Paul Bachner

Amniotic fluid proteins in normal and Rh-sensitized pregnancies

Abstract Amniotic fluid proteins (481) were determined for 221 normal and Rh-sensitized pregnancies. The normal range and mean values are shown for various stages of gestation. Determination of normal values for amniotic fluid proteins during early gestation are important as a unit of reference in the prenatal diagnosis of genetically related defects. In general, the larger the birth weight of the normal infant, the lower the amniotic fluid protein value prior to delivery. In normal pregnancies the values decrease with increasing gestation. In pregnancies with mild and moderate erythroblastosis fetalis the values are essentially the same. With severe disease, the protein range is greater and the trend not always downward with increasing gestation. With hydrops fetalis, the values rise and a value of 0.800 Gm. per 100 ml. with an elevated bilirubin level is diagnostic of hydrops fetalis.

Tissue Effects of Lysolecithin Injected Subcutaneously in Mice.

Summary A series of mice was injected subcutaneously with lysolecithin and the tissues examined at measured intervals. Within 10 minutes after injection, striking edema with necrosis of fat tissue was evident at the injection site. Subsequent changes included infiltration with neutrophil leukocytes and histiocytes and hyalinization and necrosis of muscle cells. Despite the marked edema and contrary to previous reports, vascular damage was not demonstrated by light microscopy. The production of lysolecithin could account for much of the local necrosis resulting from snakebite.

Anniversary of Q-Probes and Q-Tracks Quality Assurance Programs

In 1986, the late Dr Israel (‘‘Dick’’) Diamond stated that ‘‘in the clinical laboratory our product is dependable, timely, and economical information. Quality assurance must determine whether this is what the patient is receiving and whether the laboratory has contributed to the patient’s optimum and frugal care.’’ 1 Dr Diamond’s words, still relevant today, were written as part of a dialogue with the leaders of the Joint Commission on Accreditation of Healthcare Organizations (now The Joint Commission). At this time (1987), the Joint Commission on Accreditation of Healthcare Organizations had embarked on a major multiyear project designed to identify ‘‘clinical indicators that active practitioners and experts in specific clinical fields determine to be most relevant to quality care.’’ 2 This project elicited concern within the pathology and laboratory community in that Joint Commission on Accreditation of Healthcare Organizations inspectors—not always familiar with the realities of laboratory practice—would seek to make pathologists fully accountable for practices and clinical outcomes that were often beyond the immediate control of the laboratory service. The conceptualization of the Q-Probes program arose primarily from the long-term and pioneering commitment of the College of American Pathologists and pathologists to well-established programs of quality assurance and improvement (eg, accreditation, proficiency testing). The rapid implementation of the QProbes program reflected the recognition by the College of American Pathologists leadership of the need to develop a comprehensive portfolio of periodic, specific, and robust offthe-shelf indicators (‘‘snapshots’’) of laboratory performance that were susceptible to quantitative and statistical analysis and would provide pathologists and their laboratory colleagues with the tools to measure their individual performance against group benchmarks and then to use the results to monitor, identify priorities, and improve performance. The Q-Tracks monitors were developed later to establish critical benchmarks in quality metrics and to monitor changes in performance over time. This program has successfully defined multiple benchmarks in many disciplines of the laboratory and has demonstrated significant performance improvement in benchmarks and in individual laboratory performance over time. As the 3 papers in this special section devoted to the QProbes and Q-Tracks programs demonstrate, the goal has been achieved and, during the past 25 years, the programs have resulted in the accumulation of a vast database of laboratory and pathology service performance. The benchmarks of performance continue to serve as a guide to improved performance for laboratories in the United States and worldwide. Many of the indicators are a routine component of quality assurance practice in most laboratory settings and have become components of compliance with accreditation and regulatory requirements. The scope and depth of the data concerning laboratory performance are told in the numbers (Table). The accumulated database is a comprehensive snapshot of laboratory medicine during the past 25 years but also is a valuable source of information and benchmarks for laboratories looking for ways to improve the quality and efficiency of their practices. Will Q-Probes and Q-Tracks still be viable programs 25 years from now? If so, what will they look like, and what will be the challenges to Q-Probes and Q-Tracks and possible successor programs in the future? Any attempt to make predictions over time brings to mind the words of the Nobel laureate physicist Niels Bohr that prediction is very difficult, especially if it’s about the future. Nonetheless, a short-term perspective identifies 3 key themes that will characterize health care and laboratory medicine and pathology. The constantly increasing volume and complexity of data—particularly molecular and genetic—will require interpretive, operational, and computational capabilities not currently available. In the short term, recent requirements from the Department of Health and Human Services with regard to electronic health records will challenge pathologists and laboratory services. Can we envisage a Q-Probes study or Q-Tracks monitor in 2020 or sooner that will provide data on the integration of laboratory data into the electronic health record? It is almost a certainty that current economic pressures and constraints on the health care system will continue and that pathologists and laboratory services will be under Accepted for publication May 9, 2014. From the Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington. The author has no relevant financial interest in the products or companies described in this article. doi: 10.5858/arpa.2014-0244-ED Reprints: Paul Bachner, MD, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose St, Room MS119, Lexington, KY 40536-0298 (e-mail: paul. bachner@uky.edu).