RE: [Histonet] SMAD4
Which stainer are you using? Because some clones will not work on a Venatana stainer. Willem Van: histonet-boun...@lists.utsouthwestern.edu namens Chakib Boussahmain Verzonden: ma 23-4-2012 4:20 Aan: histonet@lists.utsouthwestern.edu Onderwerp: [Histonet] SMAD4 Hello histonet, Does anyone uses SMAD4 antibody? If so, can you tell where can I find a good one? Can you also share the staining protocol? dilution? epitope retrieval? Your help will be appreciated so much. Thank you. Chakib Boussahmain Histotech ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet Disclaimer: Dit e-mail bericht is uitsluitend bestemd voor de geadresseerde(n). Verstrekking aan en gebruik door anderen dan geadresseerden is niet toegestaan. Indien u niet de geadresseerde bent, wordt u verzocht de verzender hiervan op de hoogte te stellen en het bericht te verwijderen. In verband met electronische verzending kunnen aan dit e-mail bericht geen rechten worden ontleend. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RE: Qualifications for grossing
David, after reading your post I was not at all surprised to see that you are a PA. I am assuming that explains your vitriol towards techs that gross. Yes, CLIA does provide the educational requirements for high complexity testing, but what on earth makes you think that a tech with the proper CLIA qualifications can gross without proper training by a pathologist? CAP requires that as well as extensive documentation of training AND a list of the specimens approved by the Lab Director that a 'non-pathologist' is allowed to gross. I'm sure you can tell that I am a Histotech with an Associates Degree and I do the grossing in my lab. I can assure you that I do a good job and if there is EVER any question regarding how to gross in a specimen I will get a pathologist. To make it clear, just because we tech's that gross do not have a masters as a pathologist assistant, we care just as much about the patients we serve as a PA does. Another point I would like to make is that very often we gross not by choice but because it is what our pathologists demand of us and they wouldn't put us there if we couldn't do the job. Believe me, when I say that I do want to get my masters as a PA, but I haven't been able to find a program that accommodates someone who is working full time and can not afford to quit to go back to school. I am currently finishing up my Bachelors, because I still want to pursue it. Joanne Clark, HT Histology Supervisor Pathology Consultants of New Mexico -- Message: 8 Date: Mon, 23 Apr 2012 16:32:34 -0700 From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] Qualifications for grossing To: Glen Dawson ihcman2...@hotmail.com Cc: histonet histonet@lists.utsouthwestern.edu Message-ID: ca+f+rhoy4dypx0mpoq65rrrvldxobv_0acspzbgqrpv8ygv...@mail.gmail.com Content-Type: text/plain; charset=ISO-8859-1 Glen, Below are the requirements for high complexity testing, as outline by CLIA. You can reference the CLIA '88 ruling, specifically look at Subpart M, Section 493.1489 The requirements are weak, to say the least. I am not alone in the opinion that just because CLIA allows it, it is not necessarily appropriate for the minimum qualified person to be grossing certain specimens. Having someone other than an M.D., or ASCP certified PA do anything larger than a skin shave is not good medicine. But, in answer to your question - yes, the government allows inadequately trained personnel to perform high complexity testing. Sec. 493.1489 Standard; Testing personnel qualifications. Each individual performing high complexity testing must-- (a) Possess a current license issued by the State in which the laboratory is located, if such licensing is required; and (b) Meet one of the following requirements: (1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (2)(i) Have earned an associate degree in a laboratory science, or medical laboratory technology from an accredited institution or-- (ii) Have education and training equivalent to that specified in paragraph (b)(2)(i) of this section that includes-- (A) At least 60 semester hours, or equivalent, from an accredited institution that, at a minimum, include either-- (1) 24 semester hours of medical laboratory technology courses; or (2) 24 semester hours of science courses that include-- (i) Six semester hours of chemistry; (ii) Six semester hours of biology; and (iii) Twelve