Objectives: Maintaining specimen identity during surgical pathology tissue processing is critical. Epic Beaker Laboratory Information System requires sequential scanning of specimen label and grossed ...blocks (block confirmation) to ensure specimen identity. We report our institutions experience with wrong tissue in block (WTIB) grossing errors before and after adopting block confirmation. Methods: During the first 18 months of Beaker implementation, block confirmation was not required. We then mandated block confirmation for a 3-month period. To ensure compliance, we then built a "hardstop" feature that prevents scanning any unconfirmed blocks onto a packing list. We reviewed WTIB incidents pre- and postimplementation of these solutions. Results: Before using block confirmation, we had WTIB incidents involving 17 (0.043%) of 38,848 cases. When we mandated block confirmation use, we had WTIB involving 2 (0.043%) of 4,646 cases. After implementing the hard stop feature, we had WTIB incidents involving 2 (0.005%) of 42,411 cases. Overall, there was an 88.4% (0.043% vs 0.005%; P < .001) reduction in WTIB incidents using block confirmation with a hard stop. Conclusions: Beaker is a customizable platform that can be tailored to a laboratory's workflow. By using barcoding, implementing custom-built features, and improving workflow protocols, we significantly reduced WTIB errors.
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GEOZS, IJS, NUK, OILJ, SBJE, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
4.
Wrong Tissue in Block Weaver, Kaitlin D; De Los Santos, Yanel; Gaffar, Maira ...
American journal of clinical pathology,
09/2021, Volume:
156, Issue:
4
Journal Article
Peer reviewed
Open access
Abstract
Objectives
Maintaining specimen identity during surgical pathology tissue processing is critical. Epic Beaker Laboratory Information System requires sequential scanning of specimen label and ...grossed blocks (block confirmation) to ensure specimen identity. We report our institution’s experience with wrong tissue in block (WTIB) grossing errors before and after adopting block confirmation.
Methods
During the first 18 months of Beaker implementation, block confirmation was not required. We then mandated block confirmation for a 3-month period. To ensure compliance, we then built a “hard stop” feature that prevents scanning any unconfirmed blocks onto a packing list. We reviewed WTIB incidents pre- and postimplementation of these solutions.
Results
Before using block confirmation, we had WTIB incidents involving 17 (0.043%) of 38,848 cases. When we mandated block confirmation use, we had WTIB involving 2 (0.043%) of 4,646 cases. After implementing the hard stop feature, we had WTIB incidents involving 2 (0.005%) of 42,411 cases. Overall, there was an 88.4% (0.043% vs 0.005%; P < .001) reduction in WTIB incidents using block confirmation with a hard stop.
Conclusions
Beaker is a customizable platform that can be tailored to a laboratory’s workflow. By using barcoding, implementing custom-built features, and improving workflow protocols, we significantly reduced WTIB errors.
Lack of ganglion cells on adequate suction rectal biopsy is the gold standard for diagnosis of neonatal Hirschsprung disease (HD), and the presence of ganglion cells precludes such a diagnosis.
A ...10-day old male neonate presented with clinical symptoms concerning for HD. However, suction rectal biopsies demonstrated submucosal ganglion cells on the distal suction rectal biopsies (2 cm from anal verge) and not on the proximal (3 cm from anal verge), with similar findings on repeat biopsies. Clinical suspicion remained high, and diagnostic laparoscopy with intraoperative biopsies confirmed aganglionosis with a sigmoid transition. A pull through resection confirmed the diagnosis of distal rectal skip segment HD (SSHD) with a ∼6 cm length of circumferential aganglionosis extending into the proximal sigmoid.
Discordant results on suction rectal biopsies should raise the possibility of SSHD. Awareness of the entity can facilitate timely definitive management in neonatal period.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Lack of ganglion cells on adequate suction rectal biopsy is the gold standard for diagnosis of neonatal Hirschsprung disease (HD), and the presence of ganglion cells precludes such a ...diagnosis. Case report: A 10-day old male neonate presented with clinical symptoms concerning for HD. However, suction rectal biopsies demonstrated submucosal ganglion cells on the distal suction rectal biopsies (2 cm from anal verge) and not on the proximal (3 cm from anal verge), with similar findings on repeat biopsies. Clinical suspicion remained high, and diagnostic laparoscopy with intraoperative biopsies confirmed aganglionosis with a sigmoid transition. A pull through resection confirmed the diagnosis of distal rectal skip segment HD (SSHD) with a ∼6 cm length of circumferential aganglionosis extending into the proximal sigmoid. Conclusions: Discordant results on suction rectal biopsies should raise the possibility of SSHD. Awareness of the entity can facilitate timely definitive management in neonatal period.
