[Histonet] BASIS FOR QUALITY WORK IN A HISTOTECH
Karen Kay
Karen.Kay <@t> albertahealthservices.ca
Mon Dec 17 12:41:01 CST 2012
Good Morning,
I am moved to add my response to this question, not only to provide an opinion on the query, but to extend a request to those who respond to any query, be it this one or others. Please do not respond in such a caustic manner as to belittle the person sending in the initial request!!! This is not a a forum for this type of remark and is just plain rude!
One poses a question to the members of the Histonet expecting assistance with an operational issue and for the most part, one receives good help in this regard,
Travis,
An opinion to your query is to establish a Quality Assurance program which includes clear and distinct guidelines as to the expectations of your laboratory.
In addition, ensure that a general/individual discussion be conducted with your staff, outlining the quality issues and the effect that they have on a patient's diagnosis. In our Laboratory (staff of 12) we will have a general discussion with all of the staff if there is a particular trend that is occurring. In addition, when required, a separate meeting with the technologist/assistant is held if required.
These meetings are documented should there be any further actions taken and for subsequent staff evaluations
Some of the recommendations or references you have already been given in this regard looks like they would be helpful to you.
Thank you
Karen J Kay, MLT
Supervisor - Histopathology and Cytology Laboratory Chinook Regional Hospital
South Zone West - Alberta Health Services Lethbridge, Alberta, Canada
karen.kay <@t> albertahealthservices.ca
-----Original Message-----
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Sent: December 17, 2012 10:54 AM
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Today's Topics:
1. RE: Re: Basis for Quality Work in a Histotech (joelle weaver)
2. Chemical Inventory/MSDS Program (Annette Hall)
3. Re: Basis for Quality Work in a Histotech (Genest, Sharon SktnHR)
4. RE: Basis for Quality Work in a Histotech (Cheri Miller)
5. RE: Re: Basis for Quality Work in a Histotech (Lynette Pavelich)
6. RELIA Special Job Alert for Supervisors and Managers
12-17-2012 (Pam Barker)
7. Human bcell and Tcell Ab (Mike Tighe)
8. RE: Basis for Quality Work in a Histotech (Morken, Timothy)
9. Re: Basis for Quality Work in a Histotech (Sheila Haas)
10. RE: Basis for Quality Work in a Histotech (Lynette Pavelich)
11. RE: Basis for Quality Work in a Histotech (Morken, Timothy)
----------------------------------------------------------------------
Message: 1
Date: Sun, 16 Dec 2012 19:29:03 +0000
From: joelle weaver <joelleweaver <@t> hotmail.com>
Subject: RE: [Histonet] Re: Basis for Quality Work in a Histotech
To: <rsrichmond <@t> gmail.com>, <histonet <@t> lists.utsouthwestern.edu>
Message-ID: <SNT135-W275542CCA0E90D4FBBDF8FD8330 <@t> phx.gbl>
Content-Type: text/plain; charset="iso-8859-1"
Good suggestion, Deming's PDCA is a good, straightforward framework to begin with.
Joelle Weaver MAOM, HTL (ASCP) QIHC
> Date: Sun, 16 Dec 2012 11:50:37 -0500
> From: rsrichmond <@t> gmail.com
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Re: Basis for Quality Work in a Histotech
>
> Travis Troyer at Peterson Laboratory Servcies in Manhattan, Kansas
> (Hey, one of my grandfathers was born there!) asks: >>This is a
> question for all of the lab supervisors. I am the supervisor of two
> histotechs. I am not doing techwork now, but have 10 years of
> experience. The pathologists are getting more and more upset at the
> lack of quality in the work and the mistakes that are happening. I was
> wondering if anyone had some ideas on what sort of a goal to set up
> and how to reward/punish for variations from that goal. For example,
> if the goal is three mistakes for the month, what is the best way to
> reward them for making that goal and what would be best if they had
> more mistakes in a given time frame. We are all feeling the budget
> crunch and the pathologists are trying to figure out a good
> solution.<<
>
> Well, speaking as a small-lab pathologist, what I'd want to do is tell
> you exactly what the "lack of quality" and the "mistakes" I'm seeing
> are. Some of them, like specimen mixups and errors in accessioning,
> would be your problem to get right. With problems like bad microtomy
> and faulty staining, I'd want to look at a lot of slides with you (a
> double-headed microscope is needed for this purpose, and I'm guessing
> you haven't got one). Then I'd want you to look at those slides with
> your two histotechs. This daily process would go on for a long time,
> perhaps permanently. If you were out of the office, I'd want to do the
> daily review directly with one of the histotechs.
