[Histonet] Ventana dispenser issues - AGAIN

[Terri Braud via Histonet]

When will this company ever learn? I'm at my wit's end with failed dispensers 
from Roche Ventana.  The volume of time I've wasted on this issue with this 
company is monumental.  They refuse to give true tracking information on the 
dispensers.  We have a relatively new Ultra.  The instrument is lovely, but the 
stains completely unreliable because of the dispenser failure.  Worse yet, one 
can never tell when the dispenser will fail.  It might fail right out of the 
box, or work fine for 30 tests and fail on 31.  This problem has been going on 
since the end of 2017 and still is continuing.  I know I'm not alone because of 
the recalls and most recently, the Medical Device Ongoing Action published 
5/11/2018. Reaching out to the company is like trying to talk to a politician 
who talks in circles.  I'm truly at a loss and would welcome any suggestions 
from non-Roche employees.
Frustrated, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor

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Re: [Histonet] Downtime

[Terri Braud via Histonet]

Hi Nancy - Please see my answers filled in below.  I hope that helps.  
Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Message: 1
Date: Sun, 29 Apr 2018 20:57:29 +
From: Nancy Schmitt 
Subject: [Histonet] Downtime

Hello All-
We recently experienced some downtime with our computer systems - more than the 
usual 1-2 hours for maintenance.  Some was isolated to our Anatomic Pathology 
system, and some of the downtime was organization wide.  We are an independent 
laboratory system that operates with Cerner CoPath for Anatomic Pathology, MLab 
from McKesson for LIS and we then interface with Powerchart and EPIC at our 
hospitals.  There is nothing like a little downtime to make you take another 
look at your processes.  My questions:

1.   What computer product are you currently using for Anatomic Pathology?
Answer: Sunquest CoPath Plus

2.   Are you satisfied?
Answer: Extremely

3.   Do you have your own IT group or is it maintained by outside resources?
Answer: There is an IT group for the hospital, but both myself and the office 
supervisor have full system manager access to CoPath as well as the servers.  
With little exception, all modifications or enhancements to CoPath are made by 
myself or the office supervisor.  Occasionally, we need IT help when dealing 
with interfaces.

4.   Are you interfaced with hospital or other?
Answer: We are interfaced with Soarian Clinical and Mobile MD for reporting and 
Soarian Financial for billing.  All of our patient data comes from Soarian 
Financial, through Sunquest Clinicals to CoPath.  We also have a slide engraver 
interfaced. Cytology orders are entered through Soarian Clinical, but Surgical 
Orders are still submitted on a manual requisition.  

5.   What critical functions do you provide during downtime?  Are you 
giving verbal reports?  Are you typing reports on a backup laptop?
I appreciate any input you are willing to share and I am sure there will be 
others taking note of this valuable conversation!
Answer: During a Soarian/Sunquest/CoPath downtime, we immediately switch to a 
manual log for specimens, and a WORD format for our reports. Our personal PCs 
almost never go down together so we type on them in WORD.  Reports are manually 
signed by the pathologist and faxed by the office staff.  Stat procedures such 
as FNAs and Frozens and all report notifications are called into the physicians 
and documented and signed.  All of this is entered into the down system once it 
returns to normal.



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[Histonet] Power outage effects

[Terri Braud via Histonet]

We use a backup generator for power outages, and also, all critical instruments 
are plugged into an appropriate sized UPS (Uninterrupted Power Supply) to hold 
them for about 2 hours of uninterrupted power until the generators kick in. 
Basically what Allan Wang said in his reply.
Just remember that your backup generator has to be outside to avoid nasty fumes.
Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

   5. effect of power outage on tissue processor (Matthew Fleming)
   6. Re: effect of power outage on tissue processor (Allan Wang)

Message: 5
Date: Fri, 20 Apr 2018 08:02:47 -0500
From: Matthew Fleming 
Subject: effect of power outage on tissue processor
Folks,

I'm just wondering about the effects of a power outage on the tissue in a 
tissue processor. I have a small dermatopathology lab, which moved about a year 
ago to a location more prone to power outages. Last weekend the power was out 
for about 7 hours, which meant that the tissue was in 100% alcohol for about 5 
hours, when it is programmed for 2, I believe. The tech who cut the tissue said 
it seemed a little dehydrated, but the slides looked fine.

After that, I got a quote for an automatic backup generator for the building, 
but it came in at $20,000, which was much more than I was expecting and an 
expense I'd certainly like to avoid if possible. I spoke to the guy who 
maintains my equipment, who said our tissue processor (a Sakura E300) should 
not be harmed by a power outage and would pick up where it left off once the 
power returns. He also said that it can sense when the paraffin in the supply 
bins is melted and wouldn't try to use any wax that isn't.

But still, a power outage could certainly mean that the tissue remains in a 
solution longer than programmed, as happened last weekend. My question is, how 
much of a risk does this pose? Could it damage the tissue so much as to make 
the ultimate sections uninterpretable?

I should mention that I know when the power goes out, because the building has 
a fire alarm connected to a monitoring service that calls when the power goes 
out. So, as an alternative to spending $20K, I could get a manual generator and 
just go in and plug it in when the power goes out, or if it is out for more 
than an hour or two.

Thanks in advance for your advice.

Matthew Fleming, MD
Fleming Dermatopathology
Brown Deer, WI


--

Message: 6
Date: Fri, 20 Apr 2018 12:45:07 -0400
From: Allan Wang 
To: Matthew Fleming 
Cc: histonet@lists.utsouthwestern.edu
Subject: Re: [Histonet] effect of power outage on tissue processor
Message-ID:

Content-Type: text/plain; charset="UTF-8"

A generator is probably the cheapest option if you can go manually start it 
after a few hours.

I purchased a UPS for a DNA sequencer which shouldn't lose power when in use. 
You may also want one to add a few hours of leeway before the generator is 
needed.
You should measure the tissue processor's power consumption during usage with 
something like a Kill-A-Watt or cheaper ones to help you choose the right size 
of UPS.
The E300 manual says it draws 10.5 A at 110 V which is 1200 W, but actual usage 
could be significantly less if you aren't processing 300 samples.

I use this UPS and external battery:
https://www.amazon.com/TRIPP-SU2200XLCD-2200VA-1800W-Online/dp/B00CBQNBYI
https://www.amazon.com/BP48V27-2US-External-Battery-Select-
Online/dp/B00I3RROT2

This battery is also an option:
http://www.provantage.com/tripp-lite-bp48v60rt3u~7TRPL1CE.htm

It has a chart for runtimes with external batteries:
https://assets.tripplite.com/ups-runtime-chart/su2200xlcd-ru
ntime-chart-en.pdf

Allan Wang
Lab Manager
US Biomax

On Fri, Apr 20, 2018 at 9:02 AM, Matthew Fleming via Histonet < 
histonet@lists.utsouthwestern.edu> wrote:

> Folks,
>
> I'm just wondering about the effects of a power outage on the tissue 
> in a tissue processor. I have a small dermatopathology lab, which 
> moved about a year ago to a location more prone to power outages. Last 
> weekend the power was out for about 7 hours, which meant that the 
> tissue was in 100% alcohol for about 5 hours, when it is programmed 
> for 2, I believe. The tech who cut the tissue said it seemed a little 
> dehydrated, but the slides looked fine.
>
> After that, I got a quote for an automatic backup generator for the 
> building, but it came in at $20,000, which was much more than I was 
> expecting and an expense I'd certainly like to avoid if possible. I 
> spoke to the guy who maintains my equipment, who said our tissue 
> processor (a Sakura E300) should not be harmed by a power outage and 
> would pick up where it left off once the power returns. He also said 
> that it can sense 

Re: [Histonet] Attwood tip

[Terri Braud via Histonet]

Have you tried Polyphenyl Yellow 8G instead of Tartrazine?  Just a suggestion

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal


Today's Topics:
   1. Attwood's tips please (Finlay Finlay)

--

Message: 1
Date: Mon, 9 Apr 2018 12:40:45 +
From: Finlay Finlay 
Subject: [Histonet] Attwood's tips please
Hello,
I'm trying to work up an Attwood's  method but would be keen to get a guide on 
time for the differentiation step in tartrazine solution. The method I'm using 
suggests 20 minutes at the longest with regular microscope checks. I'm 
currently at about 4 hours with only slight loss of colour in the RBC's. I know 
that the tartrazine solution will work eventually as the slides I left in over 
the weekend became fully decolourised but those time scales are unworkable.
Thanks,

Finlay Finlay

Senior Histology Technician
Forensic Medicine and Science
School of Medicine
College of Medical, Veterinary and Life Sciences University of Glasgow Joseph 
Black building

Direct Line: +44 (0) 141 3303443
E-mail: finlay.fin...@glasgow.ac.uk

The University of Glasgow Charity Number SC004401

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End of Histonet Digest, Vol 173, Issue 7



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Re: [Histonet] IHC validation

[Terri Braud via Histonet]

Just another note:  You can order unstained tissue microarrays with the 
prerequisite number of cases, both positive and negative, and stain your 
validation all on one slide.  I've done this for years and for 3 different 
validations of entire IHC platform changes, ranging from 40 to over 100 
antibodies each time.  Saves time and money.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Message: 2
Date: Fri, 16 Mar 2018 06:54:30 -0700
From: "Paula" 
Subject: [Histonet] Antibody Validation CLIA

Hello,
We've been discussing about the quantity of slides to run as a validation for 
IHC antibodies. We are governed by CLIA, and we would like to know if there is 
a set number of slides to run for a particular antibody we would like to bring 
in-house for Validation.  I think CAP requires 20 slides..?
And so we are asking if there is  a requirement with CLIA to run a certain 
number of slides, or is it up to us (the laboratory director) to decide how 
many slides to run for Validation/Verification.
Thank you in advance
Paula


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Re: [Histonet] Synoptic Reports

[Terri Braud via Histonet]

Hi Allison - We couldn't afford the program offered by our LIS vendor, but 
since they are published annually, we have a fabulous transcriptionist that 
updates and reformats all of ours every year.  She saves them as a "quick text" 
in the LIS.  They are accessible to all who are dictating/transcribing reports. 
It's not very sophisticated, but it is cheap, reproducible, easily implemented, 
and most of all, compliant.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Today's Topics:
   1. synoptic reporting (Eck, Allison)
 Good morning,
I am interested in finding out the ways that other labs stay up to date and 
compliant with the synoptic reporting requirements.  Our LIS software makes it 
quite difficult for us to integrate these as templates.  Do most labs have this 
built into their LIS, is there external software or programs that you use, do 
your pathologists just take responsibility for getting this information into 
the report?
Any advice is most appreciated
Thanks
Allison  


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Re: [Histonet] Identification of bacteria on an acrylic lens prosthesis

[Terri Braud via Histonet]

I'm certified in EM. My suggestion would be to use SEM as opposed to TEM. The 
scanning electron microscope (SEM) can also be useful to reveal morphological 
features of isolated organisms as well as for diagnosis.  There are numerous 
articles citing this technique. I believe the UC Berkley has an SEM in their 
lab.I hope this helps.  Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Today's Topics:
   1. Prosthetic lens processing, cutting? (Morken, Timothy)
Message: 1
Date: Thu, 8 Mar 2018 19:30:35 +
From: "Morken, Timothy" 
To: Histonet 
Subject: [Histonet] Prosthetic lens processing, cutting?


Hi all,
Does anyone have any experience with embedding an acrylic prosthetic lens for 
EM, or any other way ? We have a case where they wanted EM on a lens to 
identify a  specific bacteria. We have never done it and it would take some 
work to figure it out. Also, I told them that unless there is some morphologic 
marker for the bacteria, EM would not help much identifying it.
Any ideas?
Any labs that handle this kind of thing? They are willing to send it out.
Tim Morken
Pathology Site Manager, Parnassus
Supervisor, Electron Microscopy/Neuromuscular Special Studies Department of 
Pathology UC San Francisco Medical Center


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Re: [Histonet] Tissue Processor

[Terri Braud via Histonet]

After 40 years of using primarily Miles/Tissue Tek, we recently purchased 2 
Leica ASP 6025.  With the exception of a small glitch with faulty sensors, and 
a learning curve to get used to them, I would highly recommend them.  We had 
replaced an ancient K series(with the magnet) and a VIP 5.
The quality and speed of the processing from the Leica's is incredible.  We had 
great tech support in setting up and validating processing protocols.  We ended 
up using several of their pre-set protocols which worked great, especially for 
the processing of large tissues.  I was expecting better processing than our 
ancient Tissue Tek, but the idea that it outperformed the VIP 5 surprised me.  
Reagents are a snap to exchange and the software/screen is very user friendly.
I hope this helps, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
Today's Topics:

   1. tissue processor (Lisa Brenner)
--
Message: 1
From: "Lisa Brenner" 
Subject: [Histonet] tissue processor
Hello,
   We are in the market for a new vacuum infiltrating tissue processor. Our old 
VIP has been a work horse but needs replacing. What is everyone using? What 
works well? What's new?
Lisa Brenner
**


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Re: [Histonet] Everyone is a critic

[Terri Braud via Histonet]

I wholehearted agree with Linda.  Constructive criticism is one thing.  Picking 
apart the book, such as the title, is petty (and ignores the fact that "Hack" 
is also defined as: a strategy or technique for managing one's time or 
activities more efficiently; also to "cope").  Also, the criticism of not being 
comprehensive is a cheap shot.   I see very few of these helpful hints in any 
of the myriad of Histotechnology reference books on my shelf.   If a block 
isn't correctly grossed, absolutely the grossing should be addressed, but in 
the meantime, what are you going to do with the problem block (patient) that 
sits before you. It must be nice to work in 
To the Author:  From those of us Histotechnicians who have thoroughly enjoyed 
this book, please know that we appreciated the effort and the results.  
Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

