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PubMed1977

[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↗

PubMed1983

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↗

PubMed1983

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↗

PubMed1991

Team acceptance of specific recommendations for the treatment of VPI as provided by speech pathologists.

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.

Clinical Protocols↗

PubMedDate not supplied

Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose.

Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)

Acantholysis↗

PubMed1992

Attitudes to specialist recertification: results of a national survey among pathologists.

AIMS: to evaluate attitudes and preferred mechanisms in the establishment of specialist recertification for pathologists. METHODS: a national survey was conducted amongst the membership of the New Zealand Society of Pathologists. RESULTS: responses were received from 54 (62%) financial members of the society. The majority of respondents agreed with the concept of compulsory periodic recertification. The ideal recertification period should be 10 years and the system should be supervised by the New Zealand Society of Pathologists. The favoured recertification mechanism was by continuing medical education which should be funded by the individual candidate. The majority of respondents supported the establishment of voluntary recertification on a trial basis. CONCLUSIONS: the survey suggested a favourable attribute amongst pathologists to the introduction of continuing education based periodic recertification.

Attitude of Health Personnel↗

PubMed1992

[Postgraduate training of pathologists].

Specialization of institutions engaged in training of pathologists is a key condition of skilled specialists turn out. Medical colleges should be responsible for training hospital and junior physicians. Institutes for postgraduate medical education must ensure updating of the practicing pathologists knowledge and prepare them for getting special degrees and diplomas including "European Pathologist". The system of continuous training of pathologists should rest on fundamental legal base which should be warranted by the Russian Federation Ministry of Public Health.

Education, Medical, Continuing↗

PubMedDate not supplied

[Intraoperative extemporaneous examination of the parathyroid gland: what is the role of the pathologist in parathyroid pathology?].

Hyperparathyroidism (HPT), once considered a rare disease, is nowadays observed and diagnosed more frequently. Consequently, surgical treatment of HPT is often performed with good therapeutic results. The success of parathyroid surgery depends mainly on the accuracy of histopathologic diagnosis through intraoperative examination of frozen tissue specimens. Yet, parathyroid gland pathology is very complex and some of its topics even controversial. Terminology and clinico-pathological concepts in this field are constantly changing and even basic characteristics such as weight, stromal fat content and "normal " histologic patterns of these glands are still actively discussed. The pathologist must often determine, merely by studying a small bioptic specimen, not only the parathyroidal (or non-parathyroidal) origin of the examined tissue, but also the histological "normal" or "abnormality" of the tissue. In carrying out his work the experienced pathologist takes on an important task and responsibility in distinguishing between normal, early hyperplastic (asymmetric), hyperplastic or adenomatous parathyroid glands. New diagnostic technical approaches (such as Electron Microscopy, intracellular fat morphometric evaluation, parenchymal cell mass study by density gradient, etc.) enhance the possibility of reaching a reliable pathologic diagnosis, but they do not solve all the present problems and sometimes can even lead the pathologist astray. Presently the diagnosis and treatment of primary HPT should be considered an open and current problem inasmuch as definite criteria to be followed in distinguishing between normal or single enlarged glands microscopically are still lacking. Neither the degree of accuracy of intraoperative frozen section examination during parathyroid surgery nor the possibility of misleading observations in such a study has been fully evaluated. A close cooperation between the pathologist and head and neck surgeon is of utmost importance to assure the best therapeutical results obtainable from parathyroid surgery in HPT.

Adenoma↗

PubMed1991

The pathologist's workstation. Issues and an early prototype.

The role of a pathologist demands the efficient collection, processing and communication of information. Although computerization has been readily adopted in the laboratory to help with specimen processing, educational programs and technological tools for the pathologist's own information handling are at the inception stage. Many pathologists feel their role as a consultant would be enhanced by easy-to-use microcomputer information tools linked to their laboratory databases. This article provides an overview of emerging computer science trends and reviews areas in which a workstation is likely to be useful to the pathologist. A currently operational project embodying some of these concepts is described.

Clinical Laboratory Information Systems↗

PubMed1989

The role of speech language pathologists in the management of dysphagia, 1989.

Speech-language pathologists involved in the management of patients with dysphagia provide services that include evaluation, diagnosis, and rehabilitation. Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits. While dysphagia can afflict any age group, it most often presents among the elderly. Rehabilitation efforts by the speech-language pathologist are undertaken after a medical diagnosis and referral have been made. The dysphagia evaluation begins with a bedside examination that is sometimes followed by a video-fluoroscopic study. The information obtained by the evaluation results in a feeding recommendation by the speech-language pathologist that includes appropriate diet level, amount of intake per swallow, positioning and other facilitating techniques, and swallowing exercises. Patients who are motivated, moderately alert, and have some degree of deglutition are appropriate candidates for dysphagia therapy. Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oromotor control, training in laryngeal adduction and compensatory swallowing techniques, positioning, and dietary modifications. Significant improvement in the swallowing disorder of appropriately selected patients cna be obtained in a rehabilitation program with properly trained and experienced speech-language pathologists.