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Drug-eluting stents have expanded their utility to clinical and angiographic situations more complex than the initial ones. Objective: To evaluate the effectiveness of ...paclitaxel-eluting stents Active™ and Active Small™ models (Iberhospitex, Barcelona, Spain), in patients with an off-label indication versus patients with an on-label indication. Method: Prospective sub study (2007 - 2018) at CIMEQ, Havana, Cuba, in 159 patients treated with paclitaxel eluting stent, 88 with an off-label indication and 77 on-label indication. Death, heart attack, revascularization and their combination were
considered, as well as stent restenosis and thrombosis. Frequency distribution, χ2 test, Fisher's test and T-Test of difference between means, Kaplan-Meier curve and Logarithmic Range Test (Mantel-Cox) were used, with statistical significance (α <0.05). Research in line with the Helsinki declaration approved by the Scientific Council, without conflict of interest. Results: Infarction in three years of follow-up on label: 1 (1.4%) vs. off label 2 (2.3%), death 2.3% vs. 4.2%, new revascularization due to restenosis 15.9% vs. 15.5 % and late or very late thrombosis 3.4% vs. 0. 34 major combined cardiac events were recorded without significant difference between the on-label group with respect to the off-label group, 21.1% vs. 21.6% respectively; p = 0.94). Conclusions: The stents evaluated are effective and safe in patients with off-label and on-label indications, with similar incidence of death, infarction, need for new target lesion revascularization and combined mayor cardiac events, after three years of follow-up, with a low frequency of late or very late thrombosis.
Introducción: Los stent liberadores de fármacos han expandido su utilidad a situaciones clínicas y angiográficas más complejas que las iniciales. Objetivo: Evaluar la efectividad de los modelos de stent liberadores de paclitaxel Active® y Active Small®, (Iberhospitex, Barcelona, España), en pacientes con indicación off label frente a los enfermos con indicación on label. Método: Sub estudio prospectivo (2007 – 2018) en CIMEQ, La Habana, Cuba, en 159 pacientes tratados con stent liberador de paclitaxel, 88 con indicación off label y 77 on label. Se consideró la muerte, el infarto, nueva revascularización y su combinación, además la restenosis y trombosis de stent. Se utilizaron distribución de frecuencias, test de χ2, de Fisher y T-Test de diferencia entre medias, curva de Kaplan-Meier y Test de Rangos Logarítmicos (Mantel-Cox), con significación estadística (α<0,05). Investigación ajustada a la declaración de Helsinki aprobado por el consejo científico, sin conflicto de intereses. Resultados: Infarto en tres años de seguimiento on label: 1(1,4%) vs off label 2(2,3%), muerte 2,3% vs 4,2%, nueva revascularización por reestenosis 15,9% vs 15,5% y trombosis tardía o muy tardía 3,4% vs 0. Se registraron 34 eventos cardíacos mayores combinados sin diferencia significativa entre el grupo on label con respecto al grupo off label, 21,1% vs 21,6% respectivamente; p=0,94). Conclusiones: Los stent evaluados son efectivos y seguros en pacientes con indicaciones off label y on label, con una incidencia de muerte, infarto, necesidad de nueva revascularización y eventos cardíacos combinados, similar luego de 3 años de seguimiento, con baja frecuencia de trombosis tardía o muy tardía.
Background: A registry of catheterization and percutaneous coronary intervention is a key to improve the development
of human resources, equipment and devices. In Cuba official of this type ...publications, have not been found. Objective:
To characterize angiographic diagnostic procedures and percutaneous coronary intervention (PCI) at CIMEQ between
1997 and 2019. Method: Retrospective descriptive observational study in the hemodynamic laboratory, with information
obtained from the Angycor software and analyzed in SPSS 20.0. The number of coronary angiography and PCI, PCI /
Coronariography index, diagnosis, age, sex, province, arterial access and type of device were used. The ethical bases
of the Helsinki declaration were respected. Outcome. 10,974 coronary angiographies and 3,843 PCI were performed.
The mean age was 57.95 ± 11.95, 72.1% of the patients were male, 55.3% with stable angina, 53.0% from the femoral
artery and 58.1% from Havana. . The PCI / coronary angiography index from 0.10 in 1997 increased to 0.53 in 2019. The
radius artery route has been the main access route since 2013. Since 1999, the use of the conventional metal stent has
predominated. In 2004, drug-eluting stents were introduced. In 2008 it was used in 27.8% of patients. Conclusions: There is
a sustained increase in coronary angiography and percutaneous coronary intervention. Most of the patients are male
and older adults, with stable coronary disease. The radial access route and the conventional stent are used more
frequently.
Introducción: Un registro de cateterismo e intervención coronaria percutánea, es necesario para mejorar el desarrollo
de los recursos humanos, los equipos y dispositivos. En Cuba no se han encontrado publicaciones oficiales de este tipo.