>
> I hold the perhaps naive belief that people will do good work if they
> have good equipment and know what's expected of them and get feedback
> (both positive and negative. I'd a lot rather tell a histotech "Hey,
> you really pulled this patient's diagnosis out of the fire for me"
> than "This GI biopsy slide is so chattery I can't interpret it.")
>
> One of the great follies of Good Management is that people are pairs
> of hands who just need to be made to work-to-rule. If you don't know
> who Edwards Deming was, look him up in Wikipedia.
>
> Bob Richmond
> Samurai Pathologist
> Maryville TN
>
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
------------------------------
Message: 2
Date: Mon, 17 Dec 2012 05:23:48 +0000
From: Annette Hall <Annette_hall <@t> pa-ucl.com>
Subject: [Histonet] Chemical Inventory/MSDS Program
To: "histonet <@t> lists.utsouthwestern.edu"
<histonet <@t> lists.utsouthwestern.edu>
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<8B8724C83737DF41888FFD6ECCB161B121F4B597 <@t> PEITHA.wad.pa-ucl.com>
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All,
We currently are using an internally developed program to track chemical inventory and accompanying MSDS sheets. This application requires extensive resources to maintain an accurate inventory. We are looking to replace it with a commercial solution. Could you please share what solution your laboratory or hospital is using as a resource for reagent/chemical handling?
Additional thoughts about ease of use, accuracy, accessibility, maintenance resources, etc., are greatly appreciated.
Thanks,
Annette
Annette J Hall, MT
Micro/Histo/Cyto Manager
United Clinical Laboratories
205 Bluff St.
Dubuque, IA 52001
563.556.2010 x131
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Message: 3
Date: Mon, 17 Dec 2012 12:55:41 +0000
From: "Genest, Sharon SktnHR"
<Sharon.Genest <@t> saskatoonhealthregion.ca>
Subject: [Histonet] Re: Basis for Quality Work in a Histotech
To: "'histonet <@t> lists.utsouthwestern.edu'"
<histonet <@t> lists.utsouthwestern.edu>
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My first recommendation would be to look at your process is there any way that you can error proof them? Make it more difficult to make the errors.When a lot of errors are occuring sometimes it is often due to how we do the job and not who does it.
Sharon Genest
Anatomic Pathology
Process Improvement
Saskatoon Health Region
306-655-8242
sharon.genest <@t> saskatoonhealthregion.ca
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Message: 4
Date: Mon, 17 Dec 2012 08:59:29 -0600
From: Cheri Miller <cmiller <@t> physlab.com>
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
To: Rene J Buesa <rjbuesa <@t> yahoo.com>
Cc: histonet <histonet <@t> lists.utsouthwestern.edu>
Message-ID: <E3C81A010935EA41B379AC765103F3BF34688AFD22 <@t> olsrv12>
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I totally agree with you Rene. May I add as a supervisor of 6 in which all of them I trained all myself in an OJT situation.
1. Instill in them team work and pride in their profession
2. Reiterate to them that their unique skills are an important link in the health care chain.
If they lack any of above it's your job to provide them with the knowledge, skill and understanding of their critical role in the health care chain. My belief is you will see a rise in quality with minimal mistakes.
If they don???t improve after receiving all of the above they should look for another profession.
Cheryl A. Miller HT(ASCP)cm
Histology Supervisor,
Hygiene Officer
Physicians Laboratory Services
4840 F Street
Omaha, NE. 68127-0999
402 731 4145 ext. 554
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 10:38 AM
To: Travis Troyer; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance.