I really take exception to those finding fault with this book!  Maybe another 
word other than hack would have made some people feel better but we all know 
the intent.  Stating that "many of the fixes or secrets described are because 
some hack failed to do her/his job at an earlier step in the process" is 
totally incorrect.  Very few of the "hacks" has anything to do with someone 
failing to do their job.  I think this books intent was to help new people in 
the field of histology.  It has been a great form of dialog between our new 
tech and the older techs.  It has served a very good purpose.
Linda Blazek HT (ASCP)
Pathology Lab Manager
GI Pathology of Dayton
Digestive Specialists, Inc




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Re: [Histonet] CAP checklist ANP.11680 Cross Contamination

[Terri Braud via Histonet]

In response to the request to post the new phase II CAP requirement on cross 
contamination : 
**NEW**   08/21/2017
ANP.11680   Cross Contamination Phase II
There is a written procedure to prevent cross-contamination of specimens during 
grossing.
NOTE:  At a minimum, cleaning (e.g. wiping or rinsing) of forceps and scalpel 
blades between cases is required. In addition, if a laboratory processes both 
small specimens (e.g. biopsies) and large specimens (e.g. surgical resections), 
cleaning of instruments and cutting surfaces must be performed between cases. 
Avoid re-using cotton swabs/applicator sticks on multiple specimens or 
"double-dipping" the cotton swab/applicator in the ink. Some laboratories may 
choose to use disposable surfaces (e.g. formalin absorbent pads, butcher paper, 
etc.) for large cases. Grossing of similar types of specimens sequentially 
should be avoided, if feasible.
REFERENCES
1)  Lott R, et al. Practical Guide to Specimen Handling in Surgical 
Pathology. College of American Pathologists, November 2015. Available at 
http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/practical-guide-specimen-handling.pdf,
 Accessed November 4, 2016.
2)  Gephardt GN, Zarbo RJ. Extraneous tissue in surgical pathology: A 
College of American Pathologists study of 275 laboratories. Arch Pathol Lab 
Med. 1996;120:1009-14

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
   2. Re: Cross Contamination CAP policy (Bob Richmond)

Message: 2
Date: Sat, 13 Jan 2018 14:32:45 -0500
From: Bob Richmond 
To: "Histonet@lists.utsouthwestern.edu"

Subject: Re: [Histonet] Cross Contamination CAP policy
Message-ID:

Content-Type: text/plain; charset="UTF-8"

Terri L. Braud, HT(ASCP), Anatomic Pathology Supervisor at Holy Redeemer 
Hospital in Meadowbrook PA notes:

>>Our policy calls for wiping of forceps with gauze between cases at 
>>gross
and at embedding. At gross, we use a disposable absorbent lined pad on the 
cutting board for each larger case, and just a fresh c-fold paper towel between 
small biopsy cases. We do not allow double-dipping of swabs into ink, but 
instead, pour out small amounts into a large plastic weigh boat which is also 
discarded after the case. We use disposable safety scalpels, with a 70 blade 
(love 'em) for each case. For excessively bloody/fatty cases, we put the dirty 
forceps into an enzyme pre-soak (Aseptizyme) to remove all tissue debris. Then 
they are scrubbed with a brush, then rinsed in a disinfectant before being 
re-used.<<

I've never seen a pathology service (and I've worked in 80 of them) do any of 
these things, all of them good ideas. I'm glad to see the CAP taking the issue 
up. Carry-overs from case to case are common, particularly when the grosser is 
overworked and working too fast. I've never seen a serious error made as a 
result of such contamination, but I've seen a few close calls.

Terri Braud, could you copy us the actual text in the CAP inspection form?

Bob Richmond
Samurai Pathologist
Maryville TN




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Re: [Histonet] Cross Contamination CAP policy

[Terri Braud via Histonet]

Hi Roy!  The "Germinator 500"  Sounds like something from Phineas and Ferb.  
Hahaha.
Anyway - The mandate from CAP is designed to clean the instruments, not 
sterilize them.  If the instruments aren't cleaned before stuffing them into a 
250'C trough of glass beads (the Germinator),  you will just have burnt on 
fragments of other tissue stuck on forceps.  The thought of what molten 
paraffin at the embedding unit would do to those glass beads is downright 
scary.  I would certainly check with the manufacturer of both the unit, and the 
paraffin before attempting. Also, the Germinator manual states that instruments 
be allowed to cool for 30 seconds before reuse.  Can you imagine how that might 
slow everything down. It just doesn't sound appropriate for what CAP is trying 
to accomplish.
Our policy calls for wiping of forceps with gauze between cases at gross and at 
embedding. At gross, we use a disposable absorbant lined pad on the cutting 
board for each larger case, and just a fresh c-fold paper towel between small 
biopsy cases.  We do not allow double-dipping of swabs into ink, but instead, 
pour out small amounts into a large plastic weigh boat which is also discarded 
after the case. We use disposable safety scapels, with a 70 blade (love 'em) 
for each case. For excessively bloody/fatty cases, we put the dirty forceps 
into an enzyme pre-soak (Aseptizyme) to remove all tissue debris.  Then they 
are scrubbed with a brush,  then rinsed in a disinfectant before being re-used.
I sure hope this helps

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
 

  3. New Cap cross contamination at gross bench (Roy, Ryan)
Date: Fri, 12 Jan 2018 15:39:05 +
From: "Roy, Ryan" 
Subject: New Cap cross contamination at gross bench

Anyone out there see the new CAP requirement regarding cross contamination at 
gross bench and cleaning of forceps.
How are other people planning to comply. My supervisor has instructed me to use 
a Germinatior 500 at gross bench and at Embedd center.
I have no experience using these sterilizers but my initial thought is that I 
will need to be really careful not to inadvertently apply too much heat to the 
tissue.
Any thoughts appreciated,

Ryan Roy HTL (ASCP)
Manchester VA Medical Center




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[Histonet] Histology Hacks - the book

[Terri Braud via Histonet]

I just wanted to share a quick review of the new book "Histology Hacks", by 
Michael Backhus.  It is the kind of book that brings together all of the little 
tidbits that a tech picks up along a lifetime of working and networking with 
others.  It is well organized and the information is presented with the pros 
and cons of each hint.  The big bonus was that by flipping through the book in 
my department, it started a conversation on techniques and experiences with 
similar tips.  Anything that gets your Histology team excitedly talking about 
their profession is well worth the relatively small investment.  It would make 
a great staff present for Lab Week.  I don't know Michael, but kudos!  Check it 
out on Amazon.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal



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Re: [Histonet] cutting test

[Terri Braud via Histonet]

Please be sure to clear any use of a "cutting test" during the interview 
process with your institution's legal department.  If an interviewee should cut 
themselves, the liability could be steep.  If you have a clearly defined 
minimum cutting speed/quality, a better solution would be to hire the best fit 
for your lab, then, if they can't meet  the minimum requirements, then it's 
easy to let them go during the probationary period.  That's what it's for.
Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Today's Topics:
   2. Suggested Requirements for new uncertified HTs (Erin McCarthy)
   3. Re: Suggested Requirements for new uncertified HTs (Jay Lundgren)
   4. Re: Suggested Requirements for new uncertified HTs
  (Sanders, Jeanine (CDC/OID/NCEZID))

Message: 2
Date: Mon, 8 Jan 2018 10:19:00 -0600
From: Erin McCarthy 
Hi All,

I work at a Start-Up and I was our first hire. I have been practicing since
2011 when I got my certification. However, we are looking to expand, what would 
you suggest our baseline technical competencies be for a position that focuses 
exclusively on cutting and IHC. In an interview it is hard to access what a 
person is capable of, would it be acceptable for me to have applicants performs 
a cutting time test?
I am open to hiring new techs, but I want to make sure we are not hamstrung by 
a great interviewer with a lacking technical skill set.
Thanks!
Erin McCarthy, HT (ASCP)
Histotechnician
Tempus Labs
600 W. Chicago Ave.
Chicago IL 60654
Ph:(312) 638-6344 Ext.3835



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Re: [Histonet] Prostate Needle Biopsies

[Terri Braud via Histonet]

We cut levels x2 with no unstained.  We've never had a problem going back to a 
block for additional recuts or specials.  We date all our precut IHC slides 
(patient or control) with an expiration date of 6 weeks.  Slides cut for 
histochemistry stains seem to have no expiration. Hope this helps.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

Today's Topics:

   1. Prostate needle biopsies (Martha Ward-Pathology)
--
Message: 1
Date: Fri, 15 Dec 2017 17:06:10 +
From: Martha Ward-Pathology 
Subject: [Histonet] Prostate needle biopsies
I am posting this question for our Histology manager.For prostate needle 
biopsies how many levels and unstained slides are people cutting and also how 
long after the case is signed out is everyone keeping the unstained slides that 
have been cut?

Thanks in advance for everyone's help.

Martha Ward
Wake Forest Baptist Health
Winston-Salem, NC 25157




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Re: [Histonet] Sound monitoring

[Terri Braud via Histonet]

We contract with an outside company to come in and perform a sound monitor once 
a year in each room of the lab

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
*


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Re: [Histonet] Her 2 Control

[Terri Braud via Histonet]

Hey Scott - Our interpretation of CAP requirements for IHC Controls is the same 
as yours.  Our Her2 control is a microarray with  3+ case and a piece of normal 
skin to serve as our negative tissue control.
If you have normal breast tissue adjacent to your tumor control, that can also 
serve as a negative tissue control, but your procedure has to state it as such. 
 Our control tissue are 5mm punches of solid tumor, so we just add a punch of 
normal skin. 
I hope this helps, but sometimes, it's just not worth the argument.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal


Message: 2
Date: Tue, 21 Nov 2017 21:05:51 +
From: "Lindrud, Scott" 
Subject: [Histonet] Negative IHC Control for Her2
Hi All,
We are having an internal debate regarding Her2 IHC control tissue in our lab.  
We run a MTA (multi tissue array) consisting of 0+, 1+, 2+, and 3+ Her2 
staining tissue taken from lumpectomy/resection cases.  I'm in the process of 
searching for more tissue to use in future control blocks and it can be 
difficult to find tissue that is 0+ and 3+.
I've discussed this with our pathologist in charge of Histology and he says 
that we don't need to run all 4 of the cores as controls.  He says all we need 
to run is a positive control and a negative control.  He says the positive 
control could be a 2+ or 3+ and the negative control could be either a 0+ OR a 
1+.
I respectfully disagreed with him and said the negative control is not meant 
for accessing staining interpretation but to verify the sensitivity and 
specificity of the actual antibody-antigen reaction.  I said a 1+ is still 
staining the tissue where there is no staining in a 0+ reaction.  The 1+ is not 
a negative staining reaction, but a negative interpretation.   The pathologist 
says I'm wrong.
The CAP in its checklist says "It is also important to assess the specificity 
of each antibody by a negative tissue control, which must show no staining of 
tissues known to lack the antigen".To me, a 1+ Her2 staining reaction shows 
that that tissue has antigen and should not be used as a negative control.
So, after saying all that, can/should  1+ Her2 breast tissue be used as a 
negative tissue control?  Seems pretty straight forward to me, but I'm just a 
Cytotechnologist/Histotech.
Thanks for any input!
Scott
Scott A. Lindrud, MLS(ASCP)CM CTCM
Histopathology Technical Specialist/Cytotechnologist Rice Memorial Hospital
301 Becker Ave SW
Willmar, MN 56201
WP(320)231-4406
Fax(320)231-4861
scott.lind...@rice.willmar.mn.us




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--

Message: 3
Date: Wed, 22 Nov 2017 16:02:21 + (UTC)
From: Rene J Buesa 
To: "Lindrud, Scott" ,
"histonet@lists.utsouthwestern.edu"

Subject: Re: [Histonet] Negative IHC Control for Her2
Message-ID: <800857894.1231622.1511366541...@mail.yahoo.com>
Content-Type: text/plain; charset=UTF-8

You are right but, your point is?Regardless, the pathologist is the responsible 
for his/her diagnosis/interpretation and the liability is his/hers.Remember 
that for us histotechs, our "client" is the pathologist (always remembering the 
patient behind the whole process) and our essential duty is to provide the 
pathologist what s/he needs to being able to make the best and more accurate 
diagnosis.Follow his/her instructions and your life will be much simpler and 
less stressful.Ren?

On Tuesday, November 21, 2017 4:21 PM, "Lindrud, Scott via Histonet" 
 wrote:


 Hi All,

We are having an internal debate regarding Her2 IHC control tissue in our lab.? 
We run a MTA (multi tissue array) consisting of 0+, 1+, 2+, and 3+ Her2 
staining tissue taken from lumpectomy/resection cases.? I'm in the process of 
searching for more tissue to use in future control blocks and it can be 
difficult to find tissue that is 0+ and 3+.

I've discussed this with our pathologist in charge of Histology and he says 
that we don't need to run all 4 of the cores as controls.? He says all we need 
to run is a positive control and a negative control.? He says the positive 
control could be a 2+ or 3+ and the negative control could be either a 0+ OR a 
1+.

