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PubMed1998

[Classification of pathological drives in children and adolescents].

A new approach to classification of pathological drives (impulse control disorders) in children and adolescents is proposed basing on both literary data and author's own observations. 5 criteria were picked out: 1) correlation of biological and social factors in the genesis of pathological drives; 2) personal attitude to the drive; 3) presence (or absence) of the opposite motivations struggle; 4) outcome of the struggle of motivations; 5) acuteness and stability of pathological drive. The latter criterion was considered as leading, and the necessity of determination of different forms of this pathology was shown taking into the consideration characteristics of the former criteria. Such approach to systematization of pathological drives increases significantly exactness of clinical description of the syndrome, its diagnoss and peculiarities of its dynamics. Besides, it permits to cover all different forms of this pathology and cnables computer processing of clinical data.

Adolescent↗

PubMed1998

[Vascular pathology. A study of some blood parameters indicative of leukocyte activation and platelet dysfunction].

BACKGROUND: In vascular pathology the endothelial lesions easily reflect on blood cells, inducing a reactive state. In the present study the eventual presence of activation signals in leukocytes and platelets was tested. METHODS: Fifty-eight subjects with major vascular pathology and 14 with lower limbs venous insufficiency were studied, together with a control group of 25 normal subjects. Elastase PMN, superoxide ion, leukocytes and subpopulation count, platelet factor 3, clot retraction, heparin in neutralizing activity (HNA plasmatic and intraplatelet), platelet count and volume were tested. RESULTS: As regards leukocytes, it was observed a significative increase of elastase PMN and monocytes number for both the studied pathologies, of superoxide ion and leukocyte number only for major vascular pathology; for platelets, an inhibition of functionality, revealed by clot retraction test for arterious and venous pathologies and by HNA test only for the venous one. CONCLUSIONS: As regards the leukocyte activation, elastase PMN is particularly responsive to the endothelial lesion both in arterious and in venous districts, while superoxide ion appears to increase in presence of a marked alteration. The level of monocytes is indicative of an inflammatory condition and of leukocytes of an atherosclerotic inflammatory process. As for platelets, the test clot retraction is specifically sensible to the endothelial abnormality in both the arterious and venous pathologies with addition of an abnormal HNA test only in venous insufficiency. This platelet dysfunction is probably due to endothelial release of vasoactive and heparin amplifying substances.

Aged↗

PubMed2006

Residency training in anatomic pathology: looking forward in the 21st century.

Residency training in anatomic pathology in the United States elicits a wide range of fundamental questions and conflicting opinions. This paper reflects the author's opinion concerning 4 questions that are often integral to these discussions and impact the outlook on training in the current century. (1) What are the goals of residency training in anatomic pathology? (2) In the face of exponential growth of information in anatomic pathology, how are residents to be trained? (3) What changes are likely to occur in the practice and training of anatomic pathology? (4) Is combined training in anatomic and clinical pathology a viable program for the 21st century?

Humans↗

PubMed2001

Referrals for second opinion in surgical pathology: implications for management of cancer patients in the UK.

OBJECTIVE: To compare patterns of outgoing referral practice from one large district general hospital histopathology (cellular pathology) laboratory to other pathology laboratories. DESIGN: Referral cases for the relevant years were identified via hand searching of consultant referral files and from a central laboratory referral file. A comparison was made of the number and nature of pathology case referrals made to other laboratories in year 1990 with those made in year 1998. SETTING: Large district general hospital pathology laboratory in the UK. RESULTS: A statistically significant increase in the number of cases referred for a second opinion to an outside pathologist was noted, from 60 to 128 cases, representing an increase from 0.35 to 0.56% of total laboratory specimen workload (P=0.0034). In 36 (31.0%) of 116 cases from 1998 the diagnosis was altered, or a confident diagnosis was made where previously there was no definite diagnosis. Five cases with a benign in-house diagnosis had a malignant second opinion diagnosis and five cases with a malignant in-house diagnosis had a benign second opinion diagnosis. The largest single category of referred cases was for classification/grading of malignant lymphoma, comprising 27 (23%) of cases. The mean time delay between receipt of a specimen in the laboratory and issuing of the final report was 22 days (range 7-60 days). Only 25% of the referred cases were reported within 14 days. CONCLUSIONS: Referrals are an important component of pathology practice. In the UK much of this activity is performed on a 'grace and favour' basis between laboratories despite the fact that referral cases are often complex and time consuming for the recipient pathologist and laboratory. Histopathology referrals do not seem to be adequately costed and accounted for in interinstitutional service level agreements within the UK National Health Service.

