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At least 145 records · Page 8Linked to original sources

Stage A prostate cancer from pathologist's viewpoint.

Four hundred sixty-five departments of pathology in the United States were asked the following questions pertaining to Stage A prostatic cancer: (1) If a focus of adenocarcinoma is incidentally found in an enucleated specimen, what is the maximum diameter such a lesion may attain and still be considered an A-1 prostatic carcinoma? (2) If adenocarcinoma is incidentally found in a specimen resected transurethrally, how many chips may contain tumor and the lesion still be considered A-1 prostatic carcinoma? (3) What is your "routine pathologic examination" of a prostatic specimen? The majority of pathologists believe that the maximum diameter of a focal (A-1) lesion in an enucleated specimen is 5 mm., and the maximum number of transurethral chips containing tumor in a focal (A-1) lesion is three. The majority of pathologists section every chip when the specimen weighs less than 10 Gm. However, only 12 per cent of the pathologists section every chip when the specimen is greater than 10 Gm., while the others use a random section technique. There is a great diversity of techniques among pathologists in their methods of examining enucleated prostatic specimens.

Humans↗

The prognostic variability of ovarian tumor grading by different pathologists.

In a multicenter ovarian tumor study, it was shown that there are considerable differences between different pathologists when grading the same ovarian tumors. The question arises whether these differences in grading also reflect prognostic differences. To investigate this, the survival curves of the various tumor grades assigned to the same tumors by four different pathologists were investigated. The results of the present study indicate that tumor grade was strongly correlated with the prognosis, although there were considerable variations in the survival curves and in the five year survival of patients of the same grade assessed by the different pathologists. Five-year survival varied from 82 to 100% in the borderline tumors, from 49 to 80% in the well, and from 21 to 48% in the moderately differentiated tumor groups. Only the poorly differentiated cancers showed less variation. Similar interobserver differences were found in the histological typing and (strictly predefined) malignancy grades. The intraobserver variation, which was also tested after a 6-month interval, was somewhat lower, but was still present for each of the pathologists. These data clearly indicate the necessity for objective, sharply defined, reproducible criteria rather than subjective grades.

Cell Differentiation↗

Assessment of donor liver steatosis: pathologist or automated software?

Steatosis in donor liver biopsy specimens has been shown to correlate with graft dysfunction after orthotopic liver transplantation. This 2-part (laboratory pilot, clinical retrospective) study compared the traditional interpretation of steatosis by a pathologist with an automated measurement determined by an image analysis system. In our pilot study, Sprague-Dawley rats were studied prospectively by feeding them a choline-deficient diet for up to 7 days. In our clinical group, data from 49 consecutive recipients of cadaveric liver transplantation were reviewed retrospectively. In both studies, the percentages of microvesicular fat, macrovesicular fat, and total fat content within liver biopsy specimens were determined by an automated image analysis software program and a pathologist using the same set of slides. The association between fat content of the donor liver and patient survival and graft survival, along with levels of aspartate aminotransferase, alanine aminotransferase, prothrombin time, and total bilirubin after transplantation, were also examined in the clinical study. A direct correlation was observed between levels of macrovesicular fat determined by a pathologist and the automated software using livers from rats fed a choline-deficient diet and livers from deceased donors. A significant association was observed between macrovesicular fat content in the donor liver biopsy and graft survival by both techniques. We conclude that an image analysis system can be used to automate the determination of fat content in liver biopsy specimens, and that its findings correlate with both the visual interpretation by a pathologist and graft survival. Further study is needed to determine the role of an automated technique in the evaluation of donor livers for transplantation.

Animals↗

Current practice of Gleason grading among genitourinary pathologists.

