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PubMed2002

Antineutrophil cytoplasmic autoantibody in the absence of Wegener's granulomatosis or microscopic polyangiitis: implications for the surgical pathologist.

Antineutrophil cytoplasmic antibodies (ANCA) are useful serologic markers for the diagnosis and management of patients with Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA). However, problems in diagnosis and classification may occur when patients with other disorders develop ANCA. A 7-year review (1993-1999) disclosed 247 patients whose sera tested positively for ANCA by an indirect immunofluorescence method: 166 patients for cytoplasmic-ANCA (C-ANCA) and 81 patients for perinuclear-ANCA (P-ANCA) Twenty-seven patients had active pulmonary disease and underwent open-lung biopsy or transbronchial biopsy. Eight patients (30%) had a disease other than WG or MPA, and their clinical, pathological, and serological findings were reviewed. The patients, all women, ranged in age from 28 to 77 years (median, 37 y). Dyspnea (n = 6), cough (n = 6), chest pain (n = 2), and/or hemoptysis (n = 2) were present. The duration of symptoms lasted from 3 weeks to 6 years (median, 6 mo). ANCA titers were C-ANCA (n = 4; range, 1:40-1280) or P-ANCA (n = 4; range, 1:40-640). The lung biopsies disclosed nonspecific interstitial pneumonia (n = 4), bronchiolitis obliterans organizing pneumonia (n = 1), diffuse alveolar damage (n = 1), organizing diffuse alveolar hemorrhage without capillaritis (n = 1), and necrotic granuloma (n = 1). No cases showed characteristic histology for WG or MPA. The final diagnoses were various connective tissue disorders (n = 5), chronic hypersensitivity pneumonia (n = 1), postinfectious bronchitis/bronchiectasis (n = 1), and ulcerative colitis-related lung disease (n = 1). Surgical pathologists should be aware that significantly elevated ANCA titers may be associated with diverse forms of pulmonary disease. ANCA positivity alone, in the absence of appropriate clinical or pathologic findings, should not be used to substantiate a diagnosis of WG or MPA.

Adult↗

PubMed2006

Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists.

To investigate the relationship between survival in colorectal cancer patients and the number of lymph nodes examined by a pathologist, previously attributed to stage migration, we used data from a cohort of 5174 colorectal cancer patients recruited between September 1991 and August 1994, and followed-up for 5 years. We selected cases with data present on all prognostic variables, and stratified them into three groups by number of nodes examined. We made a multivariate survival comparison using a Cox regression model. In all, there were 3592 cases with data present on all prognostic variables. Patients who had >10 nodes identified had a significant survival advantage over those who had 5-10 identified, who had in turn a similar advantage over those with 0-4 identified (P<0.001). This effect was present in the whole group and at all Dukes' stages, although statistically significant only in stages B (P=0.004) and C (P=0.019). The effect remained after adjustment in a Cox regression model in which the mean number of nodes taken out by each surgical firm did not predict survival. In a sub-group with data on lymphocytic infiltration into the primary tumour a survival advantage was noted in those with prominent rather than mild infiltration (P<0.001): the former also tended to have more nodes found (P=0.015). Stage migration alone cannot explain these results, as survival advantages are noted across the whole population independent of stage. Lymphocytic infiltration into the primary tumour is prognostically important, and is associated with the number of nodes found. Reactive enlargement of lymph nodes in the mesentery may make them easier to find, reflect immune response to the tumour, and thus indirectly impact upon survival.

Adenocarcinoma↗

PubMed2004

Speech-language pathologists' opinions on communication disorders and violence.

PURPOSE: This study investigated the opinions of speech-languge pathologists (SLPs) regarding their role, education, and training in serving students with communication disorders who have been involved in violence. METHOD: A survey consisting 26 items was given to 598 SLPs from eight states representing geographic regions of the United States. RESULTS: Participants acknowledged that violence is an increasing concern. They also recognized the valuable role they have in planning prevention programs and serving on multidisciplinary teams. In contrast, SLPs' opinions suggested that they did not feel well trained to deal with violence, nor did, they feel that the communication in violence was understood by SLPs or educators. Comparisons between SLPs from different school and nonschool settings on their education and training and their role in serving this population were not significant. Participants with violence education and training responded significantly more favorably than those without such education and training on planning prevention programs; contributing important information to multidisciplinary teams in planning programs; and the impact of intervention on academics, behavior, and social interactions. Statistically significant findings indicated that both groups disagreed on understanding the role of communication in violence and being trained to provide services. However, findings need to be interpreted cautiously because both groups' means fell within the same categories of agreement/disagreement, and actual differences between groups were small. Quantitative and qualitative findings revealed that education and training are prevalent concerns of SLPs. Their written feedback suggested that SLPs provide critical information as we plan for this population. CLINICAL IMPLICATIONS: Additional education and training are needed in areas such as the role of the SLP in communication and violence, intervention that addresses behavior management, and multicultural issues.