Biopsy, Needle↗

PubMed1994

Quality improvement practices in clinical and anatomic pathology services. A College of American Pathologists Q-probes study of the program characteristics and performance in 580 institutions.

Participants of the College of American Pathologists Q-Probes program described their quality improvement practices for clinical and anatomic pathology. In 580 institutions, the median time required for a median of 12 indicators of quality was 40 hours/month, with the number of indicators and the time spent directly dependent on bed size (P = .0001). The overwhelming majority of participants reported benefit from their quality improvement programs in terms of patient outcomes, as a management tool, and for risk management. Six indicators in clinical pathology and four indicators in anatomic pathology were used in more than 75% of laboratories, whereas an additional seven indicators in clinical pathology and five in anatomic pathology were used in more than 50% of laboratories. The authors conclude that quality improvement practices are similar among laboratories, and irrespective of increasing regulatory requirements, pathologists and senior laboratory personnel spend large amounts of time for activities that they believe improve the quality of services rendered.

Humans↗

PubMed2002

[Postgraduate medical training in anatomical pathology in Japanese national universities].

In Japan, pathologists are not well recognized as clinicians. There is no nation-wide postgraduate medical training(PGMT) system for anatomical pathology(AP). PGMT of AP is performed in the department of pathology(DP) in the basic medicine(BM) in individual medical schools(MS). However, the main research field of DP of BM has gradually changed from early AP to late experimental pathology(EP), and in the recent years PGMT for AP in MS appears to be performed during intervals between EP, and good PGMT for AP is not available in the majority of MS. The diagnostic pathology division(DPD) in national university hospitals(UH) was established in Tohoku UH in 1972. Since then DPD has been established in 33 of 42 national UHs to date. Moreover, 2-years obligatory system of postgraduate clinical education was set out by the Japanese Ministry of Health, Labor and Welfare in 1994, and was arranged to start from 2004. Under these circumstances, PGMT for AP in the majority of national MSs will likely be performed in DPD of UH. However, there are not sufficient numbers of staff for PGMT usually available in DPD of UH only, and residency program for PGMT in AP has already been established in only 21 of 42 national MS and actual training courses for AP have been started in only 13 of 42 UHs to date. PGMT for AP should be performed mainly in DPD of UH, together with the help of DP of BM, and DPD of related hospitals to obtain sufficient staff, and should be arranged as a 5-year course with initial 2-year and late 3-year training system to obtain board certification by the Japanese Society of Pathology.

Anatomy↗

PubMed2005

Clinical impact and frequency of anatomic pathology errors in cancer diagnoses.

BACKGROUND: To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been poorly characterized to date. METHODS: The authors examined errors in patients who underwent anatomic pathology tests to determine the presence or absence of cancer or precancerous lesions in four hospitals. They analyzed 1 year of retrospective errors detected through a standardized cytologic-histologic correlation process (in which patient same-site cytologic and histologic specimens were compared). Medical record reviews were performed to determine patient outcomes. The authors also measured the institutional frequency, cause (i.e., pathologist interpretation or sampling), and clinical impact of diagnostic cancer errors. RESULTS: The frequency of errors in cancer diagnosis was found to be dependent on the institution (P < 0.001) and ranged from 1.79-9.42% and from 4.87-11.8% of all correlated gynecologic and nongynecologic cases, respectively. A statistically significant association was found between institution and error cause (P < 0.001); the cause of errors resulting from pathologic misinterpretation ranged from 5.0-50.7% (the remainder were due to clinical sampling). A statistically significant association was found between institution and assignment of the clinical impact of error (P < 0.001); the aggregated data demonstrated that for gynecologic and nongynecologic errors, 45% and 39%, respectively, were associated with harm. The pairwise kappa statistic for interobserver agreement on cause of error ranged from 0.118-0.737. CONCLUSIONS: Errors in cancer diagnosis are reported to occur in up to 11.8% of all reviewed cytologic-histologic specimen pairs. To the authors' knowledge, little agreement exists regarding whether pathology errors are secondary to misinterpretation or poor clinical sampling of tissues and whether pathology errors result in serious harm.

Diagnostic Errors↗

PubMed2004

Tissue pathology in undergraduate medical education: atrophy or evolution?

