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PubMed1992

Factors affecting the performance of factor VIII coagulant activity assays. Results of proficiency surveys of the College of American Pathologists.

To evaluate sources of interlaboratory variation in factor VIII coagulant assays and the effects of uniform calibration on it, data were analyzed from Survey Set H2-C, 1987, of the College of American Pathologists, Northfield, Ill, into which the College of American Pathologists Reference Preparation for Factor VIII was incorporated. Peer group performance and its improvement by uniform calibration were evaluated by comparing means, precisions, and numbers of acceptable survey scores. Results showed a poorer performance by less experience laboratories and by those that used undesirable calibrators. Substantial improvement was seen with uniform calibration, especially among laboratories that had employed poorer calibrators. Although variance component analysis showed that the type of calibrator was the most important contributor to interlaboratory variation, it accounted for only 10% of total variability. Participant summaries and questionnaires that spanned several years revealed steady improvement in methodology but no striking changes in interlaboratory variation.

Analysis of Variance↗

PubMed2005

Medical malpractice charges in Germany--role of the forensic pathologist in the preliminary criminal proceeding.

Medical malpractice charges from 1989 to 2002 were evaluated. A rising number of cases during this period is evident. The charges of practice falling below the standard of care (n = 285) were surveyed to determine who informed the prosecution, which clinical subjects are involved, what kind of charges can be found and whether such allegations can be appropriately assessed by means of a forensic autopsy. Forensic pathologists were found to be useful for ascertainment and interpretation of autopsy findings. If special questions arise, an additional expert opinion should be suggested by the forensic pathologist. There was no relevant shift in the range of subjects involved compared to former studies. The investigated charges might represent only a small fraction of cases of medical practice falling below the standard of care.

Autopsy↗

PubMed2005

[What to expect from the pathologist in the diagnostics of colorectal cancer? Experience from the clerkships in the US].

Nowadays, surgery still remains the basic treatment modality in the therapy of colorectal cancer. An exact pathological evaluation of the extent of tumour spread and the quality of the resection is also essential for indication of adjuvant therapy and for the assessing prognosis. In the treatment of colorectal cancer, it is precisely this collaboration between the surgeon and pathologist which is fundamental to the multidisciplinary approach. The pathologic examination must concentrate on the macro- and microscopic pathological anatomy, evaluation of lymph node positivity, and presence of micrometastases or other signs of local tumour progression. All these factors can help to establish the prognosis. The standards of pathological examination and methods differ between centres and countries. From personal experience during clerkships in the United States the authors offer an overview of how American pathologists approach examination of colorectal cancer, and which characteristics of the disease are concentrated upon.

Colorectal Neoplasms↗

PubMed2006

[Pathologists' assistant system in Japan].

A pathologists' assistant (PA) is recognized as a well-trained clinical technologist in pathologic examinations. Some nations including the United States and United Kingdom have developed such roles with good results. In Japan, there are some serious problems with the PA system. The most important problem is the limitation of activity, such as cutting specimens and screening biopsy samples. The latter probably conflicts with Japanese medical law. Although a PA system would relieve the burden on pathologists it should be careful to introduce of a PA system in Japan.

Humans↗

PubMedDate not supplied

The role of the pathologist in diagnosing prostate cancer and guiding therapy.

In summary, the role of the pathologist has proven indispensable in diagnosing prostate cancer, planning initial therapy, assessing prognosis, estimating the likely benefit of adjuvant therapy following prostatectomy or radiation therapy, and in following patients for possible recurrent disease. Moreover, the work of pathologists has been pivotal in the research that has lead to our present understanding of the natural history of prostate cancer and the present methods for estimating the likelihood of benefit from various therapies. Such work continues to be integral to scientific advancement in these areas.

Biopsy, Fine-Needle↗

PubMed2006

Enhancing the pathologist's role at hospital tumor boards.

Recommendations are proposed to enhance the role of the pathologist in the hospital-based tumor conference (tumor board). The modifications focus on two components integral to the conference: the presentation of salient pathologic features of each tumor selected for discussion within the time constraints allotted, and the pathologist's role as a principal institutional educator with respect to neoplastic processes. Opportunities to utilize conference presentations as a resource in other educational settings are also considered.

Neoplasms↗

PubMed1990

[Cooperation between the pathologist and surgeon in modern cancer surgery].

Management of up-to-date cancer therapy in strict accordance with histology and stage warrants more than ever a competent co-operation of the pathologist. For this reason the surgical pathologist has to act in dual roles as a diagnostician and consultant. With reference to the internationally acknowledged histological grading and classification of malignant tumors and further the refined principles of the TNM-classification, diagnostic requirements for surgical pathology have considerably been extended in the field of interdisciplinary oncology.

Biopsy↗

PubMed1991

The prevalence of atopy and hypersensitivity to formaldehyde in pathologists.