There is consensus that the Gleason system should be used for grading of prostate cancer. However, a number of controversial issues remain as regards how this grading is applied. A questionnaire was sent to 91 genitourinary pathologists in countries around the world with the purpose to survey current practice of Gleason grading. The response rate was 74%, including 43 North American pathologists and 24 from other continents. Of all participants, only 13% and 36%, respectively, ever diagnosed a Gleason score (GS) of 2 to 3 or 4 on needle biopsies (NBX), and 88% of those who did so assigned a GS 4 to <1% of cancers. Cribriform Gleason pattern (GP) 3 was acknowledged by 88% but a majority of them would classify < or =20% of cribriform patterns as GP 3. One third only accepted cribriform or fusion patterns as GP 4, but two thirds also included incomplete or poorly defined glands. For GP 5 to be identified on NBX, 83% required clusters of individual cells, strands, or nests seen at less than x40 lens magnification. Only 26% defined GS on NBX as primary + tertiary GP, and a majority would mention a tertiary pattern separately. For NBX, global or highest GS was reported by 40% and 10%, respectively, whereas 46% only gave a separate GS for each individual NBX core. In conclusion, there is a need to standardize practical application of Gleason grading both in terms of interpretation of patterns as well as how grading is reported. Our survey data provide information to general pathologists about the most common grading practices among genitourinary pathologists.

Adult↗

[The issue of professional discretion for pathologists (author's transl)].

According to German law the physician shall not disclose secrets that were confided or made known to him. The definition reads: physician is who practises the healing art (including medicine and surgery). When considering this definition part of the jurisprudence is of the opinion, therefore, that subject of such healing is exclusively the living human being and the pathologist acting as post-mortem examiner makes solely statements concerning the dead body and thus is not to be considered as physician. This opinion does not do justice to the real tasks of the pathologist. The basic idea of the tasks of the pathologist is the consultation and assistance of the physician practising the healing art. Hence the post- mortem examinations serve indirectly as healing treatment. Consequently the pathologist acts as physician and is bound to professional discretion. The result corresponds with the law enforce according to which secrets are subject to protection beyond death.

Confidentiality↗

Discrepancy in the interpretation of cervical histology by gynecologic pathologists.

OBJECTIVE: To determine if subspecialty review of cervical histology improves diagnostic consensus of cervical intraepithelial neoplasia (CIN). METHODS: After routine histologic assessment within the hospital pathology department, 119 colposcopic cervical biopsies were interpreted by two subspecialty-trained gynecologic pathologists (GYN I and GYN II) blinded to each other's interpretations and to the interpretations of the hospital general pathologists (GEN). Biopsies were classified as normal (including cervicitis), low grade (LG, including CIN I and human papillomavirus changes), and high grade (HG, including CIN II/III). The interobserver agreement rates between GEN and GYN I, between GEN and GYN II, and between GYN I and GYN II were described using the kappa statistic. The proportions of biopsies assigned to each biopsy class were compared using McNemar test. RESULTS: Interobserver agreement rates between GEN and GYN I were moderate for normal (kappa = 0.53) and LG (kappa = 0.46) and excellent for HG (kappa = 0.76). There were no significant differences in the classifications between GEN and GYN I. Interobserver agreement rates between GEN and GYN II were moderate for normal (kappa = 0.50) and LG (kappa = 0.44) and excellent for HG (kappa = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P <.001) and less likely to classify biopsies as LG (P <.001). The interobserver agreement rates between GYN I and GYN II were moderate for normal (kappa = 0.61) and LG (kappa = 0.41) and excellent for HG (kappa = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P <.001) and less likely to classify biopsies as LG (P =.01). CONCLUSION: Interobserver agreement between two gynecologic pathologists was no better than that observed between general and gynecologic pathologists. Subspecialty review of cervical histology does not enhance diagnostic consensus of CIN.

Biopsy, Needle↗

Analysis of the performance of pathologists in the grading of bladder tumors.

Fifty-seven transurethrally resected bladder tumors were analyzed to determine whether different pathologists, using the World Health Organization grading system, graded the same bladder tumor differently (interindividual consistency) and whether the same pathologist graded a bladder tumor differently at different times (intraindividual consistency). Disturbingly high inter- and intraindividual inconsistency in the grading of bladder tumors was found. All pathologists showed essentially the same degree of intraindividual inconsistency: In almost 50 per cent of cases the tumor was graded differently at different times by the same pathologist. The inconsistencies might invalidate the usefulness of bladder tumor grading in clinical decision-making.