Changes are occurring in undergraduate medical curricula and there is limited published information about how contemporary tissue pathology is taught. The aim of this study was to collect information on this topic and to invite expert opinion about best teaching practice. A postal questionnaire survey of medical schools in the UK was performed, with a response rate of 23/28 schools (82%). The two most striking findings were the variation in teaching and learning strategies between schools and the spirit of the respondents, some relishing the challenges associated with reorganization and some thoroughly demoralized. The main concerns about pathology teaching were a feeling of lack of ownership of the content taught, an overall lack of visibility of tissue pathology in teaching and assessment, and staff shortages. Respondents valued the autopsy as an educational tool but were finding it increasingly difficult to provide. On the other hand, key opportunities for pathology teaching were highlighted through the questionnaire. The potential for developments in information technology and the possibility of creating national forums to develop core curricula and generate e-resources was recognized. The findings of this study will provide a milestone against which future change in pathology education can be measured.

Attitude of Health Personnel↗

PubMed1994

Prospective randomized study of prophylaxis of superficial bladder cancer with epirubicin: the role of a central pathology laboratory. Nara Uro-oncology Research Group. (NUORG).

The preliminary results of a multi-institutional prospective randomized study of the prophylaxis of superficial bladder cancer using epirubicin (protocol NUORG SBT-003) are reported. The subjects were 129 patients with untreated superficial bladder cancer (< or = T1b, < or = G2) who were randomized into 2 groups: a transurethral resection (TUR)-alone group (63 patients) and a TUR + intravesical epirubicin (20 mg/40 ml, 30 times/2 years) group (66 patients). The nonrecurrence rate observed in the epirubicin group was significantly higher than that seen in the control group. To unify the pathological diagnosis, a central pathology laboratory (CPL) was set up for extramural review. The correspondence of the pathological diagnosis of TUR-Bt specimens between the CPL and the local pathology laboratory (LPL) was 70.5% in grading and 51.9% in staging. There was a tendency for overdiagnosis by the LPL for both the grade and the stage of tumors. However, differing interpretations by pathologists seem to exert little influence on the nonrecurrence rate at interim analysis. Further observation will be necessary to clarify the prophylactic efficacy of low-dose, long-term periodic intravesical epirubicin instillation and the influence of the disagreement in pathological findings between the CPL and the LPL on the analysis of the results.

Administration, Intravesical↗

PubMed1990

Integrated expert systems and videodisc in surgical pathology: an overview.

We present an overview of our 6-year experience in the design of expert systems for anatomic pathology. Our practical goal is to help practicing pathologists with learning, teaching, and the task of diagnosis by providing them with dynamic expert knowledge by means of a personal computer. This project could only be undertaken by first addressing a scientific goal: to characterize the problem-solving strategies that expert pathologists use in making a diagnosis and to state them in the logical terms of computer science. Our approach has been to build systems first for experimentation and then for use. The result of our work is an integrated computer-based approach that handles expert knowledge as formal relationships and morphologic images and that uses a number of logical strategies to provide multiple perspectives on diagnostic tasks. Configured as a pathologist's workstation, this approach can be expected to enhance the performance of trained general pathologists and pathologists in training. Lymph node pathology has been used as the prototype domain for this research, but care has been taken to seek a generalized authoring and inference structure that can be applied to other areas of pathology by changing the contents but not the structure itself. Excursions into various surgical pathology specialties suggest that the ways the system is constructed and exercised is fundamentally robust. Such computer-based expert systems can be expected to generate a new standard in the practice of pathology--based on the "gold standard" of classical morphology, but including the coordinated use of new methods from immunology and molecular biology in a multidisciplinary approach to diagnosis when these techniques are relevant. The benefits from this technology can be expected to be widespread with the evolution, refinement, and diffusion of these systems.

Artificial Intelligence↗

PubMed1991

Academic manpower survey of 1990: II. Kinetics in the United States (from the Joint Task Force on Pathology Manpower ASCP/CAP/APC).

Survey data obtained from chairmen of United States departments of pathology shows a continued shortage of faculty, especially those with the MD or MD/PhD degree. Losses of such faculty by responding departments during the 12 months prior to the survey were distributed as follows: retirement, 40 (15.6% of total); disability/death, 19 (7.4%); termination, 23 (8.9%); resignation, 172 (69.3%); and other, 3 (1.2%). Resignations were due primarily to decisions to join another university (41.4%) or to enter private practice (42.5%); a small proportion were due to individuals who left academe for a pathology position in government or industry, or left both academe and pathology for another field. Comparison with a similar survey performed in 1984 suggests that the manpower situation in academic pathology is worsening, especially with respect to physician faculty. An assessment of those factors known to influence manpower kinetics suggests that it will continue to deteriorate for the foreseeable future with an adverse impact on all sectors of pathology.