semester hours of chemistry, biology, or medical laboratory technology in any combination; and (B) Have laboratory training that includes either of the following: (1) Completion of a clinical laboratory training program approved or accredited by the ABHES, the CAHEA, or other organization approved by HHS. (This training may be included in the 60 semester hours listed in paragraph (b)(2)(ii)(A) of this section.) (2) At least 3 months documented laboratory training in each specialty in which the individual performs high complexity testing. (3) Have previously qualified or could have qualified as a technologist under Sec. 493.1491 on or before February 28, 1992 On Mon, Apr 23, 2012 at 1:19 PM, Glen Dawson ihcman2...@hotmail.com wrote: All, Can a histotech perform GROSSING if he/she has an associate's degree in Histotechnology from an accredited institution (Argosy in MN)? Any help would be appreciated. Thank-you, Glen Dawson BS, HT(ASCP) QIHC Histology Technical Specialist Mercy Health System Janesville, WI
Re: [Histonet] RE: Qualifications for grossing
Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you do if you had 2 specimens, one esophagus and one duodenal and they were reversed in the specimen containers by the biopsy tech? Would you be able to pick up on that mistake? 4. How should you handle a skin punch for alopecia? 5. If sent a skin for frozen, and it was a pilomatrixoma, would you know it, and would you still freeze it, or ask the pathologist first to avoid doing an unnecessary frozen? 6. When are tangential margins more appropriate than perpendicular, and vice versa? You can ask me the same types of questions as they pertain to histology, and there is no chance I can answer them as correctly, and with as much clarity as a well trained HT. The bottom line is patient care and quality. I cannot provide the level of quality in histology as you can, and a grossing tech cannot provide that quality at
Re: [Histonet] RE: Qualifications for grossing
For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo pathloc...@gmail.com wrote: From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] RE: Qualifications for grossing To: Joanne Clark jcl...@pcnm.com Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Date: Wednesday, April 25, 2012, 12:34 PM Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx
[Histonet] cloud based LIS
Is there anyone out there in Histoland who is using a cloud based LIS?? Kelly ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Problems with pAKT.
Has anyone had cross reacting problems with pAKT. I have used both Cell Signaling #3787 and #4606. Can anyone help me with this. Thanks Courtney Courtney Pierce IHC Specialist Quintiles Translational RD - Oncology Innovation Navigating the new health 610 Oakmont Lane Westmont, IL 60559 Office: + 630-203-6234 courtney.pie...@quintiles.com clinical | commercial | consulting | capital ** IMPORTANT--PLEASE READ This electronic message, including its attachments, is COMPANY CONFIDENTIAL and may contain PROPRIETARY or LEGALLY PRIVILEGED information. If you are not the intended recipient, you are hereby notified that any use, disclosure, copying, or distribution of this message or any of the information included in it is unauthorized and strictly prohibited. If you have received this message in error, please immediately notify the sender by reply e-mail and permanently delete this message and its attachments, along with any copies thereof. Thank you. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
You can reprocess, recut, and restain, but never re-gross. I for one also gross, but only skin. And yes, I DO know how to gross an alopecia specimen. Claire From: histonet-boun...@lists.utsouthwestern.edu on behalf of Rene J Buesa Sent: Wed 4/25/2012 11:55 AM To: Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo pathloc...@gmail.com wrote: ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Nothing is black and white. Perhaps exceptions are in order where the tech only does one specimen type. Perhaps. But not where techs do a lot more. There are gross techs out there doing colons, mastectomies etc. This is where big trouble brews. This is where people are not adequately trained, by NAACLS standards. CLIA '88 is the problem, not the tech. CLIA is over 20 years old, and at that time PA's were fairly new on the scene and in short supply. That is not the case today. It is time to raise the bar and improve patient care. There are no valid excuses. Today, this is no more than financial greed that accounts for misuse of personnel. Sent from my Windows Phone From: Ingles Claire Sent: 4/25/2012 10:43 AM To: Rene J Buesa; Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing You can reprocess, recut, and restain, but never re-gross. I for one also gross, but only skin. And yes, I DO know how to gross an alopecia specimen. Claire From: histonet-boun...