Humans↗

The forensic entomologist in the context of the forensic pathologist's role.

An adequate death investigation requires the combined efforts and cooperation of experts in different disciplines: crime scene technicians, death investigators, forensic pathologists, anthropologists, entomologists, other medical and non-medical professionals. These front-line experts play a crucial role in every death investigation process. The forensic pathologist normally has the legal authority to take charge of the dead body at a death scene and his primary functions are the exterior and interior examination of the cadaver by analyzing the extent of antemortem injuries and the postmortem changes and the recovery of physical evidence. He is responsible for determining how, when and why of any death which is the result of violence, suspicious or unexplained circumstances or a death which is sudden or unattended, defending and explaining the reasons for making these diagnoses in a courtroom. The forensic entomologist can provide invaluable aid in death cases where human remains are colonized by insects and in the overall investigation. His principal role is to identify the arthropods associated with such cases and to analyze entomological data for interpreting insect evidence. He is responsible for determining the period of insect activity according to all the variables affecting insect invasion of remains and their development. The major goal of medico-criminal entomology is to contribute to the determination of the time, cause, manner and place of the investigated death (especially on badly decomposed corpses or skeletonized human remains) with the support of all the elements which can be inferred from the study of insects found on the cadaver or nearby. The application of techniques devised recently in forensic entomology can allow experts in the field to collect strong entomological evidence and provide useful information not only in a death investigation including movement or storage of the remains following death, time of dismemberment, postmortem artifacts on the body but also at the scene, and even more in child neglect, sexual molestation and identification of suspects. As the role of the forensic entomologist at the death scene, at the autopsy and in the laboratory is defined and well known, this paper focuses on the difficulties that could arise if forensic pathologists and entomologists are uncertain about the procedures that they have to follow, do not realize the value of objective findings or fail to evaluate them. Although every forensic case presents a slightly different set of circumstances and has to be tackled individually, the forensic pathologist should work with the forensic entomologist from the visual observations of the cadaver on the scene, through the collection of arthropods and temperature data at the death scene and at the autopsy, up to the final report with the interpretation of entomological and other biological evidence.

Animals↗

The role of the EORTC pathologist in clinical trials: achievements and perspectives. European Organisation for Research and Treatment of Cancer.

The role of the pathologist in clinical trials (CT) is focused on three activities: pathology review, translational research, and participation in scientific committees. The primary goal of pathology review in CT is the quality control (QC) of the diagnosis and prognostic parameters. Important contributions have been achieved in the context of QC for CT such as new classifications of diseases or identification of new prognostic markers that are now widely used. Telematics implemented in some EORTC groups markedly facilitate the pathology review. The pathologist has a key-role in translational research for the identification of new targets in tissue specimens that may eventually lead to new therapeutics and for the understanding of the mechanisms involved in tumour progression. The gap between individualised prognosis and therapeutical possibilities has been considerably reduced by the development of drugs targeted on specific molecular defects. The paradigm of this is the treatment of stromal tumours by STI-571. For proper selection of patients to be treated, information on the expression of the molecules involved is needed, which is well suited for pathologists. The access to tissue resources from patients included in CT is a major goal to enhance translational research, both for brand institution and CT organisations. Active involvement of pathologists in scientific committees and interactions with the pharmaceutical industry is mandatory for an optimal design of CT protocols. In addition, translational research is a resource-consuming activity that necessitates an adequate financial flow to create a proper infrastructure at least for sponsored trials to the participating pathology departments and committees.

Clinical Trials as Topic↗

[Variability among pathologists in the histological diagnosis of diffuse interstitial lung diseases].