I respectfully disagreed with him and said the negative control is not meant 
for accessing staining interpretation but to verify the sensitivity and 
specificity of 

Re: [Histonet] Mounting media

[Terri Braud via Histonet]

Although we've used several brands with good success, our most consistent 
performer has been the Sakura Tissue Tek Glas Mounting Media #6419. When 
coverslipping, either automated or manual, the secret to avoiding air bubble 
during storage is to insure that the correct amount of media is dispensed onto 
the slide.  If the amount is insufficient, the slide will still coverslip to be 
read, but as time passes and the xylene dries out, there will be air left under 
the coverglass which will allow the stain to degrade. When coverslipping by 
hand, we go by the rule of 3 drops of media from a plastic disposable pipette 
for a 24x50 No.1 coverglass.  When techs "guesstimate" is when problems occur.  
Best of luck, I hope this helps

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal



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Re: [Histonet] Division of Path cases

[Terri Braud via Histonet]

We give the worklist to the chief Pathologist and let him make the assignments 
on a daily basis.  They are usually divided up by complexity. In the absence of 
the Chief Path, then I make the assignments.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

*


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Re: [Histonet] Elastic Stain

[Terri Braud via Histonet]

We love the Aldehyde Fuchsin with a fast-green counterstain.  Once the initial 
working stain is made up, it is a fast and easy stain to perform, not to 
mention just pretty - purple fibers against a green background.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
*


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Re: [Histonet] Supervising a histologist

[Terri Braud via Histonet]

I don't think it sounds like a strange question at all, but the quick answer is 
yes, it is perfectly legal and acceptable for an OJT Lab Assistant to be 
temporarily assigned to supervise an HTL. As long as it does not break any 
local/state requirements for licensure, or in the case of a unionized lab, and 
even then, it might be permissible since it is only a temporary "assignment" of 
responsibility in the absence of the manager/supervisor. Usually such a 
temporary position has less to do with technical expertise than a chain of 
command for reporting incidents, or assigning coverage in the absence of 
employees.  I was once made a interim director of all lab services over MTs and 
MLTs, though I have no clinical experience.  My main skill was communication 
and prioritization of work which served the position well.  In times of 
trouble, I depended on the MTs./MLTs and the pathologists to give guidance for 
technical expertise.  I would think that the same principles would apply.
Sincerely, 
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

2. Supervising a histologist (Eileen Akemi Allison)
From: Eileen Akemi Allison via Histonet 
 To: Histonet 
 Sent: Wednesday, November 1, 2017 8:20 AM
 Subject: [Histonet] Supervising a histologist
Hello Histoland:
This may sound like a strange question, but I have my reasons.? Has anyone run 
into a situation where a OJT histology assistant supervises an HTL when the 
histology manager is absent?? Is it even legal?? Any feedback would be greatly 
appreciated.
Akemi Allison BS, HT/HTL (ASCP)
Pathology Manager
Monterey Bay GI Consultants Laboratory
23 Upper Ragsdale Drive, Suite 200
Monterey, CA 93940




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Re: [Histonet] pertinent to the blog

[Terri Braud via Histonet]

Actually, the verification of instrument performance is a CAP All Common 
Checklist Requirement and should already be a part of laboratory procedure. 
COM.30550   Instrument/Equipment Performance Verification   Phase II
The performance of all instruments and equipment is verified  prior to initial 
use, after major maintenance or service, and after relocation to ensure that 
they run according to expectations.
NOTE: Instrument/equipment performance verification (NOT to be confused with 
validation or verification of the test method performance specifications) 
includes processes to verify that the instruments and equipment perform 
according to expectations for the intended use and within defined tolerance 
limits. If instruments or equipment are moved, the laboratory must perform 
appropriate function checks to ensure that they were not adversely affected by 
the relocation process or changes due to the new environment. This does not 
apply to portable equipment used following the manufacturer's instructions.
Evidence of Compliance:
✓   Written procedure to verify proper functioning of instruments and 
equipment prior to initial use, after major maintenance or service, and after 
relocation AND
✓   Records of appropriate function checks

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

-Original Message-
From: histonet-requ...@lists.utsouthwestern.edu 
[mailto:histonet-requ...@lists.utsouthwestern.edu] 
Sent: Friday, October 27, 2017 1:00 PM

Message: 2
Date: Fri, 27 Oct 2017 15:32:25 +
From: Lester Raff MD 
It was cytology, but could be histology just as easily!

http://www.chicagonow.com/downsize-maybe/2017/10/the-safety-engineers-reply-will-make-you-wonder/

Lester J. Raff, MD MBA
UroPartners
Medical Director Of Laboratory
2225 Enterprise Dr. Suite 2511
Westchester, Il 60154
Tel: 708-486-0076
Fax: 708-492-0203


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Re: [Histonet] Stain Validations

[Terri Braud via Histonet]

Just use a microarray.  They can be purchased in all sorts of varieties with 
hundreds of cases on one slide.  I use and recommend U S Biomax

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
Today's Topics:

   1. validation for special stains (Nancy Schmitt)
   2. HHV-8 (Martin, Erin)
   3. blades (Lauren Sweeney)


--

Message: 1
Date: Mon, 22 May 2017 15:11:09 +
From: Nancy Schmitt 
Subject: [Histonet] validation for special stains
Good Morning-
What is everyone doing for validation on special stains?  We have a new Artisan 
but I am struggling with finding exact validation specifications.  It will be 
difficult to find 10-20 cases on some of these stains.
Thoughts and Thank you!
Nancy
Pathology Support Services Manager
United Clinical Laboratories



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Re: [Histonet] Send-outs, cassette printers, holding cassettes, and cassette clamps

[Terri Braud via Histonet]

   1. Send-Outs (Cristi Rigazio)
Our TAT for send-outs is 1 working day (M-F). The office staff here use the 
"Slide/block Send Out" function in CoPath to track all material moving in and 
out of Anatomic Pathology and it really speed up retrieval of case material 
   
   3. Cassette printers - multi color cassettes and network ready-  (Cheryl)
Even though they are big, we still love our Leica Printers.  They are such 
workhorses and they were so easy to interface.

   5. A Question About Paraffin Times (P Sicurello)
I agree that if possible, the delay should be in formalin, but if you are 
running into a problem where that might exceed fixation times for a breast 
specimen there are 2 good alternatives.  The first one is as you stated, to 
just pull them out of paraffin and let them chill, OR you can program a "hold" 
in 70% alcohol to avoid formalin fixation beyond 72 hours, and have the process 
finish at the usual time.  Works like a charm.  Feel free to contact me for 
details. I would never leave cassettes to "cook" in hot paraffin.

   6. Extra Large Cassette Clamps for Microtomes (Sandra Cheasty)
Only use one microtome, even if you are swapping out.  Just my personal, 
unscientific opinion, but the less one disturbs the clamp/knife holder 
assembly, the better.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor, Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal


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Re: [Histonet] IF vs IHC another reason

[Terri Braud via Histonet]

Another reason that IHC is used instead of IF is with IHC, one preserves the 
ability to see tissue/cell morphology through Light Microscopy at the same time 
as the visual IHC label.  Morphology is difficult to see with IF, with the 
exception of the fluorescein labeled area.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
-Original Message-
From: Blanca Lopez via Histonet [mailto:histonet@lists.utsouthwestern.edu]
Sent: Thursday, 13 April 2017 11:10 PM
Hello!
I just need a help with a simple question...Is anyone can explain me what is 
the purpose between performing immunohistochemistry and Immunofluorescence?
Thanks  :)
Blanca Lopez
Histotech (ASCP)
UTSW Tissue Resource K1.210
Simmons Comprehensive Cancer Center
UT Southwestern Medical Center
Telephone: 214-648-7598
Email: blanca.lo...@utsouthwestern.edu



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Re: [Histonet] patient taking tissue

[Terri Braud via Histonet]

Our hospital has a policy against releasing soft tissue to anyone except a 
funeral home.  Realizing that some religions require one to be buried with all 
their body parts, release to a funeral home meets those requirements without 
someone finding human remains years down the road, with no record.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

-Original Message-
From: histonet-requ...@lists.utsouthwestern.edu 
[mailto:histonet-requ...@lists.utsouthwestern.edu] 
Sent: Sunday, April 09, 2017 1:00 PM
To: histonet@lists.utsouthwestern.edu
Subject: Histonet Digest, Vol 161, Issue 8

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Today's Topics:

   1. Return of Gross Only Specimens for Patient Use (ian bernard)
   2. Re: Return of Gross Only Specimens for Patient Use
  (Cartun, Richard)


--

Message: 1
Date: Sat, 8 Apr 2017 12:38:31 -0600
From: "ian bernard" 
To: 
Subject: [Histonet] Return of Gross Only Specimens for Patient Use
Message-ID: <007001d2b097$533a5dd0$f9af1970$@comcast.net>
Content-Type: text/plain;   charset="us-ascii"

1.   Per a patient request, before returning an amputated digit (toe) to
a patient, we will remove the 10 % NBF from the tissue by washing the tissue
in running water for how long?   

 

2.   As an alternative, we can have the provider submit the gross only
toe in saline and then relinquish the toe to the patient, explaining that 
ultimate degradation of the toe is inevitable unless fixed. Is there another 
safe fixative alternative that  can preserve the toe, say 100% alcohol and for 
how long?  The patient wants to keep his body parts for his burial.

 

3.   We will have the patient sign a  document explaining the exposure
risk to formalin fixed tissue as well as a release of medical records request 
form. Your thoughts?  

 

4.   Is there any other validated procedure to remove formalin from
foreign bodies devices or tissue before release to the patient?

 

Note: The transaction above will take place 2-weeks after the case has been 
signed out and reported to the referring provider.  Your feedback?

 

 

v/r

IB

 



--

Message: 2
Date: Sun, 9 Apr 2017 14:32:17 +
From: "Cartun, Richard" 
To: ian bernard 
Cc: "histonet@lists.utsouthwestern.edu"

Subject: Re: [Histonet] Return of Gross Only Specimens for Patient Use
Message-ID:
<9215bd4b0ba1b44d962a71c758b68d2e95415...@hhcexchmb03.hhcsystem.org>
Content-Type: text/plain; charset="us-ascii"

I strongly discourage patients from taking their tissue out of the hospital.  
Once the specimen in placed in formalin it becomes a bio-hazard.  We will 
release certain specimens for burial; however, the patient (or family) must 
contact a funeral home or mortuary to pick-up the specimen, and they must sign 
a release.

Richard

Richard W. Cartun, MS, PhD
Director, Histology & The Martin M. Berman, MD Immunopathology & Morphologic 
Proteomics Laboratory Director, Biospecimen Collection Programs Assistant 
Director, Anatomic Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596
(860) 545-2204 Fax



-Original Message-
From: ian bernard via Histonet [mailto:histonet@lists.utsouthwestern.edu]
Sent: Saturday, April 08, 2017 2:39 PM
To: histonet@lists.utsouthwestern.edu
Subject: [Histonet] Return of Gross Only Specimens for Patient Use

1.   Per a patient request, before returning an amputated digit (toe) to
a patient, we will remove the 10 % NBF from the tissue by washing the tissue in 
running water for how long?



2.   As an alternative, we can have the provider submit the gross only
toe in saline and then relinquish the toe to the patient, explaining that 
ultimate degradation of the toe is inevitable unless fixed. Is there another 
safe fixative alternative that  can preserve the toe, say 100% alcohol and for 
how long?  The patient wants to keep his body parts for his burial.



3.   We will have the patient sign a  document explaining the exposure
risk to formalin fixed tissue as well as a release of medical records request 
form. Your thoughts?



4.   Is there any other 

Re: [Histonet] Stainer vs coverslipper

[Terri Braud via Histonet]

Such a shame that you have to choose.  But, that said, a coverslipper.  Hands 
down.  If nothing else, due to safety and exposure reasons alone.  H and E 
stains can be unstained and restained, easily corrected, and easily 
accomplished in batches and the racks have HANDLES.  But with coverslipping by 
hand, there is no way to avoid contact with solvents, even if using Nitrile 
gloves, which eventually break down in any solvent.  I've used good auto 
coverslippers and bad ones, but ask any of my techs (and I did) and they would 
rather give up the stainer than the coverslipper.  We've had our Sakura Glas 
now for almost 10 years with virtually no problems.  The ability to load 60 
slides and walk away to come back to perfectly coverslipped slides is a 
blessing.  I hope this helps.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal



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Re: [Histonet] disposable grossing pad

[Terri Braud via Histonet]

I know many, including staff here, that prefer to use "chux".  They are very 
cheap, come in various sizes and adsorption levels, latex-free, with a highly 
absorbent core and soft, quick-drying coverstock so you don't get lint in your 
specimens. Use your favorite search engine to look them up.  Almost all major 
Med suppliers carry them.  Between specimens, we just toss the old one into 
red-bag waste.
I hope this helps.
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

   1. formalin pad for grossing (Wang, Weixi)
--
Message: 1
Date: Wed, 29 Mar 2017 17:09:25 +
From: "Wang, Weixi" 
Subject: [Histonet] formalin pad for grossing
Dear all Histonetters,
It has been a while since I joined the mailing list and I learned a lot here!
Now I have a question and would like to get feedbacks regarding the use of 
formalin in the grossing room. I was instructed to use the formalin-neutralized 
pads during the grossing. Any other pads or paper, absorbent or not, cannot go 
to the bio-hazardous waste. But the neutralizer pads are so costly, especially 
for grossing part, when we need to change very frequently to void the cross 
contamination between specimen.
I would like to know what is the pad/mat/paper you use for grossing, and how do 
you dispose these formalin contaminated materials.
Any feedback is deeply appreciated!
Weixi
Weixi Wang, Ph.D., HTL(ASCP)
Manager | Histology Laboratory
St. Joseph's Healthcare System
703 Main Street, Paterson, NJ 07503
Phone: 973.754.3541 | Fax: 973.754.3292
wangwe...@sjhmc.org | 
www.StJosephsHealth.org
***


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[Histonet] out with the old

[Terri Braud via Histonet]

We have just replaced our 2 old tissue processors and have one very old (1989) 
VIP3000 floor model, the one with the magnets.  It is in working condition, but 
will not hold the battery charge for the backup battery. We have been using it 
with a UPS, for 6 runs every week.  If anyone is interested in it for parts, or 
for a cheap processor, please contact me.
Now the question:  We used to use Eosin in our 1st absolute alcohol to tint our 
biopsies, but it is not recommended for the new processors.  For those of you 
in a similar position, what do you use, if anything, to help visualize tiny 
biopsies?
Thanks in advance for any suggestions.  Sincerely, Terri Braud
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

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Re: [Histonet] Handstaining IHC for MITC

[Terri Braud via Histonet]

Coming from an ancient histology tech who did IHC back in the dark ages, before 
automation, hand staining is a piece of cake.
A couple of hints:
Use a "pap" pen to circle your tissue on the slide to form a barrier to keep 
your reagents puddled in a concentrated spot and to minimize reagent use.
Use a plastic 100 slide box as an incubation chamber.  Place dampened strips of 
paper towels in the bottom to make a moist chamber, and lay the slides flat 
across the filing slots.  Keep the lid closed between steps.
Use a reliable kit and pre-dilutes to make life easier.
Best of luck.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal



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Re: [Histonet] Release of patient tissue

[Terri Braud via Histonet]

Our policy is to not release any wet tissue except by subpoena, except for 
purposes of burial, and then only released to a funeral director.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

   2. Releasing of Patient Tissue (Vanessa Keeton)
   
Date: Wed, 18 Jan 2017 10:30:35 -0500
From: Vanessa Keeton 
Subject: [Histonet] Releasing of Patient Tissue
Good Morning All!
I was wondering what everyone's policies were on releasing of patient tissue 
other than stones, placentas, and hardware.  Normally we only release stones, 
placentas, and hardware but have been receiving request for other types of 
tissues lately and was just curious as to what the norm seems to be pertaining 
to this issue and if you do release the tissue, how do you limit patient 
exposure to blood, body fluids and chemicals?
Thanks!!!
Vanessa Keeton


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Re: [Histonet] Grad Student Problem

[Terri Braud via Histonet]

My response:
My first question is what temperature are the blocks that are too brittle? And 
at what temperature are you trying to cut?  Blocks stored in cryofreezers at 
-70o C or less are far too cold to cut without brittleness.  My suggestion 
would be to pull the blocks and put them into the cryostat at -18o C for at 
least 6 hours to acclimate to that temp, then try to cut and stain for IF.