You end by bemoaning about "budget crunch" and because of that it seems to me that your 2 histotechs are not receiving a "decent" salary and, as everybody knows, you are getting what you are paying for.
With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect.
Quality of sections comes after wards and there is no "standard" for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require.
There is no such thing as "instant reward" for a good quality job; the histotech should not be treated as "dogs receiving a cookie after a trick performed" but there are 2 tools: you need to keep track of the mistakes ??? counsel the HT after a mistake ??? retrain them ??? keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that.
The ideal limit of mistakes is "0" but there is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work
Ren?? J.
From: Travis Troyer <ttroyer <@t> petersonlab.com>
To: histonet <@t> lists.utsouthwestern.edu
Sent: Friday, December 14, 2012 5:34 PM
Subject: [Histonet] Basis for Quality Work in a Histotech
This is a question for all of the lab supervisors. I am the supervisor of two histotechs. I am not doing techwork now, but have 10 years of experience. The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening. I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal. For example, if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame. We are all feeling the budget crunch and the pathologists are trying to figure out a good solution.
Thanks,
Travis Troyer
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Message: 5
Date: Mon, 17 Dec 2012 15:28:44 +0000
From: Lynette Pavelich <LPaveli1 <@t> hurleymc.com>
Subject: RE: [Histonet] Re: Basis for Quality Work in a Histotech
To: "Genest, Sharon SktnHR" <sharon.genest <@t> saskatoonhealthregion.ca>,
"'histonet <@t> lists.utsouthwestern.edu'"
<histonet <@t> lists.utsouthwestern.edu>
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Travis,
If it were me (and I've done this), I would go back to the bench and walk in their shoes to see what is really happening. Come in at the start of their shift and work right along side them. This way, you can see who/what/when is going on:
How are the machines being maintained (how often/quality of maintenance .....is the 95% really 95%, etc.)
How is the processing schedule? Does it need "tweeking"?
How is the embedding? Quality? Go ahead and embed some.
How is the cutting? Quality/quantity? Go ahead and cut some.
How is the routine staining? Maintenance good? Times good?
How are the special stains? Are protocols being followed or does each "cook" have their own recipe they follow?
How is your procedure manual(s) Does it need cleaning up? Does the special stain manual contain pictures of what a good stain should look like?
Get my drift? Lots of things to think about. I would go on the bench for a week and see what really happens every day. It may be intimidating at first, but it will show your techs and your pathologists how much you care and this should help your approach when helping them improve their techniques. This may need to be done a few times, and each time, you will see improvements. I don't know of any techs who want to do bad work, they just may need guidance in getting there.
Additionally, it will be helpful to track what infractions are going on and the frequency (we have a monthly tracking system and I report it at our QA meetings (mislabeled slides, mislabeled blocks, etc). Also, do you have a system in place to evaluate competency? This will be helpful when evaluation time comes around to approach them in areas of needed improvement. If you need help in developing a competency evaluation, the Michigan Society (www.mihisto.org) has a manual for supervisors that contains many different styles of evaluations that includes the different goals, measurements, assessment frequency, references and resources to help you develop an evaluation unique to your institution. Well worth the $5.00 investment.
Supervising at times, can be a tough job, but I can tell you really care about the patient. The best of luck to you!
Lynette
Lynette Pavelich, HT(ASCP)
Histology Supervisor
Hurley Medical Center
One Hurley Plaza
Flint, MI 48503
ph: 810.262.9948
mobile: 810.444.7966
________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu [histonet-bounces <@t> lists.utsouthwestern.edu] on behalf of Genest, Sharon SktnHR [Sharon.Genest <@t> saskatoonhealthregion.ca]
Sent: Monday, December 17, 2012 7:55 AM
To: 'histonet <@t> lists.utsouthwestern.edu'
Subject: [Histonet] Re: Basis for Quality Work in a Histotech
My first recommendation would be to look at your process is there any way that you can error proof them? Make it more difficult to make the errors.When a lot of errors are occuring sometimes it is often due to how we do the job and not who does it.