Education, Medical↗

PubMed1984

The pathologist as a consultant in cancer patient management: a patterns of care study in pathology.

The Committee on the Pathologist as a Consultant in Cancer Patient Management, a committee of the Cancer Committee of the College of American Pathologists, was formed in response to the demands made on pathologists by other medical specialists to function as consultants. The Committee on the Pathologist as a Consultant in Cancer Patient Management has evolved from the Patterns of Care Steering Committee (1979) which in turn was spawned by the Patterns of Care Study initiated by The American College of Radiology (ACR) in 1973. The objective of the ACR was to improve the quality of care by establishing guidelines for the best current management in radiation oncology through a consensus by peers. Pathology is concerned with establishing a diagnosis, providing a rationale for treatment, estimating prognosis, and evaluating outcome. Consequently, the CAP Patterns of Care Study assumed a different form from that of the ACR, adapting itself to the role of the pathologist as a consultant. Its objective, however, remained the same - to improve the quality of care by providing quality assurance of pathology reports dealing with cancer patients. Three task forces, one for each site, have been established. Each is composed of pathologists and other medical specialists from small and large community hospitals, universities, and private office practice. The primary function of each task force is to develop guidelines for data to be included in routine pathology consultation reports. These guidelines include parameters that document adequate examination of the specimen, and those essential elements which can be used to guide selection of therapy, estimate prognosis, and evaluate outcome, such as the pathologic factors required for staging. Data to help establish these guidelines have been obtained in consultation with medical specialists who are members of the task forces, as well as from the medical literature. This entire process will be discussed. Currently there is great concern about improving the quality of medical care, particularly in a cost effective manner. Assuring the quality of consultation reports is yet another way in which pathology can contribute.

Consultants↗

PubMed2005

The extent of dermatopathology education: a comparison of pathology and dermatology.

An indispensable component of all pathology and dermatology residencies is obtaining proficiency in the area of dermatopathology. The purpose of this study is to quantify dermatopathology training in pathology and dermatology residencies and the amount of continuing medical education in dermatopathology in leading journals of both fields. Dermatology residents complete more hours of dermatopathology than pathology residents. There is also more dermatopathology in the dermatology literature than in the pathology literature. Dermatopathology falls into the scope of both pathology and dermatology practice.

Dermatology↗

PubMed2006

Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: analysis for application in the diagnosis of sudden cardiac death with regard to pathology.

Although previous forensic pathological studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction, there appears to be insufficient data with regard to its cardiac pathology. The present study analyzed the heart blood, peripheral blood and pericardial fluid levels of cardiac troponin T (cTnT) in sudden cardiac deaths (n = 96) within 48h postmortem in relation to pathological findings of acute myocardial infarction (AMI, n = 34), recurrent myocardial infarction (RMI, n = 23), ischemic heart disease without any pathological evidence of infarction (IHD, n = 24) and other heart diseases (OHD, n = 15). Control groups (n = 75, survival time <24 h) within 48 h postmortem consisted of asphyxiation (n = 35), drowning (n = 27) and cerebrovascular diseases (n = 13). There was a marked correlation in the cTnT levels between right and left heart blood samples. The pericardial level was usually higher than either heart blood level, and the external iliac venous blood level was the lowest. Although postmortem time-dependent increases in heart and pericardial blood cTnT levels were observed in most groups, they were most evident for AMI and asphyxiation. In the early postmortem period (<12 h) there was no significant difference between AMI or RMI and the other groups except for drowning. After 12 h postmortem, significantly elevated heart blood and pericardial cTnT levels were observed for AMI and RMI showing multiple interstitial hemorrhages and necrosis compared to those with localized eosinophilic changes or patchy interstitial hemorrhages, IHD and OHD. These differences were the smallest for peripheral blood. For sudden cardiac death cases, the difference in cTnT level at each site among the causes of death was independent of gender, age, heart or lung weight and pathologies of affected coronary artery and severity of coronary stenosis. These observations suggest that the elevation in postmortem blood and pericardial cTnT levels in sudden cardiac death may depend on the severity of ischemic myocardial damage including the size and intensity of myocardial lesions involving multiple interstitial hemorrhages and necrosis, and also the postmortem period for heart and pericardial levels.

Adolescent↗

PubMed2001

Relational database structure to manage high-density tissue microarray data and images for pathology studies focusing on clinical outcome: the prostate specialized program of research excellence model.