If that doesn't work, then I would thaw in formalin and process as routine 
tissue for formalin fixed paraffin embedded.  The process that your student 
described in the 2nd step is not a complete, or valid process.
Depending on the T-Cell markers they are trying to demonstrate, one can 
successfully use standard IHC with appropriate clones, or with usually less 
success, use a modified IF stain procedure for FFPE sections. Since there are a 
"ba-zillion" T-cell markers, any further details are very dependent on the 
markers and the condition of the tissue.
Sincerely, Terri Braud

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
Today's Topics:

   1. grad student problem (Roberta Horner)
Message: 1
Date: Tue, 3 Jan 2017 18:05:15 +
From: Roberta Horner 
I got the following from a grad student here at Penn State. I am not sure how 
to solve his problem if possible. Does anyone have any suggestions I can 
forward?
Roberta Horner
Animal Diagnostic Lab
Penn State University

"I am having some difficulties sectioning mouse tumor samples for 
immunofluorescent analysis.  We originally went the OCT route because we are 
staining for T cell markers and were worried that the heating that occurs 
during paraffin embedding would compromise the T cell receptor.  The samples 
are a little old, but we are hoping to section and stain for immune cell 
infiltrates.  When sectioning with the cryostat, the tissue and OCT is quite 
brittle and the sample is not intact enough to transfer to a slide. Two 
colleagues have given the following suggestions:
1. Thaw the OCT blocks, remove the tissue, and place in a new block with fresh 
OCT media.  I've tried this technique on a few practice samples and the new OCT 
media seems to be less brittle and I'm able to get tissue on a slide, however 
the tissue itself still seems to be poor with either freeze or sectioning 
artifacts.
2. Thaw the OCT blocks in water, remove the tissue and place in formalin 
overnight, place in 70% EtOH, then paraffin embed.  Section on a microtome.  
Check the fluorescently labelled antibody data sheet to see if paraffin 
embedding interferes with binding.  Try to stain and see what happens.

I was hesitant to try the second suggestion because I have found no protocol 
that takes tissue originally stored in OCT blocks and subsequently redirects 
them to formalin and paraffin for microtome sectioning.  If you have any 
recommendations on how to move forward and section these difficult samples, or 
know anyone at the diagnostics lab or at Penn State that could help, that would 
be much appreciated!"

*


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[Histonet] Dispensing formalin

[Terri Braud via Histonet]

For those of you working in smaller hospital Histology labs (not staffed 24/7) 
- How does your OR/Lab handle getting specimens into fixative?
We currently use small/med prefilled containers for smaller specimens.  Does 
the OR dispense formalin into larger containers?  Do you refrigerate unfixed 
specimens?  How do you handle specimens collected after pathology hours or on 
weekends/holidays if they are not fixed?
I'm just looking for alternative processes in trying to improve ours.  Thanks!
Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

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Re: [Histonet] RTU antibodies with 1+ year expiration date

[Terri Braud via Histonet]

Just a word to the wise:  Although I certainly appreciate the well-referenced, 
sound science behind Tony Henwood's advice, as he also pointed out, if your lab 
is CAP or CLIA inspected, the regulations are quite specific that expired 
reagents cannot be used for patient work.  I agree that it is a waste, and we 
all want to be responsible and resourceful, but better to throw away and 
reorder expired reagents than a phase II deficiency.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal

   2. RTU antibodies with 1+ year expiration date (Allan Wang)
   5. Re: RTU antibodies with 1+ year expiration date
  (Tony Henwood (SCHN))
   8. Re: RTU antibodies with 1+ year expiration date (Morken, Timothy)

Message: 2
Date: Mon, 5 Dec 2016 15:42:03 -0500
From: Allan Wang 
Subject: [Histonet] RTU antibodies with 1+ year expiration date
Hello list,
Thanks for your responses to my previous dehydration question. I pretty much 
got conflicting responses about going straight to 100% alcohol, but I think I 
will just start them out in 80% alcohol to be safe.
Something that's been bugging me: Every source states that diluted antibodies 
shouldn't be kept for more than a few weeks. Yet Ventana dispensers of 
pre-diluted antibodies have expiration dates of 1 - 1.5 years, plus they sit 
out at room temperature for 5 hours at a time whenever they're used. Ventana 
provides user-fillable dispensers, but if we dilute antibodies ourselves and 
can't use them for more than a few weeks, it would be kind of pointless for 
low-volume needs.
Their specs say: "The antibody is diluted in 0.08 M PBS with 3% carrier protein 
and 0.05% ProClin 300, a preservative."
Isn't this pretty much the same stuff that antibody diluent is composed of, 
except with sodium azide instead of ProClin 300 (I think they're equivalent).
I'm already planning on doing some long-term testing of my own over a year with 
HER-2 and Ki67, but hopefully someone can provide some insight.
Thanks,
Allan Wang


Message: 5
Date: Mon, 5 Dec 2016 22:44:23 +
From: "Tony Henwood (SCHN)" 
To: Allan Wang >
Subject: Re: [Histonet] RTU antibodies with 1+ year expiration date
Hi Alan,
Not every source states that diluted antibodies only last for a few weeks, in 
fact my experience as well as those of the commercial suppliers (see their data 
sheets) indicates otherwise, for example, I just re-validated an antibody 
(CD45RO)  that was prepared 8 years ago (but unfortunately rarely used) and it 
worked very well, in fact we had to re-titre it since it seems our detection 
system has improved its sensitivity (we have a Bond 3). Since it is not 
routinely used (last time was at least 4 years ago) we have retired it.
The following is an extract from the handout of a workshop we gave on an 
Immunohistochemistry Validation workshop we gave this year:
Expired Antibodies
Usually when a new concentrated antibody is received it will have an expiry 
date of around 2 years from receipt, but most of us will find that we can 
continue to use antibodies well past this expiry date. So where are we at?
Recent discussions on Histonet reveal:
?   At least five labs admit to routinely discarding expired antibodies.
?   Why don?t companies extend expiry dates?
?   Why not freeze aliquots of antibody to extend the shelf life?
?   If controls continue to stain appropriately, then why can?t expiry be 
extended?
An expiration date labelled on a vial merely reflects the time span tested by 
the manufacturer during which performance of a reagent has remained stable. It 
does not imply per se, that the reagent will not function properly beyond the 
indicated date. In fact, because it is unrealistic for a manufacturer to test 
an antibody for aging during decades before putting it on the market, most 
expiration spans for primary antibodies are set arbitrarily within 6 to 24 
months (Balaton et al 1999).

Dr Hadi Yaziji explains: Vendors do stability testing on their antibodies, 
where they leave them at room temperature for an extended time (one month, six 
months, etc.), or they do what's referred to as 'accelerated' testing, where 
they put them in a microwave which is supposed to accelerate the degradation of 
the protein. That's usually how they decide to assign an expiration date.

Dr Hadi Yaziji also suggests that if you aliquot the antibody before its 
expiration date and store it in the -20oC freezer, the clock is in effect 
"frozen" too. For example, if there are 6 months left before the antibody 
expires and you freeze the aliquots for 5 years, then if you thaw one of the 
frozen aliquots, the thawed aliquot will still be good for 6 months. He also 
recommends that you make sure you don't thaw and re-freeze the 

Re: [Histonet] Uneven ER/PR

[Terri Braud via Histonet]

My first 2 items to check whenever I have uneven IHC staining are (1) 
Inadequate deparaffinization, (2) bad lot of charged slides - yes this can 
cause terribly streaky or spotty staining, and since you are using the Bond, 
perhaps there was an issue with coverplate placements.
Just things to consider.  Hope this helps, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:
   2. ER/PR Uneven Staining (Joanne Clark)
Message: 2
Date: Tue, 29 Nov 2016 21:09:17 +
From: Joanne Clark 
Subject: [Histonet] ER/PR Uneven Staining
I had a breast needle core today that when stained with ER and PR the staining 
was uneven throughout the core, even though the cancer cells were present in 
the entire core.  The specimen had 10 hours fixation in 10% NBF.  I could 
understand the uneven staining from inadequate fixation on large grossed in 
breast tissue, but 10 hours with  needle core biopsies has always been more 
than sufficient.  Does anyone have any ideas?  We use Leica's ER and PR 
antibodies on the BOND.
Joanne Clark, BAAS, HT(ASCP)CM
Director of Histology



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Re: [Histonet] IHC Personel

[Terri Braud via Histonet]

This should help...the IHC "test" is the pathologists' INTERPRETATION of IHC 
stain.  The stain procedure, validation of protocols and controls, and lot to 
lot validation must be signed off by a pathologist.
 Any tech that has demonstrated competency in performing the procedure, can 
perform IHC staining. Any tech can also perform an antibody work-up, provided 
the "results" are signed off by a pathologist.
Easy-peasy

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

-Original Message-

   4. Personel (Jesus Ellin)
--
Message: 4
Date: Tue, 22 Nov 2016 17:36:20 +
From: Jesus Ellin 
Subject: [Histonet] Personel
So I know I am going to open Pandoras box,, but have people been paying 
attention to the Personal requirements from CAP.

I called the CAP and asked them about the criteria concerning Moderate or High 
complexity testing, after discussing with them the situations,   IF you have a 
tech that is Licensed and Also has a QIHC, but does not minimum requirement 
Defined by CLIA in education ,, they CAN NOT do any QA/OC of IHC and antibody 
work up,, as IHC is defined as High complexity testing.

I also asked about the test systems.  The grandfather clause is only good for 
test systems that occurred for those time periods.  For instance if CLIA 
defined the test system after those dates of 1997,, then they are not included 
and the person cannot perform test and technology created after those dates, 
since the testing was not in place during the grandfather clause time.  In a 
nut shell meaning if the IHC staining and antibody was developed after those 
dates,, you are not covered by the grandfather clause to do the testing ,, can 
some help clear this up,,

So any help on this matter will do




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Re: [Histonet] Her2 Reflex

[Terri Braud via Histonet]

Re: Her2 by IHC
We reflex 1+ to FISH, too

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874




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Re: [Histonet] cold ischemic time

[Terri Braud via Histonet]

Hi Cristi - 
We have a large breast practice and we worked with the surgeons and surgical 
staff to include on the requisition:
"Collect time"
"Time in formalin"
Then at gross, the PA or pathologist grossing calculates "Cold Ischemic Time" 
and "Duration of Fixation"
All breast specimens are handled as STAT so that larger specimens can be 
dissected for a block of any residual tumor to be placed in Fixative. 
 If this is done, we calculate "Cold Ischemic Time" and  "Time in Formalin" 
from that moment.
This is all reported through a Macro.  If there is any deviation from the 
fixation guidelines (which are also printed on the report through the same 
macro) then we record the deviation and disclaimer through the "Notes" section 
on the report.
This is all laid out in our policy/procedure for breast reporting.
I hope this helps, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874


Today's Topics:
   2. Cold Ischemic time (Cristi Rigazio)

Message: 2
Date: Tue, 1 Nov 2016 08:47:43 -0400
From: Cristi Rigazio 
Subject: [Histonet] Cold Ischemic time
Hi histo land!
Referencing CAP requirement ANP.22983, how do you all document cold ischemic 
time?  Do you have a "macro" that the pathologists input or a disclaimer?  We 
were recently inspected and we include a "disclaimer" in the reports that the 
time is less than one hour, but the inspector said that it was not "Accurately 
documented in the report"...I want to fix this this, of course but wondered if 
you all had any guidance such that I don't try and recreate the wheel.  Thank 
you for your time!
Cristi



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Re: [Histonet] Bone saw

[Terri Braud via Histonet]

We use an awesome little band saw made by IMEB, Inc.  It has a small foot 
print, 4 blade types and added accessories for a super lab bone cutting 
station, and best of all, very inexpensive.
It can zip through the densest of bone, or the most delicate.  It can be set up 
as a water cooled station to reduce dust particulate, but we just have ours 
under a hood (It's that tiny!) and we use a standard blade.
Our pathologists and PA LOVE it, and so do the techs, because we get such 
fabulously decaled thin, consistent sections.
Hope this helps, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

-Original Message-
Sent: Thursday, October 27, 2016 1:00 PM
To: histonet@lists.utsouthwestern.edu

Today's Topics:
   6. bone saw (Lauren Sweeney)
--
Message: 6
Date: Thu, 27 Oct 2016 16:55:06 +
From: Lauren Sweeney 
Subject: [Histonet] bone saw

Hello histoworld,
Does anyone out there use a bone saw in their lab? We routinely have research 
cases with hundreds of femur head submissions from avian species. We currently 
use a bone saw made by Buehler from the 70's or 80's and it's a work horse, but 
the blade keeps cracking in the diamond tip from overuse during these surveys 
of hundreds of bones. I was wondering what kind of saws are out there that 
could be used for this purpose and if anyone has any experience with this? I am 
looking for something a little more durable, or if not, at least a little 
cheaper. Each blade costs about $350.
Thanks!