Sharon Genest
Anatomic Pathology
Process Improvement
Saskatoon Health Region
306-655-8242
sharon.genest <@t> saskatoonhealthregion.ca
his e-mail message may contain confidential and/or privileged information. It is intended only for the
addressee. Any unauthorized disclosure is strictly prohibited. If you are not a named addressee you should not
disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received
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secure or error free as information could be intercepted, corrupted, destroyed, arrive late or incomplete, or
contain viruses. The sender therefore does not accept any liability for errors or omissions in the contents of this
message or any damages that arise as a result of e-mail transmissions.
_______________________________________________
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http://lists.utsouthwestern.edu/mailman/listinfo/histonet
------------------------------
Message: 6
Date: Mon, 17 Dec 2012 11:03:03 -0500
From: "Pam Barker" <relia1 <@t> earthlink.net>
Subject: [Histonet] RELIA Special Job Alert for Supervisors and
Managers 12-17-2012
To: "Histonet" <histonet <@t> lists.utsouthwestern.edu>
Message-ID: <06e001cddc6f$ff1529b0$fd3f7d10$@earthlink.net>
Content-Type: text/plain; charset="us-ascii"
Hello Histonetters!!
I have several exciting opportunities for experienced Managers,
and Supervisors in hospital and private lab environments in several
locations in California. These are some of the premier employers in the
United States. The positions are of course full time and permanent. My
clients offer excellent compensation, benefits and relocation assistance.
Here are my leadership positions:
Pathology Supervisor - Fresno, CA
Histology Supervisor - Los Angeles, CA
Histology Manager - Los Angeles, CA
I anticipate multiple management openings coming available nationwide after
the holidays.
If you are interested in looking into a change in another area of the
country please let me know. That way I can keep you apprised of management
opportunities in that area.
Also if you would like more information or know of someone else who might be
interested, please contact me at relia1 <@t> earthlink.net or 866-607-3542.
I am available to discuss the opportunity at your convenience including
after hours. Thanks-Pam
There are a lot of recruiters out there right now trying to work with
histology professionals and I appreciate your support and respect your
needs. Remember I offer over 25 years of experience as a recruiter and for
over 10 years I have dedicated my practice solely to placing histology
professionals like you.
Thank You!
Happy Holidays !!
Thank You!
Pam Barker
President/Senior Recruiting Specialist-Histology
RELIA Solutions
Specialists in Allied Healthcare Recruiting
5703 Red Bug Lake Road #330
Winter Springs, FL 32708-4969
Phone: (407)657-2027
Cell: (407)353-5070
FAX: (407)678-2788
E-mail: relia1 <@t> earthlink.net
www.facebook.com <http://www.facebook.com/PamBarkerRELIA> /PamBarkerRELIA
www.linkedin.com/in/reliasolutions
www.twitter.com/pamatrelia
------------------------------
Message: 7
Date: Mon, 17 Dec 2012 16:20:11 +0000
From: Mike Tighe <mtighe <@t> trudeauinstitute.org>
Subject: [Histonet] Human bcell and Tcell Ab
To: "histonet <@t> lists.utsouthwestern.edu
(histonet <@t> lists.utsouthwestern.edu)"
<histonet <@t> lists.utsouthwestern.edu>
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Hi Everybody!
Can you guys weigh in on the best antibodies for Human B cell and Tcell staining in FFPE sections? We would like to have a fluorescent endpoint if that changes things. Thanks in advance! Hope everyone has a safe Holiday.
Mike
------------------------------
Message: 8
Date: Mon, 17 Dec 2012 16:30:23 +0000
From: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
To: "histonet <@t> lists.utsouthwestern.edu"
<histonet <@t> lists.utsouthwestern.edu>
Message-ID: <761E2B5697F795489C8710BCC72141FF02FDEC <@t> ex07.net.ucsf.edu>
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Travis,
Histology has a very complex workflow AND requires "artisan" level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting.
