Diagnostic Accuracy & Pathology Revised Reports: Evidence-Based Guideline Development

Introduction/Objective

Diagnostic errors in pathology may have adverse impact on patient outcomes and are often rectified through revised reports (RR). Improving patient outcomes with accurate RR is a tangible yet challenging benefit to assuring continuous quality improvement (CQI). Assessment and elevation of RR optimization requires counterbalance of workflow complexity in the diagnostic reporting domain. Implications inform best-practice guidelines for pathology RR and exemplify improved patient outcomes by driving down negative impacts from diagnostic errors.

Methods

A “Survey for RR in Pathology: Reality & Best Practices” was sent via email to relevant stakeholders. The 8-item survey was designed by the National Pathology Quality Registry team & ASCP’s Institute for Science, Technology & Policy. The model included quantitative and qualitative feedback to probe current experiences with RR. The survey was open April 1-30, 2019, via Key Survey and used snowball sampling.

Results

Key results illuminate necessity for RR standardization. Survey findings represent 172 respondents. Ninety- two percent of respondents indicated report accuracy as a major indication for optimizing RR practices & positively impacting patient care. Pathology practices assure appropriate RR by notifying a care provider when a change in diagnosis necessitates RR (89%) & 86% of respondents indicate delineation of RR types (e.g. addenda, amendment). Still 54% of respondents see inappropriate RR use with lack of notification to care providers and 48% indicate no delineation of RR types. This balance-counterbalance highlights deviations from optimized RR and a need for guidelines. Effects on patient care or impact to a patient’s treatment plan was indicated by 43% who affirmed stratification of diagnostic discrepancies as major vs. minor. Solely focusing on changes in diagnosis (benign vs. malignant) was heralded by 19% of respondents as a reason to categorize diagnostic discrepancies. Forty-two percent of respondents indicate data-driven CQI in the RR domain.

Conclusion

Identified RR practice gaps decrease diagnostic accuracy, confirming the need for optimal RR guidelines. RR guidelines should focus on standardized nomenclature; active dialogue between laboratory team & clinical care partners; streamlined workflows to assure accuracy; & valuing transparency to derive improved patient outcomes based on high-quality diagnostic pathology RR.

Soft X-ray Spectroscopy of a Complex Heterojunction in High-Efficiency Thin-Film Photovoltaics: Intermixing and Zn Speciation at the Zn(O,S)/Cu(In,Ga)Se2 Interface

The chemical structure of the Zn(O,S)/Cu(In,Ga)Se₂ interface in high-efficiency photovoltaic devices is investigated using X-ray photoelectron and Auger electron spectroscopy, as well as soft X-ray emission spectroscopy. We find that the Ga/(Ga+In) ratio at the absorber surface does not change with the formation of the Zn(O,S)/Cu(In,Ga)Se₂ interface. Furthermore, we find evidence for Zn in multiple bonding environments, including ZnS, ZnO, Zn(OH)₂, and ZnSe. We also observe dehydrogenation of the Zn(O,S) buffer layer after Ar⁺ ion treatment. Similar to high-efficiency CdS/Cu(In,Ga)Se₂ devices, intermixing occurs at the interface, with diffusion of Se into the buffer, and the formation of S-In and/or S-Ga bonds at or close to the interface.

Influence of antihistamine pretreatment on vancomycin-induced red-man syndrome

Twelve adult male volunteers participated in a double-blind study to determine the effect of pretreatment with histamine and/or histamine2 receptor antagonists on the incidence and severity of vancomycin-induced "red-man syndrome." Subjects received hydroxyzine, 50 mg, ranitidine, 300 mg, hydroxyzine plus ranitidine, or placebo at weekly intervals 2 h before a l-h infusion of vancomycin, 1,000 mg. The extent of erythema was evaluated by burn chart and pruritus was assessed by each subject using a rank scale; symptoms were thus classified a priori as mild, moderate, or severe and their summation determined a global severity score for red-man syndrome. There was no significant intrasubject variation between area under the concentration-time curves for histamine and vancomycin (P greater than .05). Pretreatment with hydroxyzine alone provided significant protection against vancomycin-induced erythema and pruritus (P less than .05) whereas the effect of ranitidine did not differ significantly from placebo. The combination of hydroxyzine and ranitidine offered no advantage over hydroxyzine alone. Similar results were observed for global severity scores. Thus in normal volunteers prior administration of a histamine antagonist (hydroxyzine) provided significant protection against vancomycin-induced red-man syndrome compared to that afforded by placebo. There was no significant benefit from the histamine antagonist alone or by its addition to a histamine antagonist.