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[Histonet] Tissue Processor question

[Terri Braud via Histonet]

Hi fellow Histonetters-
I'm looking for any feedback from working labs using Thermo's Excelsior 
Processor.  If you can help, can you please also include the age and usage on 
your instrument?
Thanks, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

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Re: [Histonet] Formalin in physician offices

[Terri Braud via Histonet]

We provide formalin training and small volume spill kits and neutralizing wipes 
for all physician offices owned by our health care system.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:
   2. Formalin in Physicians' Offices (Cartun, Richard)
   3. Re: Formalin in Physicians' Offices (Mequita Praet)
--

Message: 2
Date: Mon, 10 Oct 2016 19:04:29 +
From: "Cartun, Richard" 
Subject: [Histonet] Formalin in Physicians' Offices
Do physicians' offices need to have procedures/policies "on-site" regarding 
formalin if they put patient biopsy specimens into the small formalin 
containers?  What about formalin spill kits?  Thank you.
Richard
Richard W. Cartun, MS, PhD
Director, Histology & The Martin M. Berman, MD Immunopathology & Morphologic 
Proteomics Laboratory Director, Biospecimen Collection Programs Assistant 
Director, Anatomic Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596
(860) 545-2204 Fax
--
Message: 3
Date: Mon, 10 Oct 2016 21:12:00 -0400
From: Mequita Praet 
Subject: Re: [Histonet] Formalin in Physicians' Offices
Yes, that would be the best. We even included formaldehyde safety training for 
the nurses/medical assistants. Contact dermatitis can develop even from small 
amounts. 
Mequita Praet, HTL(ASCP)SLS
Former Manager Dermatology Associates
Boca Raton, FL



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Re: [Histonet] Histonet Digest, Vol 155, Issue 2

[Terri Braud via Histonet]

I just instruct the service personnel to include a single statement on the 
service report that the instrument has been tested and is functioning properly 
following service.  Worked for the last inspection.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
   2. Looking for a maintenance form (Martha Ward-Pathology)

--

Message: 2
Date: Mon, 3 Oct 2016 14:05:15 +
From: Martha Ward-Pathology 
Subject: [Histonet] Looking for a maintenance form
Does anyone have a specific form that they use to indicate that a particular 
instrument is functioning as expected after service repairs or PMs?   We need 
to document this information and I would like a simple form to fill out and 
include with the service reports.Just trying to not have to reinvent the 
wheel and would like to see what others are doing.

Thanks in advance for your help.

Martha Ward
Molecular Diagnostics Lab
Wake Forest Baptist Health
Winston-Salem, NC 27157
336-716-2109



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Re: [Histonet] water for stainers

[Terri Braud via Histonet]

Our Prisma is hooked up to tap water.  

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   3. Water for H Stainers? (P Sicurello)
   4. Re: Water for H Stainers? (Elizabeth Chlipala)

Message: 3
Date: Tue, 27 Sep 2016 09:28:25 -0700
From: P Sicurello 
Good Morning Everyone,
What type of water do you use with your automated H stainers?  House or
deionized/distilled?
We cannot buy one of the waterless, fancy schmancy H stainers at this
time.  Thank you in advance.
Sincerely, Paula
Paula Sicurello, HTL (ASCP)CM
Histotechnology Specialist
UC San Diego Health
200 Arbor Drive
San Diego, CA 92103
(P): 619-543-2872



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Re: [Histonet] Low Volume IHC

[Terri Braud via Histonet]

Hi Gareth! BioCare has a wonderful instrument, the Oncor, that has a 30 slide 
max, with full onboard antigen retrieval.  Super simple to operate.  We were a 
Beta site to test and all the techs really liked it.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:

   1. Re: Low volume IHC instrument (Eddie Martin)



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Re: [Histonet] Movat's pentachrome

[Terri Braud via Histonet]

Just wondering why you are compelled to make all the reagents in house for the 
Movat's stain.  I have used the kit k042 from Poly Scientic with fabulous 
results (and no, I have no gain from recommending them).
Their solutions are wonderfully labeled and can be replenished individually, or 
by ordering the kit.  All the time you spend making and labeling and validating 
"homemade" would offset any cost increase from purchasing their premade 
solutions.  I know.  I did the math.
Just a suggestion.  Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874





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Re: [Histonet] ER/PR benchmarks

[Terri Braud via Histonet]

The ER/PR benchmarks are those published in the notes section of the checklist 
question.  We use the lowest numbers of the ranges.  We track , patient age, 
cancer type, tumor grade, and positive or negative results, then just run the 
numbers. We also add in some extras, such as cases positive for one antibody, 
and negative for another, just for tracking purposes only. 
For Interobserver variability, at the advice of CAP, we simply allow each 
pathologist to independently read the CAP ER/PR (PMB) survey and record their 
answers.  Those are compared with the correct answers and with each other.  
They must achieve <10% variability, or be enrolled in performance improvement 
until they can.
I hope this helps.
Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

-Original Message-
From: histonet-requ...@lists.utsouthwestern.edu 
[mailto:histonet-requ...@lists.utsouthwestern.edu] 
Sent: Tuesday, August 23, 2016 1:00 PM
To: histonet@lists.utsouthwestern.edu
Subject: Histonet Digest, Vol 153, Issue 19

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Today's Topics:

   1. CAP ANP.22970 Query (Joanne Clark)


--

Message: 1
Date: Mon, 22 Aug 2016 20:05:00 +
From: Joanne Clark 
To: "histonet@lists.utsouthwestern.edu"

Subject: [Histonet] CAP ANP.22970 Query
Message-ID:
<7a7bdd92b984e847a7e71bc9c00a66d31277c...@s11maild034n2.sh11.lan>
Content-Type: text/plain; charset="iso-8859-1"

Hi Histonetters, we are wondering what everyone else out there is doing to be 
compliant with the following requirement?  We do ER and PR by IHC  but dont 
know what published benchmarks are out there to compare ourselves to.  Also, 
how do you record interobserver variability amongst the pathologists?  Any 
insights into this would be appreciated.



ANP.22970 Annual Result Comparison Phase II For immunohistochemical and 
FISH/ISH tests that provide independent predictive information, the laboratory 
at least annually compares its patient results with published benchmarks, and 
evaluates interobserver variability among the pathologists in the laboratory.
NOTE: Individuals interpreting the assay must also have their concordance 
compared with each other and this concordance should also be at least 95%.
With specific reference to estrogen and progesterone receptor studies: in 
general, the overall proportion of ER-negative breast cancers (invasive and 
DCIS) should not exceed 30%. The proportion is somewhat lower in postmenopausal 
than premenopausal women (approximately 20% vs. 35%). The proportion is 
considerably lower in well-differentiated carcinomas (<10%) and certain special 
types of invasive carcinomas (<10% in lobular, tubular, and mucinous types).
The proportion of PgR-negative cases is 10-15% higher than for ER-negative in 
each of these settings. Investigation is warranted if the proportion of 
negative cases is significantly lower in any of these settings.

Joanne Clark, HT
Director of Histology
Pathology Consultants of New Mexico
Roswell, New Mexico




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End of Histonet Digest, Vol 153, Issue 19
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[Histonet] It's getting cold in here....

[Terri Braud via Histonet]

If you've not been made aware before now, be warned.  The Department of 
Veterans affairs (DVA) has proposed a rule that would authorize any Advanced 
Practice Registered Nurse (APRN) to not only order and interpret lab tests, but 
also to perform, supervise, and direct lab testing.  The rule follows lab 
personnel requirement changes enacted by the Centers for Medicare and Medicaid 
Services (CMS) that say that a bachelor's or associate's degree in nursing is 
sufficient  to perform high complexity lab testing.
With a nod to nursing degrees that I'm sure prepare a nurse extremely well for 
nursing, there is no way that a nursing degree can adequately prepare a person 
to perform complex laboratory testing.  Unless your state has technologist 
licensure, and few do,  get prepared for nurses running the lab, and lab tests. 
 And where will that leave the histologist technician?  I'm guessing out in the 
cold.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
**


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Re: [Histonet] cleaning molds

[Terri Braud via Histonet]

We used to put them in a large stainless steel basin, with a little bit of 
Alconox brand detergent.  Fill the basin with hot water and bring to a boil on 
a hotplate.  Turn it off, let the water cool for a couple of hours and all the 
paraffin would rise to the top and solidify.  Just pick the paraffin off the 
top and discard, then rinse the soapy clean molds in clean water, drain and 
dry.  No nasty chemical soaks.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

***


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Re: [Histonet] Certification

[Terri Braud via Histonet]

Respectfully, a public forum is no place to discuss  personnel issues on such a 
personal level.  

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   4. Certification (Adesupo, Adesuyi (Banjo))

--

Message: 4
Date: Fri, 1 Jul 2016 09:45:31 -0500
From: "Adesupo, Adesuyi (Banjo)" 
To: "'histonet@lists.utsouthwestern.edu'"

Subject: [Histonet] Certification
Hi,
I hope you guys are doing great. Please I have a question and would 
appreciate your contributions. I have a tech that could not pass the 
certification test, when the ASCP were still accepting high school diploma for 
HT.
The tech is no longer eligible to take the test again, because he did not have 
the minimum requirement (i.e. Associate Degree) to register for the test. He 
wants me to promote him to Histology Lead Tech/Histology Coordinator.
What do you guys think about this?

Best regards,

Banjo Adesuyi, BMLS, HT (ASCP) HTL, QIHC, QLS
Histology Supervisor
Norman Regional Health System,
Norman, OK 73071.
Tel: 405- 307- 1145
Cell: 405-973-6363

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Subject: Digest Footer

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End of Histonet Digest, Vol 152, Issue 1



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Re: [Histonet] Testicular biopsies

[Terri Braud via Histonet]

I must be missing the obvious.  Why can one no longer use Bouins?  We still use 
Bouins.

Terri L. Braud, HT(ASCP)
   3. Testicular biopsy for infertility (Cartun, Richard)
Message: 3
Date: Tue, 28 Jun 2016 20:41:47 +
From: "Cartun, Richard" 
What are people fixing testicular biopsies in to evaluate infertility?  In the 
past, I believe fixatives such as Zenker's and Bouin's were used for this 
purpose since they enhance nuclear detail.  Obviously, those fixatives can no 
longer be used.  Thank you.
Richard
Richard W. Cartun, MS, PhD
Director, Histology & The Martin M. Berman, MD Immunopathology & Morphologic 
Proteomics Laboratory Director, Biospecimen Collection Programs Assistant 
Director, Anatomic Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596
(860) 545-2204 Fax



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Re: [Histonet] HT Certification

[Terri Braud via Histonet]

Wow, you sure picked a doozy of a subject.  Unless you work in a state that has 
specific licensure requirements, there really is nothing to prevent a 
non-certified Histology tech from doing the same duties as a certified tech
In my opinion, it's more a matter of skill sets, and as we all know, there are 
certified techs that couldn't cut their way out of a paper bag, just as there 
are non-certified techs that are Histology wizards.  The question is one of 
training and commitment. I do think that there are certain duties that could be 
set aside for certified techs, such as validation of controls and antibodies, 
Quality Assurance activity monitoring.  The difference will always be those who 
understand the theory behind the work.  At least with certification, there is a 
minimal standard for training and commitment. A good indicator of your 
institution's commitment to certification is their hiring practices for 
phlebotomy or Nurses aids - Certified or not?  If you have them and they are 
certified, then ask why.  Histotechs have always been the evil step children of 
the laboratory system.  Your institution should take pride in having a 
certified staff, but if they don't care, it will be an uphill battle to inst
 ill that commitment.
Best of luck, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:
   7. HT Certification (Vickroy, James)


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Re: [Histonet] Cytology specimens

[Terri Braud via Histonet]

We used to have problems with fluids/orders, but what we put in place seems to 
be working.
1. All fluids are received by central processing.  If a fluid has no orders, 
then central processing calls to have the orders put in. Cytology does not 
accept fluids without orders. We also encourage (though not required)  the 
physicians to fill out a "Fluid Checklist" to accompany the specimen.  Central 
processing insures that the orders were placed correctly according to that 
sheet, and rectifies any problems or conflicts.
2. Fluids are aliquoted  in central processing for all tests ordered with the 
exception of a specimen to be shared by Micro and Cytology, then it is send to 
Micro with a "Shared" sticker and the AP order stickers accompanying the 
specimen.  Micro takes what they need and passes the specimen on to us.
3. In cases of large volume fluids, central processing aliquots the fluid for 
all the departments and then sends the large balance for any cytology orders
3. With the exception of a urine, which receives a Thin Prep only, all fluids 
are prepared with a Thin Prep and if possible, a cell block.
4. With the exception of a urine, if the specimen is large, after the preps our 
techs will pour off a 50 ml aliquot into a sterile tube, label and refrigerate 
for 2 weeks.
5. The balance of bulk fluids are discarded after processing. 
I hope this helps.
Terri


Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:
   2. Cytology specimens (Martin, Gary)

Message: 2
Date: Tue, 14 Jun 2016 14:10:55 -0700
From: "Martin, Gary" 
Subject: [Histonet] Cytology specimens