OBJECTIVE: Diffuse interstitial lung diseases (DILD) form a group of diseases which affect the alveolar interstitial space and share very similar clinical, radiological, and functional features, making lung biopsy essential for establishing diagnosis, prognosis, and treatment in many cases. We aimed to see whether there was agreement in histopathological diagnosis among different groups of pathologists in their assessment of these diseases. MATERIAL AND METHODS: Biopsies were studied from 33 patients suffering from noninfectious, nontumorous DILD. The biopsies had been assessed by 2 groups of pathologists: one specializing in this type of disease and another which was not a specialist group. RESULTS: There was disagreement in the histology reports of 10 out of the 33 cases studied (30.3%): 9 cases in the group of 22 cases of idiopathic interstitial pneumonia (40.9%) and 1 in the group of 3 DILD with known or associated causes. No discrepancies were found, however, in the diagnosis of primary DILD or DILD associated with other, less well-defined processes. CONCLUSIONS: We believe that idiopathic interstitial pneumonias are the DILD which pose most problems for pathologists. Therefore, the study of DILD requires specific dedication by pathologists and other professionals and specialists.

Adult↗

Comparison of speech-language pathologists' and naive subjects' identification of synthesized /r-w/ continua.

Two 9-step continua varying in F2 and F3 frequencies between exemplary /r/ and /w/ were synthesized to represent child and adult talkers. Stimuli from the full and truncated versions of the continua were presented to naive subjects in Experiment 1 and to speech-language pathologists in Experiment 2. Shifts from full range continua category boundaries occurred in Experiment 1 for both truncated "R" and truncated "W" conditions and in a direction opposite to the truncated end of the continuum. The results of Experiment 2 indicated that the full-range category boundaries for speech-language pathologists differed from those for naive subjects but that the boundary shift for truncated "R" was as great as that for naive subjects and the boundary shift for truncated "W" was greater than that for naive subjects. These findings indicate that speech-language pathologists are more likely than naive individuals to judge ambiguous /r/ sounds as "W" and that the phonetic judgments of speech-language pathologists about /r/ sounds are no more stable than those of naive subjects.

Adult↗

The ASCUS : SIL ratio and the reference laboratory pathologist.

The atypical squamous cells of undetermined significance (ASCUS) : squamous intraepithelial lesion (SIL) ratio was proposed to monitor laboratory use of the ASCUS diagnosis. This study addresses problems associated with comparing pathologists by this means. An intuitive example showed the ASCUS : SIL ratio depends on the prevalence of smears from patients who actually have SIL. In this study of 2000 cervical smears, each of five pathologists made 400 diagnoses. Differences among proportions of SIL diagnoses were statistically significant; differences among proportions of ASCUS diagnoses were not. Had an ASCUS : SIL ratio upper limit of 3.0 been used, two pathologists would have been misidentified as having high ASCUS diagnosis rates. Unlike the situation for laboratories, potential variability in SIL prevalence requires caution in the use of this ratio in assessing pathologists. An alternative measure that is independent of prevalence, the ASCUS : SIL odds ratio, is posited.

Diagnosis, Differential↗

The responsibilities of speech-language pathologists toward children with ADHD.

The speech-language pathologist has the skills needed to be an active participant in both the diagnostic and intervention phases of the treatment of children with ADHD. Many of the behaviors that define ADHD are directly linked to communication. Westby and Cutler (1994) assert that "the strong association between language disorders and ADHD suggests the possibility of a common antecedent to both disorders, perhaps a temperamental or neurological characteristic linked to deficits in behavioral regulation" (p. 61). Although the speech-language pathologist may not have the security of standardized test scores to support his or her diagnosis, behaviors that cannot be tested (e.g., pragmatics and social interactions) may be keys to a child's classroom difficulties. As discussed, many of the criteria found in the DSM-IV diagnostic criteria for ADHD are characteristics of pragmatic skills. Supported by Barkley's (1993) new theory of ADHD which is based on poor response inhibition or inability to delay responses, the speech-language pathologist can be an important resource to both the teacher and parents by helping them understand the behaviors exhibited by an ADHD child. The impulsivity that is so disruptive in the classroom is directly linked to the inability to delay responses. It is agreed that continued research into the behavioral characteristics associated with ADHD as well as their long-term implications for learning is needed. ADHD is a multifaceted developmental disorder. There is no known cure for ADHD, and we are dependent on early diagnosis and ongoing intervention to reduce its lifelong effects. Effective treatment must be multi-modal and involve the coordination of a professional team as well as the child's family. It is vital that we help children with ADHD develop positive self-esteem, effective social skills, and good pragmatic language skills that will eventually have a positive impact on their functioning in all aspects of their interactions with their environment. If this is accomplished, the effects of ADHD will be minimized. The speech-language pathologist needs to take a leadership role in this process.