The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though "shortcuts" can be thought of as intentionally risking making mistakes "on purpose," the "purpose" being to save time or effort).
Workflows can be "engineered" to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is "why." Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found.
For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away).
We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes.
All these methods need to be investigated.
Rewards are also very helpful. We give out "Bear hugs" that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have "Star Awards" of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc).
Good luck with it!
Tim Morken
Supervisor, Electron Microscopy/Neuromuscular Special Studies
Department of Pathology
UC San Francisco Medical Center
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 8:38 AM
To: Travis Troyer; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to??ask for such quality guidance.
You end by bemoaning about "budget crunch" and because of that it seems to me??that your 2 histotechs are not receiving a "decent" salary and, as everybody knows, you are getting what you are paying for.
With 10 years of??experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect.
Quality of sections comes after wards and there is no "standard" for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require.
There is no such thing as "instant reward" for a good quality job; the histotech should not be treated as "dogs receiving a cookie after a trick performed" but there are 2 tools: you need to keep track of the mistakes ??? counsel the HT after a mistake ??? retrain them ??? keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that.
The ideal limit of mistakes is "0" but there??is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work Ren?? J.????????
From: Travis Troyer <ttroyer <@t> petersonlab.com>
To: histonet <@t> lists.utsouthwestern.edu
Sent: Friday, December 14, 2012 5:34 PM
Subject: [Histonet] Basis for Quality Work in a Histotech
This is a question for all of the lab supervisors.?? I am the supervisor of two histotechs.?? I am not doing techwork now, but have 10 years of experience.?? The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening.?? I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal.?? For example,?? if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame.?? We are all feeling the budget crunch and the pathologists are trying to figure out a good solution.
Thanks,
Travis Troyer
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
------------------------------
Message: 9
Date: Mon, 17 Dec 2012 08:57:39 -0800 (PST)
From: Sheila Haas <micropathlabs <@t> yahoo.com>
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
To: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>,
"histonet <@t> lists.utsouthwestern.edu"
<histonet <@t> lists.utsouthwestern.edu>
Message-ID:
<1355763459.39171.YahooMailNeo <@t> web122002.mail.ne1.yahoo.com>
Content-Type: text/plain; charset=utf-8
Tim,
I'd be interested in more information in your labeling at the microtome that has all but eliminated errors. Would you share?
??
Thank you,
Sheila Haas
Laboratory Manager
MicroPath Laboratories, Inc.
________________________________
From: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>
To: "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>
Sent: Monday, December 17, 2012 11:30 AM
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
Travis,
Histology has a very complex workflow AND requires "artisan" level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting.
The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though "shortcuts" can be thought of as intentionally risking making mistakes "on purpose," the "purpose" being to save time or effort).
Workflows can be "engineered" to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why??? BTW, Bill Gates said the most important word in his vocabulary is "why." Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found.
For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away).
We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes.
All these methods need to be investigated.
Rewards are also very helpful. We give out "Bear hugs" that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have "Star Awards" of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc).
Good luck with it!
Tim Morken
Supervisor, Electron Microscopy/Neuromuscular Special Studies
Department of Pathology
UC San Francisco Medical Center
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 8:38 AM
To: Travis Troyer; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to??ask for such quality guidance.
You end by bemoaning about "budget crunch" and because of that it seems to me??that your 2 histotechs are not receiving a "decent" salary and, as everybody knows, you are getting what you are paying for.
With 10 years of??experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect.
Quality of sections comes after wards and there is no "standard" for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require.
There is no such thing as "instant reward" for a good quality job; the histotech should not be treated as "dogs receiving a cookie after a trick performed" but there are 2 tools: you need to keep track of the mistakes ??? counsel the HT after a mistake ??? retrain them ??? keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that.
The ideal limit of mistakes is "0" but there??is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work Ren?? J.????????
