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PubMed1995

New South Wales group pathology services--the Southpath model.

There has been significant rationalisation of public pathology service provision in New South Wales through the formation of group pathology services. These services are a fundamental change in the method of service organisation and delivery and little has been reported detailing their organisational and financial structures. Southpath, the group pathology service of the Southern Sydney Area Health Service, has improved service delivery, improved productivity by 18.2 per cent and reduced pathology expenditure per admission by 19.2 per cent. This paper describes the organisation of Southpath as knowledge of the organisational structures and performance of the group pathology service is necessary for the evaluation of this change in the method of service delivery and is essential to the current debate on the value of public pathology services.

Budgets↗
PubMed2001

Evaluation of a method that supports pathology report coding.

OBJECTIVES: The paper focuses on the problem of adequately coding pathology reports using SNOMED. Both the agreement between pathologists in coding and the quality of a system that supports pathologists in coding pathology reports were evaluated. METHODS: Six sets of three pathologists each received a different set of 40 pathology reports. Five different SNOMED code lines accompanied each pathology report. Three pathologists evaluated the correctness of each of these code lines. Kappa values and values for the reliability coefficients were determined to gain insight in the variance observed when coding pathology reports. The system that is evaluated compares a newly entered report, represented as a multi-dimensional word vector, with reports in a library, represented in the same way. The reports in the library are already coded. The system presents the code lines belonging to the five library reports most similar to the newly entered one to the pathologist in this way supporting the pathologist in determining the correct codes. A high similarity between two reports is indicated by a large value of the inproduct of the vector of the newly entered report and the vector of a report in the library. RESULTS: Agreement between pathologists in coding was fair (average kappa of 0.44). The reliability coefficient varied from 0.81 to 0.89 for the six sets of pathology reports. The system gave correct suggestions in 50% of the reports. In another 30% it was helpful for the pathologists. CONCLUSIONS: On the basis of the level of the reliability coefficients it could be concluded that three pathologists are indeed sufficient for obtaining a gold standard for evaluating the system. The method used for comparing reports is not strong enough to allow fully automatic coding. It could be shown that the system induces a more uniform coding by pathologists. An evaluation of the incorrect suggestions of the system indicates that the performance of the system can still be improved.

Clinical Laboratory Information Systems↗
PubMed2001

[Pathology 2001: odysssey and navigation].

The opening of a new millennium might be a suitable moment of looking backward and, moreover, to look forward what will happen to medicine in general and to pathology in particular during the next decades. In the 19th century, the concept of cellular pathology was ushered into medicine explaining diseases by basic cell and tissue injuries. The 20th century was characterized by a tremendous methodical progress in morphology connecting the cellular concept without a gap to present molecular medicine. In this opening address, famous pathologists are represented as examples for the different aspects of scientific and practical pathology, which has continually contributed authoritative information with clinically relevant significance to the understanding of diseases of man. The deciphering of the human genome shall have implications for several medical disciplines including pathology. However, much has to be done to find all the links between genomic abnormalities and the complete causal and formal pathogenesis of known and unknown diseases. Morphological studies carried out by the wide spectrum of methods available in modern pathology are regarded as the best effort to explain the structural aspects of the many human diseases. Taken together, the anatomic concept of disease completed by a genome-wide view shall remain the speciality of scientific medicine, so that basic and diagnostic pathology shall not perish in the future.

Germany↗
PubMed2001

[What does the medical student learn in pathology in Germany, China and the USA?].