Attention Deficit Disorder with Hyperactivity↗

Toxicogenomics, drug discovery, and the pathologist.

The field of toxicogenomics, which currently focuses on the application of large-scale differential gene expression (DGE) data to toxicology, is starting to influence drug discovery and development in the pharmaceutical industry. Toxicological pathologists, who play key roles in the development of therapeutic agents, have much to contribute to DGE studies, especially in the experimental design and interpretation phases. The intelligent application of DGE to drug discovery can reveal the potential for both desired (therapeutic) and undesired (toxic) responses. The pathologist's understanding of anatomic, physiologic, biochemical, immune, and other underlying factors that drive mechanisms of tissue responses to noxious agents turns a bewildering array of gene expression data into focused research programs. The latter process is critical for the successful application of DGE to toxicology. Pattern recognition is a useful first step, but mechanistically based DGE interpretation is where the long-term future of these new technologies lies. Pathologists trained to carry out such interpretations will become important members of the research teams needed to successfully apply these technologies to drug discovery and safety assessment. As a pathologist using DGE, you will need to learn to read DGE data in the same way you learned to read glass slides, patiently and with a desire to learn and, later, to teach. In return, you will gain a greater depth of understanding of cell and tissue function, both in health and disease.

Animals↗

Role of the speech-language pathologist in palliative hospice care.

In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.

Cognition↗

The usefulness of pathologists' assistants.

The usefulness of pathologists' assistants (PAs) has not been assessed rigorously. Data from a time-motion self-report log generated by an Allegheny General Hospital (Pittsburgh, PA) PA and from the corresponding surgical specimen logs were reviewed to determine the daily distribution of PA time and multiple parameters of practice for gross examination of specimens. Using these data in specific scenarios, PA and non-PA practices were compared. The majority of the PA's time (56.5%) was spent performing gross examination of surgical biopsy specimens. The average cost of gross examination per specimen for a PA and a pathologist was $4.37 and $15.19, respectively. In this practice setting, $91,970.00 is saved per year by the use of a PA. The use of PAs instead of pathologists results in considerable practice cost savings ($560,000 in a practice of 50,000 specimens) or saves pathologists time to perform other necessary functions. PAs are highly useful in an era of cost containment.

Cost Allocation↗

Pathologists' participation in postmortem examinations for patients with dementia.

Pathologists (n = 571) in Michigan were surveyed to examine the problem of limited access to autopsy experienced by families of patients with dementia and to assist with the implementation of the Michigan Dementia Program. The survey determined the extent to which pathologists performed autopsies for patients with dementia and/or were willing to do so as part of a statewide Postmortem Examination Program. Responses from 394 pathologists (69%) indicated that 49% were willing to perform brain removal and 44% were interested in learning more about the statewide program. The survey results were used to recruit pathologists, to identify potential problems, and to provide baseline data against which to measure the effects of a fully implemented program.

Attitude of Health Personnel↗

Personal usage of medical radiological procedures by radiologists, pathologists, and their families.

The Radiation Registry of Physicians was established to study the biologic effects of prolonged occupational exposure to low levels of ionizing radiation. Questionnaire responses from radiologists and a comparable group of medical specialists, pathologists, provided information about personal and familial exposure to medical radiation. This first report from the 1973 survey of radiologists and pathologists (5077 and 2914 respondents, respectively) shows that a significantly greater percentage of male radiologists, their spouses and their children reported diagnostic and therapeutic radiographic procedures than did male pathologists and their immediate family members. Responses from female physicians show similar relationships but the number of such specialists is too small for meaningful analysis. The exposure differential between radiologists and pathologists suggests that personal medical radiation exposure is an important component of the total x-ray exposure of radiologists.

Data Collection↗