From: Travis Troyer <ttroyer <@t> petersonlab.com>
To: histonet <@t> lists.utsouthwestern.edu
Sent: Friday, December 14, 2012 5:34 PM
Subject: [Histonet] Basis for Quality Work in a Histotech
This is a question for all of the lab supervisors.?? I am the supervisor of two histotechs.?? I am not doing techwork now, but have 10 years of experience.?? The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening.?? I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal.?? For example,?? if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame.?? We are all feeling the budget crunch and the pathologists are trying to figure out a good solution.
Thanks,
Travis Troyer
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------------------------------
Message: 10
Date: Mon, 17 Dec 2012 17:11:44 +0000
From: Lynette Pavelich <LPaveli1 <@t> hurleymc.com>
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
To: Sheila Haas <micropathlabs <@t> yahoo.com>, "Morken, Timothy"
<timothy.morken <@t> ucsfmedctr.org>, "histonet <@t> lists.utsouthwestern.edu"
<histonet <@t> lists.utsouthwestern.edu>
Message-ID:
<89F4666A496DC949A819ECC40E11C867BF56D279 <@t> EXCHANGEMB1.hmc.hurleymc.com>
Content-Type: text/plain; charset="gb2312"
Would also love to hear! $$ for bar coding too far away!
Lynette
Lynette Pavelich, HT(ASCP)
Histology Supervisor
Hurley Medical Center
One Hurley Plaza
Flint, MI 48503
ph: 810.262.9948
mobile: 810.444.7966
________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu [histonet-bounces <@t> lists.utsouthwestern.edu] on behalf of Sheila Haas [micropathlabs <@t> yahoo.com]
Sent: Monday, December 17, 2012 11:57 AM
To: Morken, Timothy; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
Tim,
I'd be interested in more information in your labeling at the microtome that has all but eliminated errors. Would you share?
Thank you,
Sheila Haas
Laboratory Manager
MicroPath Laboratories, Inc.
________________________________
From: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>
To: "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>
Sent: Monday, December 17, 2012 11:30 AM
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
Travis,
Histology has a very complex workflow AND requires "artisan" level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting.
The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though "shortcuts" can be thought of as intentionally risking making mistakes "on purpose," the "purpose" being to save time or effort).
Workflows can be "engineered" to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is "why." Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found.
For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away).
We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes.
All these methods need to be investigated.
Rewards are also very helpful. We give out "Bear hugs" that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have "Star Awards" of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc).
Good luck with it!
Tim Morken
Supervisor, Electron Microscopy/Neuromuscular Special Studies
Department of Pathology
UC San Francisco Medical Center
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 8:38 AM
To: Travis Troyer; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance.
You end by bemoaning about "budget crunch" and because of that it seems to me that your 2 histotechs are not receiving a "decent" salary and, as everybody knows, you are getting what you are paying for.
With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect.
Quality of sections comes after wards and there is no "standard" for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require.
There is no such thing as "instant reward" for a good quality job; the histotech should not be treated as "dogs receiving a cookie after a trick performed" but there are 2 tools: you need to keep track of the mistakes ?? counsel the HT after a mistake ?? retrain them ?? keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that.
The ideal limit of mistakes is "0" but there is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work Ren?? J.
From: Travis Troyer <ttroyer <@t> petersonlab.com>
To: histonet <@t> lists.utsouthwestern.edu
Sent: Friday, December 14, 2012 5:34 PM
Subject: [Histonet] Basis for Quality Work in a Histotech
This is a question for all of the lab supervisors. I am the supervisor of two histotechs. I am not doing techwork now, but have 10 years of experience. The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening. I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal. For example, if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame. We are all feeling the budget crunch and the pathologists are trying to figure out a good solution.