Sixty-three pathologists in active practice in the province of Alberta, Canada, provided a history regarding atopy and sensitivity to formaldehyde. Serum samples were assayed for total IgE level and the presence of IgE with specificity toward timothy grass, cat, house dust, and formaldehyde. Twenty-nine of the subjects (46.0%) gave a history of atopy that was confirmed in 12 by either IgE level or a positive radioallergosorbent test. Twenty-nine (46.0%) complained of formaldehyde sensitivity. In this study, no pathologist had allergen-specific IgE directed against formaldehyde, and there was no evidence of a tendency for atopic subjects to be more prone to sensitivity to formaldehyde. However, this may be related to a deliberate reduction in exposure by individuals experiencing adverse effects.

Drug Hypersensitivity↗

PubMed1991

Management of vocal nodules: a regional survey of otolaryngologists and speech-language pathologists.

This study surveyed 21 otolaryngologists (70% return) and 32 speech-language pathologists (46% return) in Maine about the treatment of vocal nodules in children and adults, referral patterns, effectiveness of therapy, and adequacy of speech-language pathologists' training. Differences in opinions between the two professional groups were found in treatment of children and referral patterns.

Adult↗

PubMed1990

Understanding pathologists (an exercise in communication): 1. Understanding pathology.

Pathology is a discipline that is often approached with some reserve by nonpathologists. In this four-part series the author aims to 'demystify' the subject. The objective of this first article is to improve understanding of the purposes, limitations and methodology of pathology. In essence the role of the diagnostic histopathologist is to help the clinician help the patient. If, in the request for help, the clinician states clearly why a histological examination is required and gives a relevant history, the pathologist finds it much easier to return a useful report. The subsequent three articles in this series will look in some detail at biopsy techniques, the pathologist's report and special laboratory investigations.

Biopsy↗

PubMed1990

[The most important prospects and tasks in improving the postgraduate instruction of pathologists under perestroika].

It is suggested to reorganize the postgraduate training of pathologists by improving the technical basis of pathology chairs in accordance with modern achievements of medicine and state examinations requirements. The postgraduate training should be continuous and be realized by a self-education and pathologist participation in special courses and teaching cycles with subsequent qualification examination for the 2nd, 1st and highest category (after 5, 7 and 10 years, respectively).

Certification↗

PubMed1989

[The importance of the pathologist to the clinical decision in glomerular diseases].

The indication to treatment of glomerular diseases in adults can only be based on the morphologic findings by light-, immunofluorescent- and electronmicroscopic examination. The majority of clinically diagnosed glomerulonephritides cannot be successfully treated according to current knowledge. Clinical findings, therefore, must help to decide where a biopsy should be performed or where one can do without histologic evidence without any disadvantage for the patient. The diagnosis of "glomerular disease" can be made by examination of erythrocyte morphology in the urine and from urinary protein pattern by poyacrylic-gel-electrophoreses. Having obtained this diagnosis, the indication for biopsy is possible, if a system of clinically defined stage is applied, as acute-, oligosymptomatic- and chronic progressive glomerulonephritis syndrome. A biopsy should be taken in any case of the nephrotic syndrome and urgently in the case of rapidly progressive renal insufficiency. Combined immunosuppressive treatment eventually in conjunction with plasmaphoresis has improved the prognosis of RPGN essentially and a biopsy should then be taken as soon as possible. It would be desirable, therefore, for the clinician if he could get the pathologists findings even on weekends or on holidays, to avoid any delay in starting the treatment. Special treatment regimes usually are chosen according to morphologically defined subgroups of glomerulonephritides. The valuable help of the pathologist in these normal cases becomes most evident, where a histologic finding can't be ascribed to any defined group and no evaluated treatment regimen is available. This is demonstrated by some clinical cases.

Biopsy↗

PubMed1989

High incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital: an epidemiological study.

Between 1935 and 1950 tuberculosis was the most common cause of death in Japan. Subsequently, the mortality rate, incidence, and prevalence of tuberculosis have decreased remarkably due to socioeconomic improvements and development of specific chemotherapy. It has been suspected that the incidence and prevalence of pulmonary tuberculosis in hospital workers, particularly those employed in pathology divisions, may be higher than those for other health care workers. However, there have been no reports on this subject. We conducted a questionnaire survey to assess and compare the incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital with that in other employees of the University. Data on history of treatment for tuberculosis were obtained. The incidence of pulmonary tuberculosis in pathologists was significantly higher than that in other university employees, including clinical doctors who see patients with tuberculosis. These findings suggest that specific environmental conditions in the Pathology Division represent an occupational hazard although the infection might be contracted from other hospital staff.

Adult↗

PubMed1989

Assessment of interlaboratory variability in analytical cytology. Results of the College of American Pathologists Flow Cytometry Study.