From the point of view of a medical student who studied at a couple of universities in Germany, one semester at a medical school in the USA, and who was involved in an exchange-program with a Chinese university, the importance of pathology as a main part of the medical course is stressed.--In Germany and the USA, pathology is a central subject in the medical course studies. After studying how the human body functions correctly (anatomy, physiology etc.), the medical student learns the pathological basics of diseases. Then clinical training, including electives or rotations, starts, where the student enters clinical settings and learns how to treat these diseases. As medicine is going to be more and more specialized, this will sooner or later also have consequences on the system of medical teaching. In the USA, for example, it is to a certain extent possible to specialize during clinical rotations already. For this reason, pathology is going to be even more important in the future.--In China there are two medical systems that exist independently: Our so-called Western Medicine and Traditional Chinese Medicine. The biggest difference in traditional medicine seems to be that diseases are treated without any (western) knowledge of their pathological background, but with the empirical knowledge of 5000 years of Chinese Medicine (so-called "black-box-system").--In conclusion, pathology is fundamental to the understanding of diseases in humans in Western Medicine. The facts taught are, of course, the same everywhere. There are differences as far as the teaching methods are concerned, both between the different countries and within Germany. Most important is the attitude of both medical students and teaching staff.

China↗
PubMedDate not supplied

The systemic conception and its methods in pathology. Theses for a theoretical attempt.

A theoretical attempt concerning the use of the systemic conception and of its methods in pathology and in morphological research is presented in several theses. These bear on the systemic conception, the open informational biological systems, the structural analysis useful in biology and medicine, the possible development in the normal and pathological morphology. Some other theses are referred to: the pathological process as a whole and its features as a system formed by lesions and sequences, the internal and external relationships of pathological processes, the effects of different structural-organizational levels involved, the ensemble of determining factors, the stereotypes of pathological processes and the possibilities to influence them by the organismic mechanisms and by extrinsic interventions, including therapeutic ones. The relatively independent evolution of constituted pathological processes and its relationships with the integrating suprasystem (the organism) are also discussed.

Diagnosis↗
PubMed2005

Dusting off another shelf: further comments on classic gynecologic pathology books of yesteryear.

Selected outstanding books from the older literature on gynecologic pathology are reviewed with emphasis on drawing attention to the abundant helpful information and often outstanding illustrations that are worthy of review by present-day pathologists. This represents a follow up to a previous similar essay that appeared in Volume 19:67-84, 2000. The first three books cover general gynecological pathology: Gynecological Pathology by Carl Abel; Gynecological and Obstetrical Pathology by Robert T. Frank; and Haines and Taylor's Gynaecological Pathology by Magnus Haines and Claud W. Taylor. Each of them emphasizes the time-honored problem of mimicry of malignancy by diverse benign lesions or even aspects of normal histology. Awareness of the clinical background and cooperation between the clinician and pathologist are emphasized. The other three books considered are all devoted largely or exclusively to the ovary: Ovarian Tumors by Hans Selye, Ovarian Neoplasms, Morphology, and Classification by Karel Motlik, and Special Tumors of Ovary and Testis and Related Extragonadal Lesions by Gunnar Teilum. The book of Selye has a truly remarkable encyclopedic coverage of the older literature, the references being so comprehensive that they are presented in a separate volume. A number of aspects of the histopathology of ovarian tumors that have been emphasized in recent years are noted in Selye's book. Dr. Motlik's book presents a very high quality consideration of the differential diagnosis of ovarian tumors. Teilum's book contains a masterful account of the histopathology of germ cell tumors emphasizing a neoplasm with which his name will always be associated, the yolk sac tumor (endodermal sinus tumor). Numerous beautiful and refreshingly large illustrations are provided, and Dr. Teilum's interest in comparative pathology is evident in the pages, his linking of the famous Schiller-Duval bodies with the endodermal sinuses of the rat placenta, being the most notable example.

Gynecology↗
PubMed2005

Some variations of case-based techniques for the teaching of undergraduate pathology.

The challenges to the teaching of undergraduate pathology include adapting to the ever-evolving medical curriculum and the emergence of new teaching technologies. Nevertheless, pathology remains the crucial bridging medical discipline, with the pathology teacher playing an important role in consolidating the basic medical sciences and leading in the clinical disciplines. In this report, variations of case-based teaching of undergraduate pathology are discussed. These can be used in pathology lectures, tutorials and practical sessions, both traditional and computer-based. They contribute to the pathology teacher's repertoire of teaching tools and help add relevance and zest during class.