I would like to poll the Histo group concerning cytology specimens. The 
discussion has come up about when to discard a fluid after processing, and 
fluids that have no orders. Also, because we are a contracted service for the 
hospital, and are not connected to their LIS. Cytology's that are ordered do 
produce a requisition that sometimes does not follow the specimen, which leads 
to missed processing. How are others handling these two situations. 
Thanks 




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Re: [Histonet] Formaldehyde Education

[Terri Braud via Histonet]

Annual Formaldehyde safety education should be part of your on-boarding 
process, as well as annual education, per OSHA

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   4. Formaldehyde annual education (Vickroy, James)
Message: 4
Date: Tue, 7 Jun 2016 20:01:21 +
From: "Vickroy, James" 
Subject: [Histonet] Formaldehyde annual education


I seem to recall that we once had to document that we went over the hazards of 
formaldehyde to the staff annually.  Does anyone still do this?   I know the 
rules on monitoring but as I was going over a past procedure I saw that we used 
to reeducate the staff each year.
Jim
Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com
**


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Re: [Histonet] stored unstained sections

[Terri Braud via Histonet]

Cut slides stored at room temp seem to last quite a long time for routine 
stains, however, cut slides do demonstrate a loss of antigenicity for IHC 
staining, depending on the antibody.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874


Today's Topics:

   1. retaining cut slides to keep or not to keep (Rachel M Gonzalez)

Message: 1
Date: Mon, 6 Jun 2016 13:15:13 -0400
From: Rachel M Gonzalez 

Hi everyone,
I work in a research lab and have a number of slides that have been cut by the 
previous person in this position. Several slides are over one year.  I would 
like to know what is the standard practice for keeping cut slides? I have used 
them and they stain just fine but the question was brought up in a lab meeting.
How long can you keep unbaked slides? Room temperature/4C
How long can you keep baked slides? Room temperature/4C
Thanks
Rachel Gonzalez PhD




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Re: [Histonet] Dirty HP Antibody

[Terri Braud via Histonet]

We had the same issue a few years ago with the Ventana HP antibody.  Then we 
tried the antibody from Zymed and it was so much better.  Now we use BioCare's 
antibody, and it is very clean.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874




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Re: [Histonet] vibrations

[Terri Braud via Histonet]

With experience and certification in both, I think that problems from ambient 
vibrations are much less severe in Histology than EM.  There are special 
vibration dampening worktables, often used for EM, that would eliminate the 
problem for cutting stations, or any other sensitive equipment, and still allow 
you to use the space.  I hope this helps.  Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

-Original Message-
From: histonet-requ...@lists.utsouthwestern.edu 
[mailto:histonet-requ...@lists.utsouthwestern.edu] 
Sent: Monday, May 16, 2016 1:00 PM
To: histonet@lists.utsouthwestern.edu
Subject: Histonet Digest, Vol 150, Issue 18

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Today's Topics:

   1. floor vibration (Nancy Schmitt)
   2. Re: floor vibration (Paula Keene Pierce)


--

Message: 1
Date: Mon, 16 May 2016 15:03:25 +
From: Nancy Schmitt 
To: "'histonet@lists.utsouthwestern.edu'"

Subject: [Histonet] floor vibration
Message-ID: 
Content-Type: text/plain; charset="us-ascii"

Happy Monday!
We are moving to a new space and part of our area is above the laundry - there 
is some vibration from there.  Does anyone have any experience with this and 
could you please share how you accommodated this?  Special flooring, pads, etc.
Thank you much!

Nancy Schmitt HT, MLT (ASCP)


Message: 2
Date: Mon, 16 May 2016 15:29:35 + (UTC)
From: Paula Keene Pierce 
To: Nancy Schmitt ,   Histonet

Subject: Re: [Histonet] floor vibration
Message-ID:
<1798931453.3273285.1463412575143.javamail.ya...@mail.yahoo.com>
Content-Type: text/plain; charset=UTF-8

Refuse the space and ask to be moved somewhere else.
Years ago our EM scopes were on the fourth floor and lines in photos taken 
could be seen from the vibration from people simply walking down the halls.
Finally moved the scopes to the basement on a section of concrete cut out 
completely separate from the rest of the building.?Paula Keene Pierce, BS, 
HTL(ASCP)HTPresidentExcalibur Pathology, Inc.5830 N Blue Lake DriveNorman, OK 
73069PH 405-759-3953FAX 405-759-7513www.excaliburpathology.com

  From: Nancy Schmitt via Histonet 
 To: "'histonet@lists.utsouthwestern.edu'" 
 Sent: Monday, May 16, 2016 10:03 AM
 Subject: [Histonet] floor vibration
   
Happy Monday!
We are moving to a new space and part of our area is above the laundry - there 
is some vibration from there.? Does anyone have any experience with this and 
could you please share how you accommodated this?? Special flooring, pads, etc.
Thank you much!

Nancy Schmitt HT, MLT (ASCP)




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Re: [Histonet] Histo/Cyto staining

[Terri Braud via Histonet]

We run both stains on our Sakura Prisma, but they share no common reagents 
except for the final Xylene unload station.  We do use the combination CytoKwik 
stain, which combines the OG6 and EA50 steps, to reduce the number of steps in 
our Cytology stain procedure. We only run non-gyn, too.  It is so much 
easier!

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874



Message: 7
Date: Tue, 10 May 2016 14:54:55 +
From: "Mullen, Mary" 
Subject: [Histonet] Cytology/Histology Staining Question
Hello all,
I work in a small, low volume community hospital and was recently asked by a 
coworker why we do not just run both our cytology and histology slides on the 
same automated stainer (with their respective protocols).
What I am wanting to know is if there is anyone currently running both staining 
protocols on a single automated stainer using common alcohols/xylenes/water? 
What are the pros/cons? Has there been any cross-contamination issues.
We only run non-gyn cytology, all gyn cytology is sent out.
Thanks,
Mary K. Mullen, HTL(ASCP)CM
Histotechnologist
UPMC Northwest
Seneca, PA



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Re: [Histonet] Slide Printer

[Terri Braud via Histonet]

We've used Leica for 8 years and everyone here loves it.  We have it loaded 
with Leica brand plus slide, Leica regular clipped corner slides, and Thin Prep 
Slides from Cytologic.  It was easily interfaced with CoPath, seldom jams, and 
we average about 1 unexpected service call per year in addition to the annual pm

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Message: 17
Date: Thu, 5 May 2016 18:45:39 -0400
From: Ginny Achstetter 

I need a recommendation on a slide printer. Tried the Leica and liked it but it 
only works well with their round edged slides and they aren't charged.  
Sent from my iPhone




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Re: [Histonet] Wrist Pain

[Terri Braud via Histonet]

This is an repetitive stress injury and is not to be trifled with.  I know that 
I have a tech that occasionally uses a wrist brace to embed, but also to sleep 
with at night. 
I strongly recommend using ergonomic friendly embedding forceps available from 
selected Histology supply companies.  Also, for the technician to be seen by 
your employers occupational health provider for appropriate documentation and 
follow-up.  
Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874




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Re: [Histonet] Passing the HTL

[Terri Braud via Histonet]

BIG Congratulations! To Patrick Lewis on passing your HTL

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

7. I did it  I am now a certified HTL (Lewis, Patrick)
Message: 7
Date: Tue, 26 Apr 2016 16:30:28 +
From: "Lewis, Patrick" 
Subject: [Histonet] I did it  I am now a certified HTL
Hi Everyone
After years of putting it off, I finally took my ASCP HTL  exam and passed it.
Huzzah!
Patrick.
Patrick Lewis
Research Associate II Bench
Seattle Childrens Research Institute
206-884-1115



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Re: [Histonet] Specimen submission pads

[Terri Braud via Histonet]

We, too, had the same problem.  The GI rooms were cutting telfa pads so they 
would fit in the formalin containers, and the pads were falling apart.  We 
finally asked that they just put the specimens directly into the formalin. That 
way we can decide in the gross room, the best way to submit the tissue.  Mesh 
bags, lens paper, or foam sponges.  We've found that well fixed GI biopsies can 
easily be processed using "foam sponges" and are easy to retrieve for embedding 
and show no "foam pad cut artifact".  We use Mesh bags for multiple tiny 
particles, and lens paper for tiny individual fragments.
I hope this helps. Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:

From: Linda Margraf via Histonet [histonet@lists.utsouthwestern.edu]
Hi Histonetters,
We are having trouble in the Gross room,  removing small specimens from the 
pads/gauze that OR personnel put them on which they then immerse in formalin.  
We thought the gauze was challenging to remove tiny specimens from but have 
found that the Telfa pads the OR is now using come apart in the fixative and 
are even more challenging to work with. The GI lab uses sponges but they would 
be too small for the usual size containers the OR send us.  Any suggestions?
Thanks in advance,
Linda M
***


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Re: [Histonet] GI biopsies

[Terri Braud via Histonet]

We cut 3 levels, 40 microns apart, all mounted on the same slide

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874




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Re: [Histonet] Cryostat with UV disinfection

[Terri Braud via Histonet]

For those of you that are CAP accredited, and use a cryostat with UV 
disinfection, how do you get around the CAP requirement listed below? We were 
told the UV disinfection did not replace wiping down with a tuberculocidal 
disinfectant at room temp. Do you have an approved tuberculocidal disinfectant 
that will work at cryostat temps?  Curious minds would like to know!  
ANP.23410   Cryostat DecontaminationPhase II
There is a written procedure for the decontamination of the cryostat at defined 
intervals, and under defined circumstances, and decontamination records are 
evident.
NOTE:  The cryostat must be defrosted and decontaminated by wiping all exposed 
surfaces with tuberculocidal disinfectant. The cryostat should be at room 
temperature during decontamination unless otherwise specified by the 
manufacturer. This should be done at an interval appropriate for the 
institution; this must be weekly for instruments used daily. Trimmings and 
sections of tissue that accumulate inside the cryostat must be removed during 
decontamination. Although not a requirement, steel mesh gloves should be worn 
when changing knife blades. 
Terri L. Braud, HT(ASCP)



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Re: [Histonet] Skin billing

[Terri Braud via Histonet]

Our institution follows the CPT coding and associated billing, just as you 
explained. For those surgeries done within our facilities, there is a specific 
list of specimens which must be submitted.  This was agreed upon by med staff 
and is listed in the bylaws, in response to the following CAP question:
ANP.10032   Surgical Pathology Microscopic Exemptions   Phase I
There is a policy regarding what types of surgical specimens (if any) may be 
exempt from microscopic examination.
NOTE: Irrespective of any exemptions, microscopic examination should be 
performed whenever there is a request by the submitting or attending physician, 
or at the discretion of the pathologist when indicated by the clinical history 
or gross findings.  If there is such a policy, it should be approved by the 
medical staff or appropriate committee.  Typical exempt specimens include 
foreskins in children, prosthetic cardiac valves without attached tissue, torn 
meniscus, varicose veins, tonsils in children below a certain age, etc.
As far as physician's offices and the rules that regulate them, I don't know. 
Generally, the 88302 and 88304 are lesser charges anyway. I hope this helps. 
Sincerely, Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
--
Message: 2
Date: Tue, 8 Mar 2016 22:07:45 +
From: "Vickroy, James" 
Subject: [Histonet] Billing for skin biopsies
There was a question today that I felt pretty comfortable answering but still 
thought I would see what others have found out on this subject.   
Dermatologists are always asking if there is a lesser pathology charge for a 
skin lesion removed for cosmetic purposes.   My understanding is that while a 
clinician can charge less for removing something for cosmetic purposes once it 
goes to the pathology lab the charges are based on diagnosis and therefore the 
accepted CPT codes are generally 88302 ( plastic repair), 88304 (cyst 
debridement, skin tag) and 88305 for (other than the cyst, debridement, skin 
tag, or plastic repair).   And.we can't charge differently just 
because it was removed for cosmetic purposes.Please let me know your 
thoughts on this and if things are done differently at your institution.
I have told a clinician that they might not have to submit the "cosmetic" skin 
biopsy for pathology however I also don't believe that is a good idea either.
Jim
Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com
**


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Re: [Histonet] Processing cytology and cell block protocols

[Terri Braud via Histonet]

We are a similar sized hospital with an 8,000/yr Surgical load of mixed large 
and small cases.  We process 1000 Non-gyn Cytology cases, assist with FNA 
collection in Interventional Radiology.  We also assist with about 130 bone 
marrow collections, including smears and processing.  There is myself, and 3 
other Histotechs and we do it all! 
 
