Biomedical subjects

B Goldberg-Kahn

Publications and source records attributed to B Goldberg-Kahn.

3 recordsLinked to original sources

PubMed1997

Medical informatics training in pathology residency programs.

Computers and information technology are increasingly used by pathologists, necessitating training in such technology in pathology residency programs. We surveyed 176 programs in the United States and Canada to assess informatics training in terms of instructional methods used, computer availability, and type of training offered. Eighty-four programs replied, for a response rate of 48%. Ninety percent of programs reported offering formal informatics training, but only 68% of programs required it. A rotation dedicated to teaching informatics was provided in 24% of the programs; in 44% of programs, informatics was integrated with other rotations. The most common instructional methods used were hands-on experience with microcomputers and the use of tutors. In 94% of programs, computers were available for resident use; in 60%, residents had individual computers assigned to them. Five programs offered a dedicated informatics rotation but did not provide residents with individual computers, and 22 programs required informatics training but did not provide residents with individual computers. Comparison of these data with data from 1993 shows an increase in programs offering (90% vs 84%) or requiring (68% vs 59%) informatics. Fewer programs offer a dedicated rotation (24% vs 31%) or integrate informatics training with other rotations (44% vs 69%). These data suggest that although informatics training is considered important by most training programs, inadequate resources and lack of formal, structured programs may limit training.

Canada↗

PubMed1997

The cost of diagnosis: a comparison of four different strategies in the workup of solitary radiographic lung lesions.

INTRODUCTION: Due to the large numbers of negative results of sputum examinations in the face of malignant disease, we used a decision analytic model to determine whether, and under what conditions, sputum cytology (Spt) might have a cost-effective role to play in the approach to lung lesions. METHODS: We constructed a decision analytic model to compare the utility of Spt, image-directed fine-needle aspiration (FNA), bronchoscopic examination (Bronch), and open biopsy (OBx) in the evaluation of lung lesions. Prevalence and cost data were derived from local databases and diagnosis-related groups. Diagnostic sensitivity (sens) and specificity (spec) of the tests were derived from the literature and local data. Output of the model was lowest cost per correct malignant diagnosis and included surgical treatment costs. We did not attempt to model survival data or morbidity. Sensitivity analyses were performed using cost, test sensitivity, and lesion size variables. RESULTS: In the baseline case, a patient who is a surgical candidate with lesion size 2.8 cm, prevalence of malignancy=0.67, FNA sens=0.95, Bronch sens=0.80, Spt sens=0.51, OBx is the best initial procedure with a cost per correct diagnosis of $12,888. Sputum examination has the highest cost per correct diagnosis of $63,424. FNA and bronchoscopy have cost per correct diagnosis of $21,543 and $16,615, respectively. Sens analysis shows that OBx is the preferred strategy in the workup of lung lesions in patients who are surgical candidates older than 30 years of age. Spt is the preferred strategy only when the patient is not a surgical candidate, the lesion size is large (>4.7 cm), and only if sputum sens is >0.45. CONCLUSIONS: Spt is not cost-effective in clinical practice, except when the patient has a large clinically unresectable lesion and the laboratory can demonstrate sufficient test sens.

Age Factors↗

PubMed1997

Survey of management training in United States and Canadian pathology residency programs.

One hundred seventy-six United States and Canadian pathology residency programs were surveyed to assess the status of management training for residents. Specific questions in the survey concerned approaches to management, instructional methods used, topics covered, and length of management rotations. Eighty-four programs (48%) responded to the survey. This group represented a cross section of all programs as to location, size, and type of program. Of the 84 programs, 81 (96%) offered management training, while 54 programs (64%) offered a management course. Management training usually occurred in combination with other rotations, most frequently clinical pathology subspecialties. A dedicated management rotation was reported in 19 programs (23%). The most common method of instruction was apprenticeship/mentor followed by didactic lecture. A majority of programs used multiple instructional methods. The five most frequently covered topics were budgets, personnel issues, quality assurance, utilization, and instrument evaluation, but a wide variety of topics were included in management curricula surveyed. There was an emphasis on clinical laboratory administration. Nonpathologist instructors, such as medical technologists, hospital administrators, and business executives, were used for formal didactic exercises, while teaching by pathologists occurred predominantly by mentoring during clinical pathology rotations.

Administrative Personnel↗