Communication Disorders↗

PubMed2007

The critical shortage of speech-language pathologists in the public school setting: features of the work environment that affect recruitment and retention.

PURPOSE: The primary focus of this study was to elicit the perspectives of speech-language pathologists (SLPs) regarding features of the work environment that contribute to and/or hinder recruitment and retention in the public school setting. METHOD: A questionnaire was distributed to SLPs employed in 10 school districts in Central Florida representing small, medium, and large school districts. The primary goal of the questionnaire was to elicit the perspectives of school-based SLPs regarding (a) factors in the work environment that contribute to retention, (b) factors in the work environment that hinder retention, and (c) issues that may contribute to the recruitment and retention of SLPs in the school setting. A total of 382 questionnaires was obtained, yielding a 64.5% response rate. RESULTS: The participants ranked working with children, school schedule, and educational setting as primary reasons for their satisfaction with working in the public school setting. The participants ranked workload, role ambiguity, salary, and caseload as primary reasons for their dissatisfaction with working in the public school setting. CONCLUSION: Themes emerged from the data that provide insight into several factors that serve as powerful influences in understanding issues of recruitment and retention of SLPs in the public school setting.

Humans↗

PubMed2003

Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists.

The diagnostic criteria used to identify developmental apraxia of speech (DAS) have been at the center of controversy for decades. Despite the difficulty in determining the characteristics that differentiate DAS from other speech acquisition disorders, many children are identified with this disorder. The current report presents the criteria used by 75 speech-language pathologists to establish a diagnosis of DAS. Although 50 different characteristics were identified, 6 of these characteristics accounted for 51.5% of the responses. These characteristics included inconsistent productions, general oral-motor difficulties, groping, inability to imitate sounds, increasing difficulty with increased utterance length, and poor sequencing of sounds. These results are consistent with the general ambiguity of the diagnostic criteria of DAS and suggest that no single deficit is used among clinicians.

Apraxias↗

PubMed2005

Thickened liquids: practice patterns of speech-language pathologists.

This study surveyed the practice patterns of speech-language pathologists in their use of thickened liquids for patients with swallowing difficulties. A 25-item Internet survey about thickened liquids was posted via an e-mail list to members of the American Speech-Language-Hearing Association Division 13, Swallowing and Swallowing Disorders (Dysphagia). Responses of 145 professionals who primarily manage adult dysphagia are reported. Although the majority affirmed that thickening thin liquids was an effective intervention strategy, opinions about effectiveness were more favorable for nectar-thick versus honey-like and spoon-thick consistencies. Respondents also acknowledged that their patients had little liking for thickened liquids. Results highlight issues related to products and staff training, as well as perceptions concerning the factors that might affect patients' acceptance of and compliance with use of the products.

Deglutition↗

PubMed2005

Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist.

The purpose of this study was to examine the various ways in which independent-feeding patients with dysphagia justified their noncompliance with swallowing recommendations suggested by a speech-language pathologist (SLP). Sixty-three independent-feeding dysphagia patients between the ages of 65 and 100 years who had been identified by the SLP or staff as noncompliant with SLP recommendations were interviewed about their reasons for noncompliance. Reasons were classified into 8 categories: (a) denial of a swallowing problem, (b) dissatisfaction with the preparations such as thickened liquids or pureed foods, (c) assuming a calculated risk for noncompliant behaviors, (d) rationalizing their noncompliance in the face of contradictory evidence, (e) minimization of the severity of their problem, (f) verbal accommodation while maintaining noncompliance, (g) projection of blame toward the SLP, and (h) deflection of noncompliance by referring to an external authority. Reasons for noncompliance were discussed in light of theory and research on denial, coping mechanisms, and the social-cognitive transition model. Implications were drawn for SLP practice in dealing with noncompliant independent-feeding patients with dysphagia.