Thanks,
Travis Troyer
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
------------------------------
Message: 11
Date: Mon, 17 Dec 2012 17:52:23 +0000
From: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
To: "Lynette Pavelich" <LPaveli1 <@t> hurleymc.com>, "Sheila Haas"
<micropathlabs <@t> yahoo.com>, "histonet <@t> lists.utsouthwestern.edu"
<histonet <@t> lists.utsouthwestern.edu>
Message-ID: <761E2B5697F795489C8710BCC72141FF02FE6C <@t> ex07.net.ucsf.edu>
Content-Type: text/plain; charset=utf-8
Here is our slide labeling procedure. It is simple, but we insist it be followed. This will be modified once barcoding is instituted to use scanning ID of slides vs block.
We also instituted block ID beads at the embedding center. That has helped tremendously to identify people that may need embedding retraining.
One other thing I should mention. People in the lab should be told to trust their inner voice. We had several labeling errors that on investigation were suspected or ignored by a tech in the chain or events. In one case the sectioning tech pulled the wrong block from the file, labeled the slides with that block number and sent it to the IHC group. An IHC tech took the slide and noticed the number was wrong but ASSUMED the sectioning tech had made an error, so "corrected" the number to match the request on her log. The mistake was only caught by the pathologist who noticed the IHC slide did not match the H&E slide from the proper block.
I tell my techs: Trust your instincts. If something seems wrong - for whatever reason - STOP!!! Investigate the issue. You will save time, effort, and maybe lives.
I also tell my techs not no pathologist will remember how fast you were, just how many mistakes you made.
Tim Morken
+++++++++++++++++++++++++++++++++++++++++++
Slide Labeling Procedure at the Microtome
Slide labeling at the cutting station is the most important part of the process used to identify slides. A mistake at this point will cause a mix-up in slides or cases and could lead to improper diagnosis and treatment for patients.
Because this is such an important step the following procedure must be followed exactly. Deviation may cause mislabeling. Deviation from the procedure may be cause for reprimand and termination.
Important points:
1. Label slides for one block at a time.
2. Do not pre-label slides before cutting sections from a block, or for any other blocks.
3. Work with one block at a time as much as possible. If the block must be re-soaked before completing the slide count then the block must be isolated from the other blocks to prevent a mix-up.
4. The stainer tech will compare stained slides to the blocks to ensure they are correct.
Sectioning Procedure
1) Pick up the next page of the processing log and the blocks that are on that page.
2) Verify that the blocks picked up are on the processing log.
a. Put the blocks in order according to the processing log.
b. Put a check mark ????????? next to the block line on the log to indicate the block is present in the group.
c. Note any problems with the blocks
1. Put an ???X??? mark next to any problem blocks and note the problem.
a. Add-ons
b. Missing
c. Reprocessing needed
d. Re-embedding and reason
e. other
3) Face-trim the blocks and put them on ice (if necessary) in order as shown on the processing log.
4) Pick up the first block on the log.
a. Do not pre-label slides for this or any other block
5) Place the block in the microtome and cut sections according to
a. requests on the processing log and established sectioning requirements
b. ???Tissue Sectioning Standards??? of the Sectioning section of the Histology Laboratory manual
6) Pick up the proper number of sections on the appropriate slides.
7) Label the slides
a. Write the Accession number and Part letter/number of the block on the microtome.
b. Label slides with your initials (legibly)
c. Label initial slide in the group with the cassette color and page number (this slide is first in the rack and faces forward for the Stainer person to see)
d. NOTE: If the block must be re-soaked to complete the slide count, then isolate the block on the ice tray by putting it at the back of the tray facing backwards. This will indicate that some slides have been cut previously.
8) Place the slides for H&E in the H&E staining rack
a. Write the color and page number of the processing log on the first slide of the rack.
b. Place slides in the rack beginning at the front of the rack and working backward.
c. Place designated ???unstained??? slides in separate rack(s) for use later (IPOX, Specials, etc).
d. Discard any unused slides with sections on them.
9) Take the block from the microtome and put it in the cardboard filing box.
10) Clean the surface of the water with a Kimwipe or paper towel. Be sure there are no tissue fragments floating on the water bath.
11) Cross off that case on the processing log with a diagonal line through the entire case.