Education, Medical, Undergraduate↗
PubMed1991

[The future of clinical pathology].

Predictions of the future of pathology must encompass not only anticipation of scientific advances, but the important relationships with other physicians, scientists, health care agencies, hospitals, the public, and the government. The last fifty years have seen advances dwarfing all medical science throughout previous time, with sweeping changes in laboratory medicine in more recent years. For example, advent of molecular pathology will generate opportunities for the pathologist to lead not only in diagnosis, but to accurately predict and prevent disease, and to participate in treatment. Genetic engineering, which promises revolutionary improvement in medicine with already exciting advances in heritable disease. Immune status abnormalities, organ transplantation, and even mental disease, offers great opportunities for clinical pathologists. Currently there is much variation in definition and practice of anatomic and clinical pathology throughout the world. Scientific advances will merge the roles of these two branches more closely. The American Board of Pathology already foresees changing the current separate certifications in anatomic and clinical pathology into one certification in pathology. Multiple subcertifications will be offered to meet the certain increase in applicable clinical science in many related disciplines. The pathologist expert in a new field will assume a more activist role in clinical medicine and will be positioned to become the "information specialist" who will be required, with the aid of computerization, to assemble, correlate, and apply this burgeoning medical knowledge, which in many cases will transcend the abilities of any one medical specialist or allied scientist. The public become insatiable for knowledge and then access to this new medical science.(ABSTRACT TRUNCATED AT 250 WORDS)

Forecasting↗
PubMed1989

[The role of pathological anatomy in the health affairs of the USSR. Its origin, organization and reform].

Organizational transformation of pathological anatomy within the national health service of the USSR is part of general restructuring of society. Emphasis will be laid on the establishment of independent "Pathologico-Anatomic Units" no longer subordinated to medical superintendents of hospitals. These will be comparable to large pathological institutes and will replace the great number of small hospital-based pathology departments. The above units will be set up with a view to stimulating introduction of modern diagnostic methods in pathology and to providing conditions for more efficient scientific evaluation of bioptic and postmortem findings. An account is given of pathological anatomy and its post-war record in the USSR, and the point is made that forthcoming challenges can be met only by larger institutions. The importance of autopsy is underlined, with reference being made to the need for higher quality standards in medical services for the general public. It would be wrong to conclude that the importance of autopsy has declined against the background of growth in medical knowledge. Postmortem findings will continue to be a valid basis on which medical specialists can train their own medical thinking and can learn about the dialectics of pathological processes. Postmortem investigations have rather gained in importance today, when natural courses of many diseases can be strongly modified by medical intervention and when an iatrogenic component may occasionally come up as an additional cause of death.

Humans↗
PubMed1989

Role models in pathology. A new look at an old issue.

Recent trends indicate that pathology is becoming a less attractive specialty to US medical graduates. This article discusses role models as an important but underutilized tool in medical education, and pathology education, in particular. Historically, the term role model has been used to describe a hero or a good teacher. Social scientists who study specialty choices in medicine, however, consider role model to be a much more heterogeneous concept. The information gained from these studies, therefore, needs to be sorted out carefully if erroneous conclusions about role models are to be avoided. For example, personality traits and attitudinal assessment studies encourage, unfortunately, either a totally passive stance toward recruitment, or a selective approach to those students who fit the specialty profile. However, there is no available evidence to support such approaches in pathology. Indeed, faculty role models have consistently been found to be influential recruiters into specialties that are not well known to the students (eg, pathology). Many different types of role models are present in pathology. Two important types are clinical consultants and physician-researchers. Positive faculty role models are an effective way to remove false impressions and negative assumptions about the practice of pathology, and they should be used more explicitly in recruiting efforts.

Attitude of Health Personnel↗
PubMed1986

[Significance of a theoretical pathology for the scientific cognitive process in medicine].

