Bruce A. Friedman

The tissue microarray data exchange specification: A community-based, open source tool for sharing tissue microarray data

BackgroundTissue Microarrays (TMAs) allow researchers to examine hundreds of small tissue samples on a single glass slide. The information held in a single TMA slide may easily involve Gigabytes of data. To benefit from TMA technology, the scientific community needs an open source TMA data exchange specification that will convey all of the data in a TMA experiment in a format that is understandable to both humans and computers. A data exchange specification for TMAs allows researchers to submit their data to journals and to public data repositories and to share or merge data from different laboratories. In May 2001, the Association of Pathology Informatics (API) hosted the first in a series of four workshops, co-sponsored by the National Cancer Institute, to develop an open, community-supported TMA data exchange specification.MethodsA draft tissue microarray data exchange specification was developed through workshop meetings. The first workshop confirmed community support for the effort and urged the creation of an open XML-based specification. This was to evolve in steps with approval for each step coming from the stakeholders in the user community during open workshops. By the fourth workshop, held October, 2002, a set of Common Data Elements (CDEs) was established as well as a basic strategy for organizing TMA data in self-describing XML documents.ResultsThe TMA data exchange specification is a well-formed XML document with four required sections: 1) Header, containing the specification Dublin Core identifiers, 2) Block, describing the paraffin-embedded array of tissues, 3)Slide, describing the glass slides produced from the Block, and 4) Core, containing all data related to the individual tissue samples contained in the array. Eighty CDEs, conforming to the ISO-11179 specification for data elements constitute XML tags used in the TMA data exchange specification. A set of six simple semantic rules describe the complete data exchange specification. Anyone using the data exchange specification can validate their TMA files using a software implementation written in Perl and distributed as a supplemental file with this publication.ConclusionThe TMA data exchange specification is now available in a draft form with community-approved Common Data Elements and a community-approved general file format and data structure. The specification can be freely used by the scientific community. Efforts sponsored by the Association for Pathology Informatics to refine the draft TMA data exchange specification are expected to continue for at least two more years. The interested public is invited to participate in these open efforts. Information on future workshops will be posted at http://www.pathologyinformatics.org (API we site).

An analysis of blood transfusion of surgical patients by sex: a question for the transfusion trigger.

The factor or constellation of factors which precipitates blood transfusion in hospitals can be termed the “transfusion trigger.” The blood transfusion experience of 535,031 male and female surgical patients was compared in order to evaluate the importance of the hematocrit as a component of this transfusion trigger. Transfusion data presented support the hypothesis that surgeons use the same support and ceiling hematocrit levels to regulate blood transfusion in men and women, despite the fact that women have lower hematocrits. The use of a lower hematocrit support level to govern the blood transfusion of female surgical patients should be considered. Data cited showing that women have a degree of physiologic adaptation to their lower hematocrits suggest that this change could be introduced without causing increased morbidity. A net saving of blood would most certainly result from it.

Adrenal cortical neoplasms producing Cushing's syndrome. A clinicopathologic study

The clinical and pathologic findings in 12 women with Cushings syndrome due to adrenal cortical neoplasms have been reviewed. The neoplasms were classified as adenomas or adenocarcinomas on the basis of the patients ultimate clinical course and histologic study was then made retrospectively. Those patients with an adenocarcinoma manifested more rapid progression of their disease and had a higher incidence of androgenic hirsutism and acne than did those with benign tumors. The most reliable biochemical index of malignancy was the great elevation of urinary 17‐ketosteroids in patients with an adenocarcinoma. The malignant neoplasms, at the time of operation, were uniformly larger than the benign ones. Moreover, none of the adenomas manifested hemorrhage or broad areas of recent necrosis. Capsular invasion was found to be a consistent histologic criterion of malignancy. Other reliable criteria of malignancy included increased and abnormal mitotic activity and severe nuclear pleomorphism. If adequate and representative tissue is submitted for microscopic examination, assessment of malignancy should be possible with a high degree of accuracy.

Short‐Term and Long‐Term Effects of Plasmapheresis on Serum Proteins and Immunoglobulins

In order to evaluate the short‐term and long‐term effects of plasmapheresis on serum proteins and immunoglobulins, the levels of α1, α1, β, and γ globulins, and IgG, IgA, and IgM were measured and statistically evaluated in 41 active plasmapheresis donors donating 500 to 1,000 ml of plasma weekly for up to three years. During the initial four months of plasmapheresis, the percentage of α1 and α2 globulins manifested a statistically significant rise and the IgG, IgA, and IgM concentrations declined. By the end of ten months, only the IgM continued to be depressed. Although the concentration of IgM continued to show a statistically significant decline for three years, it remained well within the normal range of values for our laboratory. Although no statistically significant difference existed between the baseline value of albumin and the level reached at the end of the third year, a gradual rise was followed by a decline in this interval.