12) When the H&E slide rack is filled take it to the 60C oven
a. Hand-write a label with the cassette color and page# as well as the time the slides will come out of the oven (10 min from current time).
b. Place the label on the front end of the slide rack (end with first slide).
c. Put the slides in the oven with the label facing forward.
13) When all the blocks have been cut, write your initials (legibly) on the bottom of the log and note the date/time.
a. Compare Blocks and slides
i. Give blocks to the Stainer area tech
ii. When staining is completed the Stainer Tech compares the stained slides against the blocks and the process log.
iii. If stained slides and blocks match, write ???Blocks/Slides match???, your initials and time at the bottom of the process log.
iv. If slide(s) and block(s) do not match, determine the problem and correct it.
v. Note the problem and correction on the process log along with your initials and time.
b. Deliver the slides back to the Stainer Tech.
14) Place the cut blocks on the filing table.
15) Fill out a workload tally sheet for the day.
-----Original Message-----
From: Lynette Pavelich [mailto:LPaveli1 <@t> hurleymc.com]
Sent: Monday, December 17, 2012 9:12 AM
To: Sheila Haas; Morken, Timothy; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
Would also love to hear! $$ for bar coding too far away!
Lynette
Lynette Pavelich, HT(ASCP)
Histology Supervisor
Hurley Medical Center
One Hurley Plaza
Flint, MI 48503
ph: 810.262.9948
mobile: 810.444.7966
________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu [histonet-bounces <@t> lists.utsouthwestern.edu] on behalf of Sheila Haas [micropathlabs <@t> yahoo.com]
Sent: Monday, December 17, 2012 11:57 AM
To: Morken, Timothy; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
Tim,
I'd be interested in more information in your labeling at the microtome that has all but eliminated errors. Would you share?
Thank you,
Sheila Haas
Laboratory Manager
MicroPath Laboratories, Inc.
________________________________
From: "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org>
To: "histonet <@t> lists.utsouthwestern.edu" <histonet <@t> lists.utsouthwestern.edu>
Sent: Monday, December 17, 2012 11:30 AM
Subject: RE: [Histonet] Basis for Quality Work in a Histotech
Travis,
Histology has a very complex workflow AND requires "artisan" level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting.
The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though "shortcuts" can be thought of as intentionally risking making mistakes "on purpose," the "purpose" being to save time or effort).
Workflows can be "engineered" to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is "why." Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found.
For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away).
We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes.
All these methods need to be investigated.
Rewards are also very helpful. We give out "Bear hugs" that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have "Star Awards" of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc).
Good luck with it!
Tim Morken
Supervisor, Electron Microscopy/Neuromuscular Special Studies Department of Pathology UC San Francisco Medical Center
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Saturday, December 15, 2012 8:38 AM
To: Travis Troyer; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Basis for Quality Work in a Histotech
First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance.
You end by bemoaning about "budget crunch" and because of that it seems to me that your 2 histotechs are not receiving a "decent" salary and, as everybody knows, you are getting what you are paying for.
With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect.
Quality of sections comes after wards and there is no "standard" for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require.
There is no such thing as "instant reward" for a good quality job; the histotech should not be treated as "dogs receiving a cookie after a trick performed" but there are 2 tools: you need to keep track of the mistakes ??? counsel the HT after a mistake ??? retrain them ??? keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that.
The ideal limit of mistakes is "0" but there is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work Ren?? J.
From: Travis Troyer <ttroyer <@t> petersonlab.com>
To: histonet <@t> lists.utsouthwestern.edu
Sent: Friday, December 14, 2012 5:34 PM
Subject: [Histonet] Basis for Quality Work in a Histotech
This is a question for all of the lab supervisors. I am the supervisor of two histotechs. I am not doing techwork now, but have 10 years of experience. The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening. I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal. For example, if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame. We are all feeling the budget crunch and the pathologists are trying to figure out a good solution.
Thanks,
Travis Troyer
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
_______________________________________________
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http://lists.utsouthwestern.edu/mailman/listinfo/histonet
------------------------------
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End of Histonet Digest, Vol 109, Issue 19
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