A critical examination of current trends in medicine demonstrates the need for a deepened theoretical foundation. Of particular importance is the development of theoretical pathology. The goals, methods and content of theoretical pathology are discussed and contrasted with those of general and special pathology. Although general pathology incorporates some elements of theoretical pathology, the latter is based on the theory of cognition rather than empirical science. Dialectic materialism is an essential element of this discipline. The development of theoretical pathology demands an interdisciplinary approach on the part of physicians, natural and social scientists and must be based on a broad concept of human disease.

Cognition↗
PubMed1987

The future of pathology. Council on Long Range Planning and Development.

The American Medical Association Council on Long Range Planning and Development has identified trends in the environment of medicine and has assessed their likely implications for the pathology specialty. Competition and economic pressures focused on the hospital setting are likely to continue to affect the choice of delivery site for pathology practice. During the past decade, the pathology specialty has been subject to extensive regulation, placing a new focus on the role of the laboratory within the hospital and generating new ventures for the provision of pathology services. A continuing challenge to the specialty is management innovation and adaptation in the face of regulatory restrictions and cost-containment experiments. The significant forces for change affecting the demand for services and the shape of future provision of pathology services include rapid advances in technology and scientific knowledge, funding for biomedical research, training for research pathologists, demographic trends in the population, and medical liability trends. Finally, with renewed emphasis on quality of care in the health professions, the pathology specialty has the potential to make substantial contributions to the quality and art of medical practice and is likely to remain at the center of efforts to refine methods of quality assessment and implementation.

American Medical Association↗
PubMed1979

[The function of pathology at service of clinical special disciplines in past and presence (author's transl)].

The intent of this presentation shall be a contemplation about the character and the position of the pathology in the past and its determination in the presence after changing of many tasks. The allsurrounding pathology as a general system and doctrin of diseases continues in the pathology in spite of the separation of pathophysiology and pathobiochemistry in teaching and researching methods. The necessary development of an organ-pathology supported by the clinical specialisation again demands a conform functional and structural style of thinking in pathic processes. Way and realization possibilities of this demand in the daily practice especially for lung pathology are discussed and proposed. The pathology is a service of other clinical specialities and has to promote advances of knowledge.

Humans↗
PubMed1980

Pathology in the Soviet Union.

Five pathologists from the United States visited the Soviet Union for three weeks in April 1978 to learn of the training in and the practice of pathology in that country. The major observations of the Americans were that (1) pathology is a medical specialty in the Soviet Union, with practice limited to anatomic pathology; (2) exfoliative cytology and clinical pathology are not part of pathology; (3) interest, both clinical and experimental, in occupational, environmental, and geographic pathology is conspicuous; (4) an autopsy rate of 90% to 95% is customary; and (5) there is an organized and hierarchical framework for practice, with career patterns established early and change infrequent.

Autopsy↗
PubMed1994

A pathologist-designed imaging system for anatomic pathology signout, teaching, and research.

Pathology images are derived from gross surgical specimens, light microscopy, immunofluorescence, electron microscopy, molecular diagnostic gels, flow cytometry, image analysis data, and clinical laboratory data in graphic form. We have implemented a network of desktop personal computers (PCs) that allow us to easily capture, store, and retrieve gross and microscopic, anatomic, and research pathology images. System architecture involves multiple image acquisition and retrieval sites and a central file server for storage. The digitized images are conveyed via a local area network to and from image capture or display stations. Acquisition sites consist of a high-resolution camera connected to a frame grabber card in a 486-type personal computer, equipped with 16 MB (Table 1) RAM, a 1.05-gigabyte hard drive, and a 32-bit ethernet card for access to our anatomic pathology reporting system. We have designed a push-button workstation for acquiring and indexing images that does not significantly interfere with surgical pathology sign-out. Advantages of the system include the following: (1) Improving patient care: the availability of gross images at time of microscopic sign-out, verification of recurrence of malignancy from archived images, monitoring of bone marrow engraftment and immunosuppressive intervention after bone marrow/solid organ transplantation on repeat biopsies, and ability to seek instantaneous consultation with any pathologist on the network; (2) enhancing the teaching environment: building a digital surgical pathology atlas, improving the availability of images for conference support, and sharing cases across the network; (3) enhancing research: case study compilation, metastudy analysis, and availability of digitized images for quantitative analysis and permanent/reusable image records for archival study; and (4) other practical and economic considerations: storing case requisition images and hand-drawn diagrams deters the spread of gross room contaminants and results in considerable cost savings in photographic media for conferences, improved quality assurance by porting control stains across the network, and a multiplicity of other advantages that enhance image and information management in pathology.