@lists.utsouthwestern.edu on behalf of Rene J Buesa Sent: Wed 4/25/2012 11:55 AM To: Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo pathloc...@gmail.com wrote: ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Qualifications for grossing
Yupp he strikes again. Joanne, I strongly agree with your perspective. Many Techs do not have formal expensive educations and have sat on the bench for many years and eventually became grandfathered in. Those techs are the life blood of pathology. It has only been in recent years that licensure has become a larger part of health care requiring personal to obtain certification to hopefully increase patient care. But, this argument is becoming a thing of the past, because CLIA, CAP, JOCA have set standards that personal must meet regardless of the extensive OJT. I am qualified to gross based on these accrediators standards. It is others opinions that think these standards are weak. If the argument is greed, than people should understand that employee payroll is the highest cost within a laboratory so to help cut cost to our bankrupt health care system, why not pay a Histologist who is clearly qualified to do a job they have been doing since the beginning of pathology. The pathologists assistant profession began in 1969 with a pilot training program at the Veterans Administration Medical Center (VAMC) in Durham, North Carolina. In 1856 William Perkin discovered the dye mauve that was used in the early 1860s by F W B Benke of Marlbery. Joseph Janavier Woodward, a surgeon in the US Army, used fuchsine and aniline blue to stain human intestines. Paul Ehrlich realized that the chemical dyes obtained from coal tar did not simply color cells but combined with the chemical elements within them to form new substances. The Swiss chemist Friedrich Miescher, in 1869 used aniline dyes to examine the cell nucleus. In 1875 Carl Weigart, Ehrlich's cousin, demonstrated the fuchsine derivative methyl violet stained bacteria as opposed to tissue. The first histologist, Marcello Malpighi (1628-1694), an Italian anatomist, is in fact considered the true Father of Histology. 1819, A. Mayer created the term Histology. In the sequence of the previous word tissue, made use of two classical Greek root words (histos = tissue and logos = study So, my point is I do believe Histo's have been involved since the very beginning. We as a profession have a combined experience well beyond that of any formal education. Last thought, and I quote, I know I would make mistakes, and mistakes may be considered part of the learning process, but do we really want to accept that in health care? Mistakes should happen in school, not with a real, live patients tissue. This statement clearly conflicts with all aspect of becoming a medical professional. Our state/government funded hospitals employ thousands of residents each year who treat thousands of indigent and paying patients. This is their school. Histologist do interships within hospitals to get training. This is their school to. Nurses, MLT's, MA's, everyone in health care learns the actual (beyond books)trade from watching and working with skilled persons who have many years of experience. They would not place a student with a person who has a degree but no experience. My education qualifies me to be trained by anyone in my field of pathology, and I should be used where my skills will best serve my department and increase patient care. Each one of us serves a purpose and is valuable, no matter what job we perform with what amount of education. The law is weeding out those who are no longer qualified to work in out field, they set the standard. Let's let them make the decisions on who is qualified to do what and stick together to ensure its fair to each one of us. Can't we all just get along...hehehehehe Nicole Tatum HT, ASCP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] size of cut/transfer method affect staining?
