERED: Knowledge of role of digital technology including smart and connected devices in rapid diagnosis of COVID-19 is an evolving area of scientific investigation. This review discusses the importance of rapid at-home point-of-care testing, highlighting the possible role of smart and connected device-based molecular diagnostics for COVID-19. EXPERT OPINION: Accurate and rapid diagnostic modalities have the potential to improve accessibility and efficiency of diagnosis of symptomatic and asymptomatic patients and could be instrumental in timely implementation of appropriate therapeutic interventions as well as public health measures to mitigate spread of infection. With emerging challenges like newer viral variants, global vaccine shortages and vaccine hesitancy, accurate diagnostic testing with the ability to rapidly identify infection remains critical. Digital technologies are likely to become important tools in future of healthcare and technological advancements may play a crucial role in response to COVID-19 with the goal of ultimately overcoming this pandemic.

Data on the utilization of paraneoplastic syndrome autoantibody testing at an academic medical center.

Paraneoplastic syndromes are rare conditions associated with characteristic autoantibodies produced by malignancy, although similar autoantibodies and clinical presentations may occur in the absence of any neoplasm. Testing for paraneoplastic syndromes often involves panels of autoantibody assays. While autoantibody testing may reveal or confirm actionable clinical diagnoses, inappropriate utilization of testing may be low yield and further lead to false positives that may confuse the clinical picture. There is thus opportunity to improve patient care by analyzing patterns of paraneoplastic autoantibody test utilization. The data in this article provides results from detailed retrospective review of patients tested by 7 autoantibody tests or test panels offered by two large reference laboratories in the United States. The data include 1,446 tests performed on 1,338 unique patients at an academic medical center. For all results, detailed chart review revealed main category of presenting symptoms, patient location at time of testing (either inpatient or outpatient), sex, age, whether cancer was present at the time of testing or later detected, and the specific results of the testing. The data are summarized by category of testing and specific autoantibodies.

Leukemic Transdifferentiation of Follicular Lymphoma Into an Acute Histiocytic Leukemia in a 52-Year-Old Caucasian Woman.

We report an instructive case of acute myeloid leukemia with histiocytic differentiation (acute histiocytic leukemia) arising in a patient, a 52-year-old woman with a history of follicular lymphoma. The results of genetic studies proved a clonal relationship between the lymphoma and the leukemic cells. To our knowledge, this is the first report of leukemic transdifferentiation of follicular lymphoma into modified base 5-methylcytosine (M(5)c)-like acute histiocytic leukemia and the first reported karyotype on a transdifferentiated neoplasm.

Effect of specimen type on free immunoglobulin light chains analysis on the Roche Diagnostics cobas 8000 analyzer.

The measurement of free immunoglobulin light chains is typically performed on serum; however, the use of alternative specimen types has potential benefits. Using the Freelite™ kappa and lambda free light chains assay on a Roche Diagnostics cobas 8000 c502 analyzer, we compared three specimen types (serum, EDTA-plasma and lithium heparin plasma separator gel-plasma) on 100 patients. Using Deming regression and eliminating outliers (limiting data to light chain concentrations below 400 mg/L), the three specimen types showed comparable results for kappa light chain concentration, lambda light chain concentration, and kappa/lambda ratio with slopes close to 1.0 and y-intercepts close to zero. EDTA-plasma showed slightly more positive bias relative to serum than lithium heparin. Analysis using EDTA-plasma and lithium heparin plasma showed comparable linearity, precision, and temperature stability. A single sample showing hook effect (not in the comparison set) gave comparable results using either plasma specimen type. For the Freelite™ kappa and lambda free light chains assay, both EDTA-plasma or lithium heparin-plasma can serve as acceptable substitutes for serum, at least for the Roche cobas 8000 analyzer.

Low-cost workflow improvement reduces gastrointestinal block use 17% by altering classic histotechnology testing.

OBJECTIVES: Gastrointestinal (GI) biopsy specimens were previously limited to four per cassette to facilitate established internal technical work practices and histotechnology best practice guidelines. We evaluated the workflow of these biopsy specimens. METHODS: We implemented three specific changes: (1) up to 10 GI biopsy specimens could be placed in each cassette, (2) histotechnologists would no longer orient GI biopsy specimens, and (3) embedding would be in a straight line rather than diagonal. We evaluated the effects of these changes on total block numbers, quality of slides, and perceptions of staff. RESULTS: The mean number of cassettes used was reduced 17% for GI biopsy cases, or an overall decrease of 3% of total blocks processed by our histopathology laboratory. Slide quality was unchanged. Staff reported increased job satisfaction. CONCLUSIONS: This simple, low-cost, low-effort process change yielded immediate and significant time savings for grossing and histology staff, increased job satisfaction, and challenges conventional histotechnology teaching.