The history of pathology informatics: A global perspective

Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.

Patterns of blood utilization by physicians: transfusion of nonoperated anemic patients.

Prior studies have suggested that a high percentage of blood transfusions to hospital patients are unnecessary. If such transfusions can be reduced, more blood would be made available for those patients with legitimate blood requirements. In this study, blood transfusion of 401 nonoperated hospital patients with anemia as the final diagnosis explaining admission and with admission hemoglobin values ≥10 gm/dl was analyzed. These patients were drawn from a 300 hospital sample distributed across the United States. Descriptive data showing the extent to which this selected population of patients is transfused with blood must be considered as one measure of unnecessary blood transfusion in this country. Hospital‐based programs designed to identify and eliminate unnecessary blood transfusions should be established. The first step in the creation of such programs at the hospital level must be the development of guidelines for blood transfusion derived through the cooperative efforts of hospital physicians who fully understand and accept the rationale for them. Once guidelines for blood transfusion are established in a hospital, transfusion practice need only be measured against them.

Plasmapheresis-Induced Hemodilution and Its Effects on Serum Constituents

Samples were obtained from 23 plasmapheresis donors before, during, and after double plasmapheresis. Seventeen chemical analyses were performed on these specimens and the results were subjected to statistical analysis. Representative samples can be obtained from plasmapheresis donors before the procedure has begun, immediately after the first unit of whole blood has been removed, or 15 minutes after the completion of the entire procedure. The sample obtained after the first unit of whole blood has been removed will show dilutional lowering of the uric acid concentration, and the 15‐minute equilibration sample will show dilutional lowering of the inorganic phosphorus concentration. Short‐term donors and long‐term donors manifest a somewhat different hemodilutional response to plasmapheresis.

A study of blood utilization in association with hysterectomy

We performed a retrospective study of 167 women undergoing hysterectomy in a large tertiary‐care teaching hospital in order to assess intraoperative blood requirements and to study the decision‐making process that occurs when blood is transfused intraoperatively. Recommended preoperative blood orders for hysterectomy patients based on data from the study are provided. Although “type and screen” is commonly considered to be an adequate preoperative order for patients undergoing vaginal hysterectomy, our data indicate that 2 units may be a more appropriate order when the procedure is combined with pelvic floor repair. The preoperative hematocrit, the estimated intraoperative blood loss, and the duration of the hysterectomy were integral to the decision‐making process. If women undergoing hysterectomy were transfused intraoperatively only when their hematocrit actually fell to 30 percent, and not in anticipation of such an event, unnecessary transfusions would be reduced.

Recycling older blood by integration into the inventory of a single large hospital blood bank: a computer simulation application.

Recycling units of older blood from hospital blood banks with high outdate rates to other hospital blood banks with a high level of transfusion activity and a low outdate rate to increase the probability of utilization of the blood prior to outdating is an accepted method of inventory control. The purpose of this study was to determine with the use of a computer simulation the effects of integrating a variable number of units of ten‐day‐old blood into the inventory of a single large hospital blood bank. The analysis involved separate consideration of the recycling of 30, 60, 90, 120, 180, 240, 300, and 360 units of ten‐day‐old blood with one, three, and five deliveries per week into the modeled blood bank inventory. With one delivery per week and a 30 per cent outdate rate for blood ten days old or older at the hospital or hospitals from which the blood is recycled, the net saving achieved per week by recycling these variable quantities is 5, 4, 13, 17, 7, 0, –17, and –50 units; for a 50 per cent outdate rate, the net saving achieved is 11, 16, 31, 41, 43, 48, 43, and 22 units. Possible net saving of blood based on three and five deliveries per week and other outdate rates is also given. The frequency of blood delivery has no significant effect on the net saving of blood in the blood recycling plans evaluated. The implementation of an automatic blood recycling program, a practical and effective method for reducing blood outdating in a multi‐hospital regional blood system, is discussed in detail.

Informating, not automating, the medical record

The author suggests that reference should be made in the future to the need to informate and not to automate the medical record. The reason for this recommended semantic change is first to avoid the mistaken notion that the computerization of medical records will reduce the number of personnel processing medical information. Instead, personnel will shift their attention from rote clerical activities to analytic activities made possible by the creation of new data bases by computers. These new data bases, a byproduct of informating the medical record, describe work processes and lend themselves to analytic activities which will enhance quality and efficiency in hospitals. The recent availability of report generators on commercial Laboratory Information Systems (LISs) mark their transition from automating to informating systems. One example of an ad hoc report used to enhance quality and efficiency in the clinical laboratories is the throughput report.