Hi, I am attempting to do dual staining with 2 antibodies. One works fine but I am having trouble getting consistent staining with the second. I recently noticed previous user was requesting 3uM microtomy sections on tape, then going TPC, xylenes/etoh, AR,etc. I have been using 4um floated sections and can just not see the same staining using same everything else. Does anyone have thoughts about this? I was thinking perhaps the TPC/tape leaves the cells more permeable or affects AR efficiency. I am currently going to test side-by-side...just trying to get a general opinion on the matter as immunohistochemistry is not my area of proficiency. Matthew A. Smith, PhD MSPH Postdoctoral Fellow, Clinical Investigations Laboratory of Eric Haura, MD tel: 813-745-6193 | email: matthew.sm...@moffitt.orgmailto:matthew.sm...@moffitt.org P Please consider the environment before printing this email. This transmission may be confidential or protected from disclosure and is only for review and use by the intended recipient. Access by anyone else is unauthorized. Any unauthorized reader is hereby notified that any review, use, dissemination, disclosure or copying of this information, or any act or omission taken in reliance on it, is prohibited and may be unlawful. If you received this transmission in error, please notify the sender immediately. Thank you.___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Well said. Hazel Horn Supervisor of Histology/Autopsy/Transcription Anatomic Pathology Arkansas Children's Hospital 1 Children's Way | Slot 820| Little Rock, AR 72202 501.364.4240 direct | 501.364.1302 office | 501.364.1241 fax hor...@archildrens.org archildrens.org 100 YEARS YOUNG! JOIN THE PARTY AT ach100.org -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Wednesday, April 25, 2012 11:34 AM To: Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you do if you had 2 specimens, one esophagus and one duodenal and they were reversed in the specimen containers by the biopsy tech? Would you be able to pick up on that
RE: [Histonet] RE: Qualifications for grossing
Thank you Hazel. Sent from my Windows Phone From: Horn, Hazel V Sent: 4/25/2012 12:18 PM To: Davide Costanzo; Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing Well said. Hazel Horn Supervisor of Histology/Autopsy/Transcription Anatomic Pathology Arkansas Children's Hospital 1 Children's Way | Slot 820| Little Rock, AR 72202 501.364.4240 direct | 501.364.1302 office | 501.364.1241 fax hor...@archildrens.org archildrens.org 100 YEARS YOUNG! JOIN THE PARTY AT ach100.org -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Wednesday, April 25, 2012 11:34 AM To: Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you
[Histonet] ER PR antibodies for rat tissue
Hi, I've been using Dako 1D5 (ER) and Biogenex PR88 (PR) on rat tissue for a number of years. I was curious if anyone out there working with rat tissue and has found any ER or PR clones that might work better. Has anyone tried rabbit monoclonals on rat tissue, e.g. SP1 (ER) or Y85 (PR)? Thanks, John - John McGinley Cancer Prevention Laboratory Colorado State University ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Im sorry you feel that way about me. There is nothing snide here. I respect your opinion and have no foul words for you. Im happy that you have earned your education. I currently am in school trying to further mine, and I belive an education is so important. To a person and a profession. Have a wonderful day. Nicole Tatum, HT ASCP Try to keep your snide remarks quiet, and respond with some degree of respect. We will not always agree, but there is no strike there. You dislike me,, that's fine. But keep your personal comments to yourself. If you can be that mature. Sent from my Windows Phone From: Nicole Tatum Sent: 4/25/2012 12:09 PM To: Joanne Clark; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Yupp he strikes again. Joanne, I strongly agree with your perspective. Many Techs do not have formal expensive educations and have sat on the bench for many years and eventually became grandfathered in. Those techs are the life blood of pathology. It has only been in recent years that licensure has become a larger part of health care requiring personal to obtain certification to hopefully increase patient care. But, this argument is becoming a thing of the past, because CLIA, CAP, JOCA have set standards that personal must meet regardless of the extensive OJT. I am qualified to gross based on these accrediators standards. It is others opinions that think these standards are weak. If the argument is greed, than people should understand that employee payroll is the highest cost within a laboratory so to help cut cost to our bankrupt health care system, why not pay a Histologist who is clearly qualified to do a job they have been doing since the beginning of pathology. The pathologists assistant profession began in 1969 with a pilot training program at the Veterans Administration Medical Center (VAMC) in Durham, North Carolina. In 1856 William Perkin discovered the dye mauve that was used in the early 1860s by F W B Benke of Marlbery. Joseph Janavier Woodward, a surgeon in the US Army, used fuchsine and aniline blue to stain human intestines. Paul Ehrlich realized that the chemical dyes obtained from coal tar did not simply color cells but combined with the chemical elements within them to form new substances. The Swiss chemist Friedrich Miescher, in 1869 used aniline dyes to examine the cell nucleus. In 1875 Carl Weigart, Ehrlich's cousin, demonstrated the fuchsine derivative methyl violet stained bacteria as opposed to tissue. The first histologist, Marcello Malpighi (1628-1694), an Italian anatomist, is in fact considered the true Father of Histology. 