Adaptation, Psychological↗

PubMed2005

Evidence-based practice among speech-language pathologists: attitudes, utilization, and barriers.

A total of 240 speech-language pathologists responded to a questionnaire examining attitudes toward and use of research and evidence-based practice (EBP). Perceived barriers to EBP were also explored. Positive attitudes toward research and EBP were reported. Attitudes were predicted by exposure to research and EBP practice during graduate training and the clinical fellowship year (CFY). Clinical experience and opinions of colleagues were used to guide decision making more frequently than research studies or clinical practice guidelines. Only exposure to research and EBP during the CFY predicted use of evidence-based resources. Respondents reported a decline in exposure to research and EBP as they moved from graduate training into the CFY. A lack of time was perceived as a barrier to EBP.

Attitude of Health Personnel↗

PubMed1979

The speech-language pathologist's role in understanding the genetics of Van der Woude syndrome.

A family report of three generations of Van der Woude syndrome (cleft lip or palate and lip pits) is presented to show that the speech-language pathologist may play an important role in identifying patients with this defect. Understanding the genetic basis of this syndrome and documentation of family history through pedigree analysis can be instrumental in identifying other family members potentially affected with speech disorders. Because the diagnosis of Van der Woude syndrome was made in one member of the family in the pedigree, three other family members who had never received previous diagnosis or treatment of their speech disorders were identified. Other family members were referred for genetic counseling. The concepts of autosomal dominant transmission, variable expression, incomplete penetrance, and the pedigree technique for recording family history are also presented.

Child, Preschool↗

PubMed1980

Articulation norms used by practicing speech-language pathologists in Oregon: results of a survey.

Recent investigations of children's developing articulation abilities indicate substantially earlier ages for speech-sound acquistion as compared to traditional norms. Speech-language pathologists in Oregon were asked which developmental norms they used when assessing articulation development. The majority refer to Templin's 1957 investigation instead of more recent norms. Those respondents who did not use developmental norms reported other factors and sources as useful references when determining articulation status. Clinical implications of these findings are discussed.

Child↗

PubMed1999

A survey of biomedical scientists and consultant pathologists involved in the cervical screening programme.

The past decade has seen a transformation in the National Health Service Cervical Screening Programme (NHSCSP) largely driven by responses to various screening scandals. Independent inquiries into these laboratory failures have identified a number of contributing factors. The aim of this postal survey was to determine how widespread these factors are throughout screening laboratories in England. The results indicate that issues around recruitment and retention of staff, the training of pathologists and low morale appear to be widespread. However, the results do not indicate a widespread breakdown in working relationships between consultants and biomedical scientists, although there is room for improvement in their relationships with hospital management. Finally, there seem to be mixed messages about the commitment of consultants to the screening programme.

Burnout, Professional↗

PubMed1998

Coronary artery remodelling and the assessment of stenosis by pathologists.

When atherosclerotic plaques develop, the cross-sectional area of the artery at that point often increases to accommodate the plaque without any reduction in lumen size. In consequence the angiogram does not detect a high proportion of atherosclerotic plaques. The increase in size of the artery (compensatory dilatation-arterial remodelling) varies widely in degree between different plaques even in the same artery. Dilatation of a degree to prevent any loss of lumen size is regarded as adequate compensatory dilatation. In contrast, other plaques are associated with no or minimal increase in the vessel cross-sectional area and a reduction in lumen size in present (inadequate compensation). High-grade stenosis is in particular associated with a total failure of remodelling. Such plaques may have had a rapid growth phase, out-pacing the ability of the medial smooth muscle cells to undergo a rearrangement. The phenomenon of remodelling has important consequences for pathologists who use the traditional method of comparing the lumen size relative to the cross-sectional area of the vessel at the site of a plaque to measure stenosis. The area of the vessel at this point may be anything up to 60% above its size before the plaque developed. An error is introduced which on average overestimates diameter stenosis by 30% when compared to an angiographic equivalent method in which the lumen size at the lesion is compared to the lumen size at an adjacent segment of artery without a plaque.

Arteriosclerosis↗

PubMed2000

Sentinel node biopsy in breast cancer: recommendations for surgeons, pathologists, nuclear physicians and radiologists in Australia and New Zealand.