Computer Systems↗
PubMed1976

[The history of the pathological anatomy in the Soviet Union (author's transl)].

The development of the pathological anatomy in Russia and in the Soviet Union is described, beginning from the foundation of the first prosecture in 1707 up to the present time. In the first half of the 18th century, this special branch was supported by Peter I, whereas it developed very slowly in the second half of the 18th and in the 19th century. The importance of the school of pathologists of Moscow as well as of that of Petersburg and Leningrad, respectively, which played an essential role in the pathological anatomy is demonstrated by the work of some of the most outstanding representatives of the Russian and Soviet pathology. After the Great Socialist October Revolution infectious and nutritional diseases were in the centre of the pathological investigations. At present, the development of the Soviet pathology is characterized by a rapid increase in the number of pathological institutes and departments as well as by the introduction of new apparatuses and technics into the research work. Some of the most important scientific problems are mentioned.

Communicable Diseases↗
PubMed1993

A comparison of pathology usage in three New South Wales public hospitals.

Data on pathology testing in New South Wales public hospitals are extremely limited. Pathology laboratory billing files and hospital admissions and transfer files were used to obtain data on the pathology testing frequency and cost of testing at three New South Wales public hospitals. Data were also extracted that allowed a comparison of test ordering frequency and cost of testing for various groups of admitting specialists. A high degree of similarity was found in the test ordering patterns at each hospital with 16 common tests or test groups in the top 20 tests or test groups at each hospital. These 16 tests or test groups accounted for 78, 82 and 88% of the total pathology expenditure at each hospital. The total cost of pathology per occupied bed day was found to be A$26.23, A$34.63 and A$44.66 at each hospital and represented 5.5, 5.2 and 6.8% of the total cost per occupied bed day, respectively, at each hospital. Variation was found between hospitals in the cost per occupied bed day for surgery, medicine, obstetrics and gynaecology and paediatrics. Three major reasons for the variations in pathology costs were identified as variations in outpatient loads, variations in test ordering patterns among medical practitioners and casemix.

Ambulatory Care↗
PubMed1993

Manpower deficiencies in cardiovascular pathology. Implications for medical care of cardiovascular diseases.

The general shortage of pathology manpower has been well documented, but virtually no published data are available on cardiovascular pathologists. To address this situation, the Society for Cardiovascular Pathology surveyed all chairpersons of academic pathology departments, chiefs of academic clinical cardiovascular programs, including adult and pediatric cardiology and cardiovascular surgery, in the United States and Canada, regarding their perceptions of cardiovascular pathology manpower and the training and areas of expertise necessary for a competent cardiovascular pathologist. Of total respondents, 41% stated that their institution's department of pathology needed to add a cardiovascular pathologist, 39% of respondents replied that money and funding were available to hire an additional cardiovascular pathologist, yet only 19% stated that their institution intended to add a cardiovascular pathologist. In regard to career orientation, 77% of respondents wanted a cardiovascular pathologist capable of both diagnostic work and basic research. The survey results show a significant discrepancy between apparent institutional needs for cardiovascular pathologists and hiring plans, implying that there is a substantial shortage of cardiovascular pathologists. This deficiency in cardiovascular pathology manpower has important ramifications for the amount and quality of medical services that can be provided to clinical cardiovascular colleagues in an era of increasingly complex pathobiological information and interventional strategies in the prevention and treatment of cardiovascular diseases.

Cardiovascular Diseases↗