With the completion of the Human Genome Project and high-throughput screening methods using cDNA array and tissue microarray (TMA) technology, there is a pressing need to manage the voluminous data sets generated from these types of investigations. Herein is described a database model to handle 1) clinical and pathology data, 2) TMA location information, and 3) web-based histology results. The model is useful for managing clinical, pathology, and molecular data on >1300 prostate cancer patients dating back to 1995 from the University of Michigan Specialized Program of Research Excellence for prostate cancer. The key components in this multidatabase model are 1) the TMA database, 2) the TMA-image database (TMA-I DB), and 3) the prostate pathology and clinical information databases. All databases were created in Microsoft Access (Microsoft, Redmond, WA). Desired patient, tissue, block, diagnosis, array location, and respective clinical and pathology information is obtained by linking the unique identifier fields among database tables. The TMA database is comprised of interrelated data from 336 prostate cancer patients transferred into 19 TMA blocks with 5451 TMA biopsy cores. Tissue samples include 1695 normal prostate, 3171 prostate cancer, 464 prostatic intraepithelial neoplasia, and 121 atrophy. All 19 TMA blocks have been analyzed over the Internet for several immunohistochemical biomarkers including E-cadherin, prostate-specific antigen, p27(Kip1), and Ki-67 labeling index. This system facilitates the statistical analysis of high-density TMA data with clinical and pathology information in an efficient and cost-effective manner. Because the review is performed over the Internet, this system is ideal for collaborative multi-institutional studies.

Databases as Topic↗

PubMed1998

Pathology slide review in gynecologic oncology.

OBJECTIVE: To analyze the diagnostic accuracy and alteration in treatment planning from interinstitution (different institution) pathologic consultation. METHODS: We reviewed pathologic reports from 720 referred patients. The diagnosis rendered from a gynecologic pathologist was compared with the original diagnosis. Discrepancies were coded as none, minor, or major. A discrepancy was major if it led to treatment alteration. A discrepancy was minor if it did not lead to treatment alteration. The judgment to declare a discrepancy was made by a gynecologic pathologist, a gynecologist, and three gynecologic oncologists. The review cost was $150 per case. The Cochran-Mantel-Haenszel test evaluated any systematic pattern in discrepancies. RESULTS: Seven hundred twenty specimens consisted of 113 vulvar, 170 uterine, 289 cervical, 105 ovarian, and 43 vaginal tissues. Six hundred one (84%) pathologic diagnoses showed no discrepancy. There were 104 (14%) minor and 15 (2%) major discrepancies. After reviewing 15 major discrepancies, six surgeries were canceled, two surgeries were modified, one adjuvant radiation treatment was added, one chemotherapy treatment was modified, and five adjuvant chemotherapy treatments were cancelled. No systematic error was identified with regard to the sources (tissue origin) or methods of obtaining the specimen (P = .675). The cost of reviewing 720 specimens was $108,000. The cost of identifying each major discrepancy was $7200. CONCLUSION: Reviewing pathology slides before definitive treatment reveals notable discrepancies in diagnoses. The cost of pathology review is globally expensive but has consequential impact on proper treatment planning for the individual patient.

Adult↗

PubMed1988

Perception testing in surgical pathology.

A test predictive of mature pathologic expertise could be of great value in the selection of individuals entering the field. Some individuals may have an aptitude superior to others to discriminate images based on the discovery of distinctive image features. This may enhance their ability to draw pathologic conclusions from clinical images and may favorably affect their performance as pathologists. A form of the Facial Recognition Test was administered to pathology residents and faculty to test this hypothesis. Facial recognition results correlated well with resident performance measured by overall faculty ratings, but only marginally with performance measured by scores on "direct recognition" slides of the American Society of Clinical Pathologists' in-service pathology exams. These preliminary results indicate that testing of visual discrimination may be predictive of resident performance in pathology. A test of this type could eventually be useful in selection and self selection of resident candidates and in development of remedial training for residents experiencing difficulty in learning morphologic interpretation.

Humans↗

PubMed1999

Some thoughts about the past and future of pathology workforce.

Comprehensive information on pathology workforce is currently not available. Prudent planning for pathology Graduate Medical Education (GME) requires more timely data than presently exist. In addition, we lack understanding of workforce kinetics in academic pathology which often serves as a buffer in times of surplus. Although the heads of community hospital and private laboratory groups control the majority of decisions regarding pathology workforce, a database of these decision-makers does not exist. However, information from the most recent published sources strongly suggests that a significant surplus already exists. Furthermore, this position is supported by earlier unpublished work from the 1994-1995 Conjoint Committee on Pathology Enhancement (CCOPE) surveys.

Education, Medical, Graduate↗