Our cell block protocol for unfixed fluids is
Centrifuge in 50ml conical tubes at 1200rpm for 10 minutes 
Pour off supernate, resuspend the pellet in buffer wash (for large volumes with 
low cell yields, we keep spinning the fluid until we get a cell pellet in the 
bottom of the tube, or we have exhausted the fluid)
Repeat centrifuge step 
Pour off supernate and fix in 10%NBF/95% Alcohol 50/50 for at least 10 minutes
Gently dislodge the fixed pellet and pour into the corner of a nylon bag into a 
cassette for routine processing
If the fixed pellet is smaller than 0.5cm in greatest dimension, then we pour 
off the fixative and add heated to liquid agar
Let cool, then gently dislodge the fixed agar pellet and place gently into the 
corner of a nylon bag into a cassette for routine processing

Hope this helps

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874


-Original Message-
From: histonet-requ...@lists.utsouthwestern.edu 
[mailto:histonet-requ...@lists.utsouthwestern.edu] 
Sent: Friday, March 04, 2016 1:00 PM

Today's Topics:
   2. Re: Fluids for Cytology 
   6. Cell block protocols 

*


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[Histonet] PA help sought

[Terri Braud via Histonet]

Our  lab is seeking an Pathology Assistant for an immediate temporary position 
for all gross responsibilities.  The position will be approximately 10-12 weeks.
We are a medium sized hospital in the NE suburbs of Philadelphia.  We have a 
friendly technical and medical staff of 2.5 pathologists and 3 technicians.  
Our block load averages about 180/day with a range of 60 to 320, and an even 
mix of large and small specimens.  Breast pathology a plus. M-F day shift only.
Agencies are welcome to respond. Thanks, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874




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Re: [Histonet] Shrinkage

[Terri Braud via Histonet]

LOL...Shrinkage...heh, heh.
But seriously, there should be little to no gross shrinkage from formalin 
fixation and if the specimen is properly fixed, then there should be very 
little gross shrinkage as it is dehydrated.  That is supposed to be the point!  
If someone is getting 30% shrinkage, there is something seriously wrong with 
their processing schedule.
Sincerely, Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor

Today's Topics:
   2. formalin and shrinkage (Gudrun Lang)


Message: 2
Date: Mon, 22 Feb 2016 16:59:21 +0100
From: "Gudrun Lang" 
Subject: [Histonet] formalin and shrinkage
Hi!
Today someone asked me about shrinkage caused by the fixation with formaldehyde 
specially on skin-biopsies.  She spoke about shrinkage of 30% percent. In my 
opinion shrinkage is mainly caused by the processing with dehydration and 
defatting. Formaldehyde renders the tissue harder but not strictly smaller. 
What is the opinion of the community?
Gudrun



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Re: [Histonet] Credentials

[Terri Braud via Histonet]

There is no CAP requirement that a person has to be certified or qualified in 
any way to perform Histology or Histology Assistant duties. As long as you can 
document their proven competency, they are good to perform any procedure.  The 
only exception in the Histology lab,  is if that tech is required to perform 
gross.  Then they must be documented to be able to perform CLIAA high 
complexity testing.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874



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Re: [Histonet] slide, cassette printers

[Terri Braud via Histonet]

We LOVE our Leica printers.  IPS and IPC.  We've been running them for over 8 
years with few problems and little down time.
We recently interfaced them to CoPath and it went very quickly and smooth.  Now 
we are loving them more than ever.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   2. Slide and Cassette Labelers (Adesupo, Adesuyi (Banjo))
Message: 2
Date: Tue, 9 Feb 2016 15:47:23 -0600
From: "Adesupo, Adesuyi (Banjo)" 
Subject: [Histonet] Slide and Cassette Labelers

Hi Guys, I hope you guys are doing great. Our lab is in the process of buying 
Slide and Cassette Labelers and I will really appreciate inputs from you guys
Best regards,
Banjo Adesuyi, BSMT, HT (ASCP) HTL, QIHC, QLS
Histology Supervisor
 Norman Regional Health System,
 Norman, OK 73071.
 Tel: 405- 307- 1145
 abades...@nrh-ok.com



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Re: [Histonet] PAP stain troubleshooting

[Terri Braud via Histonet]

Hi Charles - Not to worry.  Many of us Histo folks don't have a Cytologist to 
help.  Beth is spot on in her advice.  I just wanted to add  Orange G should 
appear yellow to orange; 15 sec to 1 minute is the usual range of staining 
times. EA is often problematic because of fundamental limitations in its 
chemical composition. Ideally, one should see clearcut hues of green and red in 
separate cells. Staining times less than about 3 minutes usually favor the 
uptake of eosin, with eosin and light green often occupying different areas of 
the same cells. Most EA formulations perform optimally in the 6-8 minute range. 
Note particularly that the OG and EA staining times are interdependent: 
relatively too much time in OG will overload cells with orange G and block the 
subsequent uptake of eosin.  Make sure you record your lots of stain as they 
are changed out, and try using a self-made buccal smear to check new lots of of 
the stain components before they are put into use.  Then, if you see a te
 st problem, you can repeat the buccal smear and compare to the original.  It 
may help you to pinpoint the problem.
Best of luck - Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   9. PAP staining quality (Beth Cox)
Message: 9
Date: Thu, 4 Feb 2016 18:06:53 -0500
From: Beth Cox 
Subject: [Histonet] PAP staining quality
Hi Charles,
A couple things to check on:
1.  The first concern I would have is your EA stain.  Poor EA staining 
will give too much orange staining and pale other counterstains (making 
them look aged).What brand are you using? Have you changed brands? 
Is your EA close to the expiration date? Is the bulk stored with light 
exposure?  I think fixing your EA will fix all the other problems.
2.  The other question I have regards your alcohol.  Have you changed 
types/brands?  Pap staining is very delicate and the different alcohols 
used can make a big difference.
Beth Cox, HTL/SCT(ASCP)QIHC
--
Message: 3 Date: Thu, 4 Feb 2016 09:50:18 -0500
From: Charles Riley 
Subject: [Histonet] PAP stain quality
Not sure if anyone out the would know the answer to this. We are having 
an issue with our PAP stained slides appearing too orange and look aged. 
If you have any idea for causes I appreciate any help

-- Charles Riley HT(ASCP)CM
Histopathology Coordinator/ Mohs
  Doctors Pathology Services, Dover DE
--



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Re: [Histonet] best glass coverslipper

[Terri Braud via Histonet]

I've had experience with several glass coverslippers over the years.  While 
I've not tried the newest/latest/greatest of other brands, I've been running 
the Sakura Glas coverslipper for 8 years without a hitch.  It has been very 
dependable, with little downtime, and extremely easy maintenance.  We have 
averaged less than 1 service call per year since purchase, outside of the 
annual pm.  At the time we purchased it, it had the shortest set up and routine 
maintenance of the 4 big players that we tried.  It is definitely a more 
sensitive system than the tape. All glass systems are less forgiving of 
technical error than tape, but the results are fabulous.  We coverslip using 
only 24 X 50, so avoid the hassles of changing sizes.  
I hope this will help.  Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
   3. Best Glass Coverslipper? (Cooper, Brian)
Message: 3
Date: Thu, 21 Jan 2016 20:35:37 +
From: "Cooper, Brian" 
Hey Histonet!

What's the best automatic glass coverslipper out there?  I only have experience 
with the Sakura tape slipper, which is AWESOME, but alas, we can't get one 
here.  Space is definitely an issue; would love to hear your experiences!

Thanks,

Brian D. Cooper, HT (ASCP)CM | Histology Supervisor Department of Pathology and 
Laboratory Medicine Children's Hospital Los Angeles
4650 Sunset Blvd MS#43- Los Angeles, CA 90027
Ph: 323.361.3357 Pager: 213-209-0184
bcoo...@chla.usc.edu



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Re: [Histonet] Consult Requests

[Terri Braud via Histonet]

If a patient or an outside hospital/doctor requests a consult, we encourage 
patients to pick up their slides at the same time as they pick up radiology 
discs, medical records, etc.  If  we need to fedex slides/reports to another 
institution we ask the receiving facility for their Fed-Ex number.  If they 
don't have one, then we eat the charge in favor of the patient getting the care 
they need.  However, if we receive a request for a research project, or for 
duplication for legal reasons, then we charge a duplication fee for the cost of 
materials.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874


   4. consult requests (Noelle Linke)
--

Message: 4
Date: Thu, 14 Jan 2016 17:59:28 +
From: Noelle Linke 
Hi all,

Question for anyone who may handle admin staff:   If a patient or an outside 
hospital/doctor requests a consult and you need to fedex slides/reports to 
another institution do you charge the patient to send these items or does your 
facility eat those charges?
Thank you,
No?lle
No?lle Linke, MS, HTL(ASCP) QIHC
Manager, Anatomic Pathology
Pacific Diagnostic Laboratories
Cottage Health System
nli...@sbch.org
Phone: (805) 324-9814
Fax: (805) 696-6433



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Re: [Histonet] better than a price gun

[Terri Braud via Histonet]

UAL (United Ad Label) has a label guns, similar to the old paper labeler which 
puts wonderful labels, your choice of rec'vd date, date open, date exp...or any 
combination of the 3. 

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
   9. Price gun (Histology Technician)

Message: 9
Date: Fri, 8 Jan 2016 14:42:33 + (UTC)

? I was thinking of using a price gun to date my supplies when they come in, 
but I can't find one to buy.? Any ideas where to search for one?What do you 
guys use to date your supplies?? I've always used a pen to write the rcd date 
and my initials but thought a price gun would be quicker and neater :) Thanks!

--

Message: 10
Date: Fri, 8 Jan 2016 15:01:08 +
From: Michael Ann Jones 
To: "Sanders, Jeanine (CDC/OID/NCEZID)" ,
"histonet@lists.utsouthwestern.edu"

Subject: Re: [Histonet] lab humidifiers
Message-ID: 
Content-Type: text/plain; charset="iso-8859-1"

We are struggling with our humidity constantly.
Colorado is dry in the winter.
We use at least two humidifiers to try to keep humidity at minimum 30% due to 
equipment manufacturer?s specs.
We have log sheets and thermometer/humidifier measurers to keep track of 
humidity.
Standard for equipment seems to be 30 - 80% humidity per manufacturer?s 
specifications of processors, etc.
Good luck 


Michael Ann Jones, HT (ASCP)
Histology Manager
Metropath
7444 W. Alaska Dr. #250
Lakewood, CO 80226
303.634.2511
mjo...@metropath.com

Providing collaborative diagnostic services, saving lives today and tomorrow.






On 1/8/16, 6:26 AM, "Sanders, Jeanine (CDC/OID/NCEZID) via Histonet"
 wrote:

>Morning everyone!
>
>What is the standard in humidity levels that most histology labs strive 
>for? And to achieve this goal, do any of you use a commercial-grade 
>humidifier?
>
>Thanks for your help and have a nice weekend!
>
>
>Jeanine H. Sanders
>Centers for Disease Control and Prevention
>1600 Clifton Rd., NE MS-G32
>Atlanta, GA 30329
>
>___
>Histonet mailing list
>Histonet@lists.utsouthwestern.edu
>http://lists.utsouthwestern.edu/mailman/listinfo/histonet




--

Message: 11
Date: Fri, 8 Jan 2016 15:35:17 +
From: Edison Narvaez 
To: "histonet@lists.utsouthwestern.edu"

Subject: [Histonet] HPV 16/18 background
Message-ID: <10d75e4b1c4f450ca1a4686118969...@ramexchange.hps.LOCAL>
Content-Type: text/plain; charset="us-ascii"

Hello,
I'm running HPV probes from Enzo on my Leica instruments, and we are noticing 
background episomal pattern on 16/18 staining of cases that are strongly 
positive for HPV 6/11, but not on cases that are 6/11 or 16/18 negative.
Is anybody experiencing this same issue and are there any suggestions.

I'm using Enzo probes, Enzo Stringency wash, Enzo mouse-antibiotin, and a 
polymer detection kit.

Thank you










The contents of this message, together with any attachments, are intended only 
for the use of the person(s) to which they are addressed and may contain 
confidential and/or privileged information. Further, any medical information 
herein is confidential and protected by law. It is unlawful for unauthorized 
persons to use, review, copy, disclose, or disseminate confidential medical 
information. If you are not the intended recipient, immediately advise the 
sender and delete this message and any attachments. Any distribution, or 
copying of this message, or any attachment, is prohibited.


--

Message: 12
Date: Fri, 8 Jan 2016 10:31:34 -0500
From: "Pam Barker" 
To: "Histonet" 
Subject: [Histonet] Happy New Year!  Here's to a Fantastic 2016!
Message-ID: <00b601d14a29$a87eeca0$f97cc5e0$@earthlink.net>
Content-Type: text/plain;   charset="us-ascii"

Hi Histonetters!
Happy New Year
Here's to a terrific 2016!!!
How did you ring in the New Year? 
I hope you had fun ushering out 2015 and welcoming in 2016.  
I know I am looking forward to an exciting new year.
 
I wanted to drop you this quick line to let you know that I have been chatting 
with clients and have some exciting new opportunities.  
Here is a list of my current open positions:
Leadership:
Histology Lab Manager - Modesto, CA
Histology Supervisor (Dermpath) - Fayetteville, AR Senior Histotech - Norfolk, 
VA  B.S. required

Histotechnicians/Histotechnologists:
Histology Tech - Norfolk, VA 15K Sign on Bonus Histology Tech - Modesto, CA 
Mohs Tech - Naples, FL HT/HTL - Milwaukee, WI Dermpath Histotech - Kansas City, 
KS Histotech - Louisville, KY (learn electron microscopy) Dermpath 

Re: [Histonet] autostainer for GMS

[Terri Braud via Histonet]

Just my 2cents.  I've had good experiences with the Artisan, both before and 
after it was purchased by Dako.
It's very user friendly and very reliable.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   2. Automated Special Stainers (Charles Riley)


Message: 2
Date: Tue, 29 Dec 2015 12:29:20 -0500
From: Charles Riley 
To: histonet@lists.utsouthwestern.edu
Subject: [Histonet] Automated Special Stainers
Message-ID:

Re: [Histonet] Slide Printer Back-up

[Terri Braud via Histonet]

Our policy calls for handwriting slides, then applying printed labels at the 
completion of the stain/coverslip.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

Today's Topics:

   1. slide printer back up (sris...@mail.holyname.org)
Message: 1
Date: Mon, 16 Nov 2015 13:31:14 -0500
From: sris...@mail.holyname.org
To: Histonet@lists.utsouthwestern.edu
Subject: [Histonet] slide printer back up

Need opinions on this matter.
What is the back up plan in your institution, for slide printers and 
cassette printers?   Are you going back to handwriting slides and putting 
a label or using  xylene resistant labels directly on to your slides.
Thanks in advance.
Nirmala Srishan
Histology Supervisor
Holy Name Medical Center
718 Teaneck Road
Teaneck NJ 07666
Lab: 201 833 3023
Office: 201 541 6328



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Re: [Histonet] Aquous Mounting Media

[Terri Braud via Histonet]

Have you tried Sigma's ImmunoHistoMount?  It was what replaced Crystal Mount 
which used to be my favorite.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

**


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[Histonet] test cost

[Terri Braud via Histonet]

Do these steps in order:

Take the total cost of your supplies + total hours salary average, for set 
period (usually use 6 months), and then divide by the number of blocks for a 
cost per block  (ie. 0.80/block)
Do  the same for slides to arrive at a cost per slide.  (ie. 1.25/stained slide)
Calculate the average costs of a block and slide by taking the average (cost of 
block + cost of slide, then divide by 2 = average cost per block/slide
Calculate the range of blocks per surg  level during that same time period  
(ie. Lev V ranges from lowest 1blk, to highest 15blks)
Calculate the range of test cost per surg level by (lowest block # X average 
cost per block/slide) = lowest cost, bottom of range
Calculate the range of test cost per surg level by (highest block # X average 
cost per block/slide) = highest cost, top of range
Show the math.  Give them the range and average for each level.