BACKGROUND: Assessment of axillary lymph node status is necessary for patients with invasive breast cancer. Sentinel node biopsy is a new minimally invasive technique that may provide accurate assessment of regional lymph node status while limiting the morbidity associated with axillary clearance. METHODS: A workshop conducted in Adelaide in November 1998 aimed to assess current sentinel node mapping and biopsy techniques, and make recommendations regarding its application in the surgical management of early breast cancer in Australia and New Zealand. RESULTS: At the conclusion of the workshop, a consensus was reached regarding indications, exclusions, sentinel node mapping/biopsy technique, nuclear medicine requirements, pathology and safety of sentinel node biopsy in breast cancer. It was agreed that a feasibility study according to an agreed prospective protocol was necessary to validate the technique by breast surgeons. Surgeons that satisfied validation criteria for the feasibility study could then consider a prospective randomized study comparing sentinel node biopsy with standard axillary dissection. CONCLUSIONS: Sentinel node biopsy in breast cancer involves close cooperation between members of a multidisciplinary team including surgeons, nuclear physicians, pathologists and radiologists. Although the technique has the potential to reduce morbidity associated with axillary surgery, surgical performance in this area will need to be closely monitored to ensure that the technique does not fall into disrepute by adversely affecting breast cancer prognosis.

Australia↗

PubMed2001

The microbe, creator of the pathologist: an inter-related history of pathology, microbiology, and infectious disease.

This brief historical review of pathology stresses the impact of microbial discovery on the development of pathology as a medical specialty. If, as it has been said, the microscope invented the pathologist, it was the microbe, especially the pathogenic bacterium, that gave him his name and made him clinically relevant.

Communicable Diseases↗

PubMed2001

Investing in emergent literacy intervention: a key role for speech-language pathologists.

Emergent literacy is a developmental period that is receiving renewed and increased emphasis in the fields of education and speech-language pathology because of its influence on the later literacy development and achievement of students. With their strong background in language, language development, and language disorders, speech-language pathologists (SLPs) can make significant contributions to the acquisition of emergent literacy skills. This article focuses on SLP direct-service roles for students with identified communication impairments and on indirect roles of assisting teachers and others to promote the emergent literacy skills of all students. In addition to the acknowledged importance of general oral language, guidelines, suggestions, and resources are offered to foster emergent literacy skills in five specific areas: (1) early phonological awareness, (2) joint book reading and sense of story, (3) alphabetic letter knowledge, (4) adult modeling of literacy activities, and (5) experience with writing materials.

Awareness↗

PubMed2001

The role of the speech-language pathologist in improving decoding skills.

In this article, we consider the processes and knowledge involved in decoding and present some instructional guidelines and suggestions for teaching students the skills necessary for proficient and fluent word reading. The roles and responsibilities of speech-language pathologists (SLPs) are also considered. It may have been enough several years ago for SLPs to focus solely on early literacy skills and phonological awareness. This is not the case today. SLPs not only need to collaborate with teachers to develop a comprehensive approach to literacy, but also should be providing direct, explicit instruction of decoding skills for students with language and learning disabilities.

Awareness↗

PubMed2001

Spelling and the speech-language pathologist: there's more than meets the eye.

Interest in spelling and spelling difficulties has increased in recent years. Like reading, spelling is no longer viewed as a strictly visual process. Rather, the language basis of spelling is evident in the phonological, orthographic, morphological, and even syntactic knowledge required to be a good speller. Speech-language pathologists (SLPs) have expertise in basic language processes that enable them to play an important role in assessment and intervention for spelling problems. Underscoring the importance of this effort are the serious social and vocational consequences attached to poor spelling and the intractable nature of spelling problems. This article reviews information about spelling-language connections, the nature of spelling problems, and assessment and intervention principles or procedures that represent best practices based on current spelling research. Implications for SLPs working with students who have spelling difficulties are suggested throughout.

Adolescent↗

PubMed2001

New or expanded literacy roles for speech-language pathologists: making it happen in the schools.

As speech-language pathologists (SLPs) working with children and youth are challenged to assume new or expanded roles with reading and writing, those SLPs practicing in the schools face specific barriers for doing so. These obstacles take two forms: individual inhibitors, involving specific people, and system inhibitors, involving the organization at various levels. To overcome these barriers, SLPs need to be proactive and take charge of their own destinies by engaging in specific actions to assume these new or expanded literacy roles. They need to make it happen by using specific tools at their disposal to influence others. These tools include marketing, effective communication, and negotiation.

Educational Status↗