Objetivo: Caracterizar los procedimientos de diagnóstico angiográfico e intervención coronaria percutánea (ICP) en el
CIMEQ entre 1997 y 2019. Método: Estudio observacional descriptivo retrospectivo en el laboratorio de hemodinámica,
con información obtenida del software Angycor y analizada en SPSS 20.0. Se utilizaron el número de coronariografía e
ICP, índice ICP/Coronariografía, diagnóstico, edad, sexo, provincia, acceso arterial y tipo de dispositivo. Se respetaron
las bases éticas de la declaración de Helsinki. Resultado: Se realizaron 10 974 coronariografías y 3 843 ICP. La edad
media fue 57,95±11,95, el 72,1% de los enfermos fueron masculinos, el 55,3% con angina estable, el 53,0% por la arteria
femoral y el 58,1% de La Habana. El índice ICP/coronariografía de 0,10 en el año 1997 pasó a 0,53 en 2019. La vía de
arteria radial fue principal vía de acceso desde el año 2013. Desde 1999 el uso del stent metálico convencional ha
predominado. En 2004 se introdujeron los stent liberadores de medicamentos, en 2008 se logró utilizarlo en 27,8% de los
enfermos. Conclusiones: Existe un incremento sostenido de las coronariografias e intervención coronaria percutánea.
La mayoría de los enfermos son del sexo masculino y adultos mayores, con enfermedad coronaria estable. Se utilizan
con mayor frecuencia la vía de acceso radial y el stent convencional.
Introduction: Heart disease is the leading cause of death in Cuba and the world. Percutaneous coronary intervention with drug eluting stents is a fundamental pillar of its treatment. Objective: To ...evaluate the effectiveness of percutaneous coronary intervention with paclitaxel eluting stents compared to bare metal stents in patients treated at CIMEQ. Method: Analytical prospective longitudinal study in 318 randomized patients (1:1) to a group treated with paclitaxel eluting stent and an identical stainless steel one, followed by three years to evaluate survival free of major adverse cardiac events (death / non-fatal myocardial infarction and need for new revascularization), restenosis and stent thrombosis. Frequency distribution, test χ2 , Fisher's test and T-Test of difference between means, Kaplan-Meier curve and Mantel-Cox test were used, with statistical significance (α <0.05). This research was in line with the Helsinki declaration and was approved by the ethic and scientific council. Results: Restenosis in the group with a paclitaxel eluting stent was 15.7% compared to 24.5% in the bare metal stent; p = 0.05. The survival free of combined major adverse cardiac events was higher in the same group 78.2% vs. 68.4%, p = 0.045. The incidence of thrombosis was low in both groups (paclitaxel eluting stents: 3.7% and 5.0% in
bare metal stents; p = 0.58). Conclusions: Treatment with paclitaxel eluting stent provides superior survival free of combined major adverse cardiac events, due to the decrease in restenosis and the need for new target lesion revascularization. However, mortality, stent thrombosis, and the incidence of myocardial infarction are similar with both stents.
Las enfermedades del corazón son la primera causa de muerte en Cuba y el mundo. La intervención coronaria percutánea con stent ármacoactivos es pilar fundamental de su tratamiento. Objetivo: Evaluar la efectividad de la intervención coronaria percutánea con stent liberador de paclitaxel comparado con stent convencional en pacientes tratados en el CIMEQ. Método: Estudio longitudinal prospectivo analítico en 318 pacientes aleatorizados (1:1) a un grupo tratado con Stent liberador de paclitaxel y otro idéntico de acero inoxidable, seguidos por 3 años para evaluar la supervivencia libre de eventos cardíacos mayores (muerte/infarto no fatal y necesidad de nueva revascularización), la reestenosis y trombosis de Stent. Se utilizaron distribución de frecuencias, test de χ2, de Fisher y T-Test de diferencia entre
medias, curva de Kaplan-Meier y Test Mantel-Cox, con significación estadística (α<0,05). Investigación ajustada a la declaración de Helsinki aprobado por el consejo científico. Resultados: La reestenosis en el grupo con stent liberador fue 15,7% frente a 24,5% en los metálicos; p=0,05. La supervivencia libre de eventos cardíacos mayores combinados fue superior en el mismo grupo 78,2% vs 68,4%, p=0,045. La incidencia de trombosis de fue baja en ambos grupos (Stent
liberadores de paclitaxel: 3,7% y 5,0% en Stent convencionales; p=0,58). Conclusiones: El tratamiento con stent liberador de paclitaxel proporciona una supervivencia libre de eventos cardíacos mayores combinados superior, por la disminución de la reestenosis y necesidad de nueva revascularización. Sin embargo, la mortalidad, la trombosis de stent y la incidencia de infarto del miocardio son similares con ambas endoprótesis.
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