Add a paragraph explaining added costs of reference lab work, special stains, 
and other charges (CPT codes) that could be incurred in order to report out a 
case.
Sometimes it is very difficult for administrators to understand how one CPT 
code may cost $5.80 or $25.00 depending on varying factors such as source of 
specimen or pathologist, and what is average for you, may not be average for 
another lab with different pathologists or cutting protocols.
Keep it short and sweet!
Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

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Re: [Histonet] Gross Room QC

[Terri Braud via Histonet]

All of our QC sheets around the department are on obnoxiously colored 
fluorescent orange clipboards.  I use 3M Command hooks to hang the clipboards 
near or on the instrument or area.  I use a single clear plastic page protector 
clipped on top of the paper to protect them from splashes, etc.
Looks nice, and they are always easy to find and use.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

   1. Gross Room QC (Histology Technician)
--

Message: 1
Date: Tue, 27 Oct 2015 18:19:09 + (UTC)
From: Histology Technician >
Subject: [Histonet] Gross Room QC
I just made up a QC sheet for my Gross Room and I'm having a hard time finding 
a spot to keep it :)? Do I tape it on the wall by the Grossing Station or put a 
magnet on it attaching to the grossing table... Any ideas?
Thanks!


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Re: [Histonet] mystery dye

[Terri Braud via Histonet]

Dear Baffled - 
Could there possible contamination from other specimens that are being 
processed at the same time?  For example, skins or other tissues with inked 
margins?
Just thinking out loud.
Pondering, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
   6. Dye ? (Melissa Burns)
--

Message: 6
Date: Fri, 25 Sep 2015 15:23:12 +
From: Melissa Burns 
Subject: [Histonet] Dye ?
Hello All-

I'm having an ongoing issue that I'm hoping all of you smart people can help me 
with! We are talking about prostate needle biopsy specimens.
We have one company that does a genetic test that is insisting that there is a 
dye present in the tissue we are sending. None of the other genetics companies 
we send to have had an issuejust this oneand not on every case we send 
them! Imagine my confuse :)
The specimens are sent in 10% NBF. There is no dye used in grossing or 
processing.
Am I missing something? Somewhere that dye may be sneaking in?
We are to the point now that they want to come to the lab and the collecting 
surgery centers and see if they can figure it out.
Baffled
Melissa

**


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Re: [Histonet] BMSS Elastic

[Terri Braud via Histonet]

Just a note:  The results of the stain are supposed to be elastic fibers: 
Blue-black to black.  If you stain something with a bluish tint, then 
counterstain over it with Van Gieson's (red)... 
Well, red and blue make purple.  Even the picture that accompanies the kit in 
the catalogue shows the fibers in purple.  Since all Ventana instruments work 
on the principle of 4 minute intervals, you can increase the level of staining 
in the Elastic Stain, 4 minutes at a time up to 32 minutes.  I think the 
decolorization step and Van Gieson's are set to the 4 minute minumum, but check 
to see.  The trick being to increase the Elastic Stain and decrease the 
differentiation (destaining) step, or the counterstain (Van Gieson's step) 
bearing in mind that the Van Gieson's will slightly continue to decolorize the 
elastic.
Best of luck.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
*


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Re: [Histonet] Non-Gyn contamination

[Terri Braud via Histonet]

Hi Nancy - 
Here is what our lab does.
All preps (slides)are fixed in individual containers before being batch 
stained. 
We stain smears separately from FNAs, and smears and FNAs, separately by case. 
All fixed thin preps are stained together.
With smears or FNAs, we insert a clean slide (labeled as the case number and 
control) and stain it along with the
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874

 batch.  That slide is examined and if found to have any contaminent from the 
case, then that triggers a filtration of all reagents and stains, with the 
container's washed.  It is then noted on the stain QC. 
So far, this has worked very well for us, and our CAP inspectors liked the 
process and documentation.
Regards, Terri
 

2. PAP stains done by hand (Nancy Schmitt)
Message: 2
Date: Fri, 11 Sep 2015 18:12:29 +
From: Nancy Schmitt 
Happy Friday-

Could you please share how you are handling the potential for cross 
contamination in non-gyn pap specimens?  Are you filtering/changing out 
solutions between each case?

I appreciate your input-
Nancy
Histology Coordinator
Dubuque, IA  52001
Check us out at www.uclaccess.com

***


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Re: [Histonet] Frozen Section WL and Billing

[Terri Braud via Histonet]

We set up our system this way - 
Example:
A specimen for frozen is sent.  You cut 2 blocks of frozen tissue, 2 levels ea.
The PA/Pathologist submits 3 additional blocks for a total of 5 blocks on the 
specimen (1-2 are the previously frozen, 3-5 additional tissue) to be cut at 
one level each.
1. At accession, the technical bill for the Lev 4 gross and micro (88305) drop 
based on the specimen type (skin biopsy)
2. The tech enters a protocol for 5 blocks, 1 HE stain each block.
3. The tech modifies the stains, and changes the HE on the first block to a 
stain  called FS1 (Frozen Section, first block) The charge for the first frozen 
block, 88341, drops in when this stain is ordered
4. The tech modifies the stains, and changes the HE on the second block to a 
stain called FSA (Frozen Section, Additional Block)  The charge for the 
additional frozen block, 88342, drops in when this stain is ordered.
5.  The tech then enters stains that are set up in the stain dictionary as a 
Label Only. There is no charge associated with these stains.
Stain FL1,  Block 1,
Stain FL2,  Block 1,
Stain FL1,  Block 2,
Stain FL2,  Block 2,
6. FL1 = Frozen Label, 1st level
   FL2 = Frozen Label, 2nd level
7. You can define as many of these Frozen Label levels as you will ever need.
8. Print the labels for the case (some systems will allow you to set up a print 
job for by Label Type, and you can select Labels Only)

It sounds a bit complicated to set up, but the steps are simple, and once it 
has been set up to use this way, it is quick, easy and accurate to use.  I 
don't know what LIS system you are using, but this is easily adaptable for 
almost any system
We also set up the system to include the Label Only slides to be included in 
the total slide count, so you get work credit there.
I hope this helps. 
Please feel free to call or contact for any questions.
Also, I'm not that far from you, if you need a little help.
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874
   2. frozen section- workload and billing (Davis, Cassie)
From: Davis, Cassie cda...@che-east.org
To: histonet@lists.utsouthwestern.edu

Hi Histofolks,
   I need to pick yours brains...we are in the middle of building a 
workable computer system for our lab we have run into a hiccup when it come to 
frozen sections. As a tech I know there is actual hands on, stop what you are 
doing, do this now  work involved. My understanding from a billing perspective 
it is not billable workload but an interdepartmental consultation between 
surgery and pathology. The problem is how to build the system so we get labels 
for our frozen section slides that does not interfere with the billable 
workload that is. I was thinking maybe it should be built in the system the 
same way a control slide is, does anybody have any suggestions?

Cassandra Davis
Histology Technician
Anatomical Pathology Laboratory
Saint Francis Healthcare
701 N. Clayton Street
Wilmington,DE 19805
Office:  302-575-8095
Email:  cda...@che-east.orgmailto:n...@che-east.org
www.saintfrancishealthcare.org



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Re: [Histonet] Frozen Section WL and Billing

[Terri Braud via Histonet]

ACK!  Yep, my bad

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874


-Original Message-
From: Cynthia Robinson [mailto:robin...@mercyhealth.com] 
Sent: Friday, August 28, 2015 3:24 PM
To: Terri Braud; histonet@lists.utsouthwestern.edu
Cc: Cassandra P. Davis
Subject: RE: Frozen Section WL and Billing

Aren't fs CPT codes 88331 and 88332?


From: Terri Braud via Histonet [histonet@lists.utsouthwestern.edu]
Sent: Friday, August 28, 2015 1:05 PM
To: histonet@lists.utsouthwestern.edu
Cc: Cassandra P. Davis
Subject: Re: [Histonet] Frozen Section WL and Billing

We set up our system this way -
Example:
A specimen for frozen is sent.  You cut 2 blocks of frozen tissue, 2 levels ea.
The PA/Pathologist submits 3 additional blocks for a total of 5 blocks on the 
specimen (1-2 are the previously frozen, 3-5 additional tissue) to be cut at 
one level each.
1. At accession, the technical bill for the Lev 4 gross and micro (88305) drop 
based on the specimen type (skin biopsy) 2. The tech enters a protocol for 5 
blocks, 1 HE stain each block.
3. The tech modifies the stains, and changes the HE on the first block to a 
stain  called FS1 (Frozen Section, first block) The charge for the first frozen 
block, 88341, drops in when this stain is ordered 4. The tech modifies the 
stains, and changes the HE on the second block to a stain called FSA (Frozen 
Section, Additional Block)  The charge for the additional frozen block, 88342, 
drops in when this stain is ordered.
5.  The tech then enters stains that are set up in the stain dictionary as a 
Label Only. There is no charge associated with these stains.
Stain FL1,  Block 1,
Stain FL2,  Block 1,
Stain FL1,  Block 2,
Stain FL2,  Block 2,
6. FL1 = Frozen Label, 1st level
   FL2 = Frozen Label, 2nd level
7. You can define as many of these Frozen Label levels as you will ever need.
8. Print the labels for the case (some systems will allow you to set up a print 
job for by Label Type, and you can select Labels Only)

It sounds a bit complicated to set up, but the steps are simple, and once it 
has been set up to use this way, it is quick, easy and accurate to use.  I 
don't know what LIS system you are using, but this is easily adaptable for 
almost any system We also set up the system to include the Label Only slides 
to be included in the total slide count, so you get work credit there.
I hope this helps.
Please feel free to call or contact for any questions.
Also, I'm not that far from you, if you need a little help.
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874
   2. frozen section- workload and billing (Davis, Cassie)
From: Davis, Cassie cda...@che-east.org
To: histonet@lists.utsouthwestern.edu

Hi Histofolks,
   I need to pick yours brains...we are in the middle of building a 
workable computer system for our lab we have run into a hiccup when it come to 
frozen sections. As a tech I know there is actual hands on, stop what you are 
doing, do this now  work involved. My understanding from a billing perspective 
it is not billable workload but an interdepartmental consultation between 
surgery and pathology. The problem is how to build the system so we get labels 
for our frozen section slides that does not interfere with the billable 
workload that is. I was thinking maybe it should be built in the system the 
same way a control slide is, does anybody have any suggestions?

Cassandra Davis
Histology Technician
Anatomical Pathology Laboratory
Saint Francis Healthcare
701 N. Clayton Street
Wilmington,DE 19805
Office:  302-575-8095
Email:  cda...@che-east.orgmailto:n...@che-east.org
www.saintfrancishealthcare.org



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Re: [Histonet] Labeling Slides

[Terri Braud via Histonet]

Hi Laura - 
We print all of our slides using the Leica printers.  Even batch cut control 
slides are pre-printed.  The only time we write on the slides is if we cut 
patient tissue applied to the control slide for IHC staining. Then we will add 
the Block ID and patient name by hand to the control slide, but a barcode label 
with all patient information is applied to the slide for processing.
I've not had good results sending stained or unstained slides though the 
printer.
I hope this helps. Regards, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874
   2. Labeling Slides (Bliven, Laura M)
  
Message: 2
Date: Tue, 25 Aug 2015 17:44:08 +
From: Bliven, Laura M bliven.la...@marshfieldclinic.org
Subject: [Histonet] Labeling Slides
Does anyone label histology slides (HE's, special stains, or IHC slides) 
without writing on the slide itself?
If you have a control section on a slide and are placing the patient tissue 
also on the slide, would you ever run the control slide through a slide printer?
Thanks
Laura



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Re: [Histonet] Weekend IHC

[Terri Braud via Histonet]

Med size hosp lab - not here

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874

   2. IHC Weekend Coverage (Cartun, Richard)
   3. Re: IHC Weekend Coverage (Victoria Baker)

Message: 2
Date: Sun, 23 Aug 2015 14:28:46 +
From: Cartun, Richard richard.car...@hhchealth.org
Subject: [Histonet] IHC Weekend Coverage


How many of you working in hospital-based pathology laboratories run IHC on 
weekends?  Thank you.
Richard
Richard W. Cartun, MS, PhD
Director, Histology  Immunopathology
Director, Biospecimen Collection Programs Assistant Director, Anatomic 
Pathology Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 972-1596
(860) 545-2204 Fax


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Re: [Histonet] Histonet Digest, Vol 141, Issue 5

[Terri Braud via Histonet]

For us, unexpected findings are noted in the report as such.  The pathologist 
calls and personally notifies the surgeon.  The date/time and person called is 
noted in the report.

Example:
NOTE: Unexpected findings of   discussed with Dr  on 7/31/2015, 
1115.

Hope this helps.

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874



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Re: [Histonet] HE stainers and LCS

[Terri Braud via Histonet]

HE Stainer - 
I love our Prisma and Glas coverslipper.  Such a workhorse.  Easy maintenance.  
Almost never any downtime.

LCS - Liquid coverslip is a type of oil, and should rinse easily in your 
alcohols during run down.  If you are seeing water, perhaps it is held in place 
with your slide label, and your alcohols are not high enough to properly 
dehydrate the slides.  We had a similar issue and that was what we encountered.
Sincerely, Terri

Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3689
Fax: 215-938-3874
**


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