American journal of clinical pathology
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Am. J. Clin. Pathol. · May 2011
Communicating pathology and laboratory errors: anatomic pathologists' and laboratory medical directors' attitudes and experiences.
Physicians are urged to communicate more openly following medical errors, but little is known about pathologists' attitudes about reporting errors to their institution and disclosing them to patients. We undertook a survey to characterize pathologists' and laboratory medical directors' attitudes and experience regarding the communication of errors with hospitals, treating physicians, and affected patients. We invited 260 practicing pathologists and 81 academic hospital laboratory medical directors to participate in a self-administered survey. ⋯ The majority of respondents (~95%) reported having been involved with an error, and respondents expressed near unanimous belief that errors should be disclosed to hospitals, colleagues, and patients; however, only about 48% thought that current error reporting systems were adequate. In addition, pathologists expressed discomfort with their communication skills in regard to error disclosure. Improving error reporting systems and developing robust disclosure training could help prevent future errors, improving patient safety and trust.
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The specialty of pathology and laboratory medicine has entered a phase in which the 4-year sequence of residency training is almost universally followed by 1 or more years of subspecialty fellowship training. Such training may occur in an American Board of Pathology-recognized subspecialty or any number of "subspecialty fellowships" that do not lead to subspecialty board certification. ⋯ After 3 years of effort, the Council of the Association of Pathology Chairs has recommended implementation of a pathology subspecialty fellowship matching program starting in the 2011-2012 recruiting year for applicants matriculating in fellowship programs in July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.
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Am. J. Clin. Pathol. · Mar 2011
Comparative Study Clinical TrialRapid detection of myocardial infarction with a sensitive troponin test.
Rapid identification and treatment of patients with a myocardial infarction (MI) is mandatory. We studied the diagnostic capacities of a sensitive troponin assay for detection of MI in emergency department patients within 2 hours after arrival. The study included 157 patients suspected of having non-ST-elevation acute coronary syndrome. ⋯ Sensitivity and specificity of creatine kinase-MB and myoglobin are lower than those of troponin. By using a sensitive troponin assay and simple algorithms, the diagnosis of MI can be determined within 2 hours after arrival at the emergency department. Measurement of myoglobin and creatine kinase-MB has no added value.
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Am. J. Clin. Pathol. · Feb 2011
Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department.
Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Serum samples obtained at the same time as blood cultures were available from 295 patients. ⋯ With a calculated threshold of 0.1475 ng/mL for procalcitonin, sensitivity and specificity for the procalcitonin assay were 75% and 79%, respectively. The positive predictive value was 17% and the negative predictive value 98% compared with blood cultures. Procalcitonin is a useful marker to rule out sepsis and systemic inflammation in the ED.