1819, A. Mayer created the term Histology. In the sequence of the previous word tissue, made use of two classical Greek root words (histos = tissue and logos = study So, my point is I do believe Histo's have been involved since the very beginning. We as a profession have a combined experience well beyond that of any formal education. Last thought, and I quote, I know I would make mistakes, and mistakes may be considered part of the learning process, but do we really want to accept that in health care? Mistakes should happen in school, not with a real, live patients tissue. This statement clearly conflicts with all aspect of becoming a medical professional. Our state/government funded hospitals employ thousands of residents each year who treat thousands of indigent and paying patients. This is their school. Histologist do interships within hospitals to get training. This is their school to. Nurses, MLT's, MA's, everyone in health care learns the actual (beyond books)trade from watching and working with skilled persons who have many years of experience. They would not place a student with a person who has a degree but no experience. My education qualifies me to be trained by anyone in my field of pathology, and I should be used where my skills will best serve my department and increase patient care. Each one of us serves a purpose and is valuable, no matter what job we perform with what amount of education. The law is weeding out those who are no longer qualified to work in out field, they set the standard. Let's let them make the decisions on who is qualified to do what and stick together to ensure its fair to each one of us. Can't we all just get along...hehehehehe Nicole Tatum HT, ASCP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Cytology Standards
Good Afternoon Histonetters, I need your help. I have been asked to come up with a list of standards for non-gyn cytologies. These standards will be used as a means of evaluating an employee for their annual evaluation. The employee will have to meet - exceed - or not meet the standard depending on their job performance. These standards will help determine their raise percentage. So here I am writing to see if anyone out in histoland has anything that they would be willing to share with me. Any help will be greatly appreciated. Amy Self Georgetown Hospital System 843-527-7179 NOTE: The information contained in this message may be privileged, confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to this message and deleting it from your computer. Thank you. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] barcoding
Wow, good point, Vinnie! Thanks for the heads up. Mequita Praet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RE: Histonet Digest, Vol 101, Issue 32
Davide and Rene, you have very valid points and I do not necessarily disagree with you. But the reality is that it is an accepted CAP/CLIA allowed practise and will continue. You both have the right to voice your opinions on the issue, but perhaps histonet which is made up mostly of techs, many of whom gross (not by choice) is not the best place to do it without causing a lot of controversy. You need to take your concerns where they might make a difference, to CAP or CLIA. If you believe in it strongly enough you will try and do something about it. Just know that those of us who do gross, do everything within our power to do the job safely for those patients we serve. Respectfully Joanne Clark, HT Histology Supervisor Pathology Consultants of New Mexico -- Message: 14 Date: Wed, 25 Apr 2012 09:34:29 -0700 From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] RE: Qualifications for grossing To: Joanne Clark jcl...@pcnm.com Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Message-ID: ca+f+rhqo7guohqtlxta1ffd2yhda0br1hefi3rdh2woji35...@mail.gmail.com Content-Type: text/plain; charset=ISO-8859-1 Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize grossing techs. For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No vitriol here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it
Re: [Histonet] RE: Histonet Digest, Vol 101, Issue 32
Very well spoken. You will note that neither of us raised this subject, but did respond to a post previously entered. And, as I clarified to another person here privately, the problem with CLIA does not just mean we are going after HT's that gross - CLIA allows ANYONE with those very minimal requirements to gross. Most gross techs are not HT's, most are off the street people with the bare bones required by law, that are taught on the job to toss biopsies into cassettes. And, many of these people do much larger cases as well - all legally under CLIA 88. It's a problem, and it is not meant to upset anyone on here. Most of those techs, as I stated, are not HT's and are not on this site anyway. The proper forum of course is to reach out to government officials and try and get that law changed. Perhaps we will. A lot of progress has been made in the area