In 1986, the College of American Pathologists introduced an interlaboratory proficiency testing program for clinical laboratories that perform flow cytometry. Specimens consisting of fresh human lymphocytes isolated from blood or tissue or neoplastic cells grown in culture were mailed to participants by overnight mail. Results of analyses for cell surface antigens on lymphocytes and for cellular DNA content were reported to the College of American Pathologists Computer Center and the summary data were mailed to participants. The results obtained to date indicate no reagent- or instrument-related biases for measurements of cell surface antigens or for cellular DNA content. Interlaboratory variability in enumerating lymphocytes of a given subset varies inversely with the percentage of such cells in each specimen. In our experience, it is feasible and practical to conduct an interlaboratory proficiency survey in clinical flow cytometry.

Antigens, Surface↗

PubMedDate not supplied

Quality assurance in cytopathology. Recommendations and ongoing quality assurance activities of the American Society of Clinical Pathologists.

The recommendations and activities of the American Society of Clinical Pathologists (ASCP) pertaining to quality assurance in cytopathology are reviewed. To assure the early detection of cervical cancer, the ASCP recommends that all women who are, or have been, sexually active should have an annual Papanicolaou smear examination, the reasons for which are discussed. To assure the optimal quality in the evaluation of these smears, the ASCP recommends that the screening should be performed (1) in an accredited laboratory by certified cytotechnologists, (2) for whom realistic workloads have been established, (3) under the supervision of a pathologist adequately trained in cytology, (4) who will maintain an ongoing quality assurance program. In addition, (5) Papanicolaou smear evaluations should be available to all patients at a reasonable cost and (6) the financial incentives for the performance of low-quality screening should be eliminated. The society's quality assurance activities discussed include the Check Sample program, self-assessment examinations, meetings and publications; planned additions to this arena include a challenge exam and proficiency survey mechanisms.

Cytodiagnosis↗

PubMed1988

The identification and antimicrobial susceptibility testing of Neisseria gonorrhoeae, 1980-1987. Results from the College of American Pathologists Microbiology Surveys Program.

The results of the College of American Pathologists (Skokie, III) Microbiology Surveys from 1980 through 1987 indicate subscriber laboratories have continued to improve their ability to identify and test the antimicrobial susceptibility of Neisseria gonorrhoeae. Bacteriology and Comprehensive Surveys participants correctly identified this organism more frequently (95% to 96%) than did the Basic Surveys Laboratories. Neisseria gonorrhoeae samples in mixed cultures were slightly more difficult (3% to 5% decreased accuracy) to identify. Antimicrobial susceptibility testing by the disk-diffusion and beta-lactamase tests were more accurate (98% to 99%) than minimum inhibitory concentration-dilution methods (92%). Currently, most laboratories use the commercially prepared beta-lactamase reagents and the disk-diffusion test. The National Committee for Clinical Laboratory Standards is currently standardizing methods for the susceptibility testing of several antibiotics against gonococci. The College of American Pathologists Microbiology Surveys will continue to monitor participant accuracy for the identification and resistance recognition of this epidemiologically important pathogen.

Anti-Bacterial Agents↗

PubMed1987

[Role of pathologists in the besieged city of Leningrad (1941-1943)].

The siege of Leningrad by fascist German troops (1941-1942) resulted in an acute food shortage which lead to severe malnutrition in the population and amongst military personnel. In the face of severe nutritional deficiency the majority of illnesses demonstrated a completely atypical clinical course and were thus difficult to diagnose. The results of autopsy first revealed the true underlying cause of death in many cases of bacterial dysentery, atypical pneumonia, generalized tuberculosis and vitamin deficiency in severely emaciated patients. As a result of the work of the Leningrad pathologists, many of whom themselves fell victim to starvation and illness, it was possible to improve the diagnosis and therapy of many disease with atypical courses. Moreover it was possible to institute preventive measures against the spread of epidemics. The overriding lesson from the bitter experience of the Leningrad pathologists is that keeping the peace must be the highest priority of all peoples and for every physician.

History, 20th Century↗

PubMed1988

Proposed goals for analytical precision and accuracy in single-point diagnostic testing. Theoretical basis and comparison with data from College of American Pathologists proficiency surveys.

Expressing total analytic variance as the sum of the squares of imprecision and inaccuracy, or bias, and applying the Cotlove rule recommended by the 1976 College of American Pathologists Conference on Analytical Goals in Clinical Chemistry, namely, that analytic variance should be less than one fourth of the appropriate biological variance, I derive a rule for maximum allowable imprecision in the context of single-point diagnostic testing that takes into account the bias of the test procedure. This rule may be expressed in terms of a population-based reference range (in particular, the range of test results shown in a group of healthy individuals) and the bias of the test method. The latter is required not to exceed one eighth (0.125) of the reference range. These concepts are applied to eight common analytes for which estimates of the biases of specific methods and of within-laboratory imprecision have been published for large numbers of laboratories participating in recent College of American Pathologists proficiency surveys. Results indicate that some methods widely used in 1978 fail to meet the minimum accuracy criterion, while others show negligible bias. Even neglecting bias, more recent data show that average within-laboratory imprecision is still too high for sodium, chloride, and calcium but acceptable for potassium, glucose, cholesterol, urea, and uric acid.

Academies and Institutes↗