Burton J L, Stephenson T J
Academic Unit of Pathology, Division of Genomic Medicine, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
J Clin Pathol. 2001 Oct;54(10):806-8. doi: 10.1136/jcp.54.10.806.
There is a perception among histopathologists that specimens are often received without adequate clinical details. This is the first study to determine the adequacy of information provided when histopathological investigations are requested.
Two thousand sequential requests for histological examination were assessed for adequacy and completeness.
There was no significant difference in the demographic details supplied by physicians and surgeons. Clinical details were inadequate in 6.1% of cases: those from physicians were significantly more often adequate (98.7% v 90.6%) and more often included a diagnosis (74.4% v 38.8%) than those from surgeons. Physicians were more likely to supply their name and contact number but requests frequently lacked details of the sender.
Specimens are infrequently received with inadequate demographic details, but clinical details and details of the sender are more often lacking. Education of clinical colleagues is required if pathologists are to manage the demand for the service.
组织病理学家普遍认为，送检的标本常常缺乏足够的临床细节。这是第一项旨在确定申请组织病理学检查时所提供信息是否充分的研究。
对连续2000份组织学检查申请进行了充分性和完整性评估。
内科医生和外科医生提供的人口统计学细节没有显著差异。6.1%的病例临床细节不充分：内科医生提供的临床细节显著更充分（98.7%对90.6%），且比外科医生提供的临床细节更常包含诊断信息（74.4%对38.8%）。内科医生更有可能提供他们的姓名和联系电话，但申请常常缺少发送者的详细信息。
送检标本很少因人口统计学细节不充分而收到，但临床细节和发送者的详细信息则更常缺失。如果病理学家要应对对该服务的需求，就需要对临床同事进行培训。