over the years, now we just need to modify the laws to reflect the times within which we live. I did want to point out one thing though - there was a comment about saving money in healthcare, and that was a valid reason to employ a grossing tech. Let's be clear on this subject - there is a BOAT LOAD of money in the technical component of AP services. This is why you see GI docs and Urologists all over the nation opening their own histo labs. They want to cash in. The reimbursement for technical charges is public knowledge - look it up and you will find the Medicare rates for your area very publicly posted by Medicare. It's not a secret. Take those rates, multiply by 80% because even Medicare does not really pay what they say and then multiply it out for your volume. Be sure to include all your 88305's and other standard charges, and add all the fees for your stains, frozen sections, decalcifying, etc. When you see just what Medicare pays your site, then look at your paycheck and ask yourself Is my lab really suffering financially? Probably not. And that is based upon Medicare rates, the truth is the lab makes more than that because most insurers pay higher than Medicare. Where does the money go? I don't think I have to tell you. On Wed, Apr 25, 2012 at 2:28 PM, Joanne Clark jcl...@pcnm.com wrote: Davide and Rene, you have very valid points and I do not necessarily disagree with you. But the reality is that it is an accepted CAP/CLIA allowed practise and will continue. You both have the right to voice your opinions on the issue, but perhaps histonet which is made up mostly of techs, many of whom gross (not by choice) is not the best place to do it without causing a lot of controversy. You need to take your concerns where they might make a difference, to CAP or CLIA. If you believe in it strongly enough you will try and do something about it. Just know that those of us who do gross, do everything within our power to do the job safely for those patients we serve. Respectfully Joanne Clark, HT Histology Supervisor Pathology Consultants of New Mexico -- Message: 14 Date: Wed, 25 Apr 2012 09:34:29 -0700 From: Davide Costanzo pathloc...@gmail.com Subject: Re: [Histonet] RE: Qualifications for grossing To: Joanne Clark jcl...@pcnm.com Cc: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Message-ID: ca+f+rhqo7guohqtlxta1ffd2yhda0br1hefi3rdh2woji35...@mail.gmail.com Content-Type: text/plain; charset=ISO-8859-1 Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US
Re: [Histonet] RE: Qualifications for grossing
I agree with Renee's post completely. When the motivation is greed, and not patient care, we, as laboratory professionals, should be concerned. I think we should all realize that the regulations are there to protect ALL of our livelihoods, HTs, PAs, MDs, HTLs, and everyone who works in the lab. Patients (insurance companies, the Federal government) would not pay for testing anymore if the results were invalid. If I were a Histology Superintendent thinking of having an under trained laboratory aide do immunohistochemistry, or gross: Could you get away with it?: Sure. Save $40,000. / year per HTL you replace, more if PA. Would you want that to be your specimen? : No. What would one nasty malpractice lawsuit cost your facility?: Potentially multi-millions of dollars. Hiring unqualified techs is false economy. Reimburse your lab aides for tuition if you want them to do high complexity testing. Apologies to any lab aides with PhDs, or any 6th grade dropouts with 30 years of X-ray Crystallography and Proteomics bench experience. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Qualifications for grossing
Wow .I am appalled with these threads. There are many of us in our field who have grown up in hospital settings learning real time Histotechnolgy and not by books. Sitting bedside with patients speaking with their loved ones. Let's respect this and move on to other topics that challenge us present day in our fields... Regards to ALL of us in our field Candace Connected by DROID on Verizon Wireless -Original message- From: Jay Lundgren jaylundg...@gmail.com To: Nicole Tatum nic...@dlcjax.com Cc: histonet@lists.utsouthwestern.edu Sent: Thu, Apr 26, 2012 01:43:38 GMT+00:00 Subject: Re: [Histonet] RE: Qualifications for grossing I agree with Renee's post completely. When the motivation is greed, and not patient care, we, as laboratory professionals, should be concerned. I think we should all realize that the regulations are there to protect ALL of our livelihoods, HTs, PAs, MDs, HTLs, and everyone who works in the lab. Patients (insurance companies, the Federal government) would not pay for testing anymore if the results were invalid. If I were a Histology Superintendent thinking of having an under trained laboratory aide do immunohistochemistry, or gross: Could you get away with it?: Sure. Save $40,000. / year per HTL you replace, more if PA. Would you want that to be your specimen? : No. What would one nasty malpractice lawsuit cost your facility?: Potentially multi-millions of dollars. Hiring unqualified techs is false economy. Reimburse your lab aides for tuition if you want them to do high complexity testing. Apologies to any lab aides with PhDs, or any 6th grade dropouts with 30 years of X-ray Crystallography and Proteomics bench experience. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