Deglutition Disorders↗

PubMed1989

[Views of pathologists and clinicians on autopsy].

The study was performed using questionnaires which were filled in by 114 pathologists and 210 clinicians. The pathologists considered the major attractive professional motivations to be the elucidation of clinical aspects and possibility to be engaged in biopsy diagnosis, the most unattractive thing was a small salary. The clinicians supported the view that an autopsy was obligatory, the ratio of supporters to ++nonsupporters among clinicians and pathologists being 2.5:1 and 1:1, respectively. The average expected autopsy cost is 50 levs, but its real one is 84 levs. The overload of dissectors decreases the quality of autopsies and requires the revision of their performance rates. Pathologists's specialization, contact with clinicians, and labour safety are also discussed in the paper. It is only one half of the clinicians who are able to determine which disease is the major one. The death certificates that are filled in by a physician are insignificant (20% of errors are due to improper diagnosis of the major disease). The authors believe that it is high time to set up a national pathoanatomical record office equipped with computers.

Attitude↗

PubMed1992

Cutaneous T-cell lymphoma. Evaluation of pretreatment skin biopsy specimens by a panel of pathologists.

BACKGROUND AND DESIGN: Cutaneous T-cell lymphoma (CTCL) frequently presents a difficult diagnostic challenge for the clinician and pathologist. To assess the diagnostic validity of conventional histopathologic findings in CTCL, pretreatment skin biopsy specimens were scored prospectively and independently by a panel of five to seven dermatopathologists and pathologists. Scores were compared with disease outcome. Repeatability of these scores was examined among observers and for the same observer. The study population consisted of 165 subjects, initially referred for suspected mycosis fungoides or Sézary syndrome. Ninety-two patients determined to have CTCL have been followed up for 6.3 +/- 3.5 years (mean +/- SD) and are categorized according to disease outcome: 22 are in complete remission, 35 are in partial remission, three have progressive lymphoma, 15 died of disease, 13 died of other causes, and four were unavailable for follow-up. Seventy-three patients determined not to have CTCL have been followed up for 5.3 +/- 3.2 years without subsequent clinicopathologic evidence of CTCL. These longitudinal data allowed comparisons of the clinical course with the original histologic interpretations. RESULTS: Data showed that the histologic scores rendered by the pathology panel did not correlate with stage of disease and were not an accurate predictor of clinical outcome, because the histologic ratings did not discriminate between patients who eventually had complete remission and those with either progressive lymphoma or who have died of disease. The results also substantiate the low inherent reliability of histopathologic findings in CTCL. Large differences existed among pathologists in scoring the study populations and repeated reading of selected cases by the same panel member resulted in a change of diagnosis 15% of the time. Among the histologic features evaluated, only the presence of mitoses in the infiltrating cells showed a trend toward an unfavorable outcome. CONCLUSION: Pathologic diagnosis in the CTCL disease spectrum should be interpreted with caution and then only in conjunction with the clinical evaluation. As expected, the use of an average value from a panel of readers added a component of stability to the histologic interpretation.

Biopsy↗

PubMed1976

Common errors made by pathologists in the diagnosis of bone tumors.

The pathologist must obtain X-rays before attempting to make a diagnosis in a bone tumor. Errors are made with both benign and malignant lesions associated with calluses. Infection may stimulate a malignant bone tumor radiographically and pathologically. Secondary aneurysmal bone cyst may dominate the radiographic and pathologic findings and obscure the primary diagnosis. Osteoblastomas are becoming increasingly difficult to diagnose. The question of whether such an entity can become malignant has not been resolved. Cartilagenous tumors are often difficult to diagnose and the pathologist must not only rely on histologic findings, but in particular pay attention to the radiographic pattern which is often diagnostic. Accuracy of diagnosis in Ewing's sarcoma is essential because the treatment now can result in a cure rate of almost 40%. Certain lesions such as lymphoma or osteosarcoma can mimic this tumor. To re-emphasize the problem, the pathologist must have all the clinical information before attempting a diagnosis of a bone tumor and without the pertinent X-ray, errors are almost inevitable.

Adolescent↗

PubMed1986

The pathologists' assistant. Distribution, use, and employer perceptions.

Pathologists' assistants have been formally trained since 1969 to assist in technical anatomic pathology procedures. The authors surveyed 165 assistants who are members of their national organization to determine the actual demographic distribution and patterns of use. One hundred respondents were slightly more concentrated in the eastern United States, usually in pathology groups larger than the national average. Assistants generally performed a large percentage of the autopsy and surgical specimen dissections and various ancillary functions: teaching, supervision, administration, or research. Sixty-six of 82 employer pathologists responded to a companion survey. They were satisfied with the assistant's work. Most hired assistants to free themselves from technical functions or to replace residents, believed that assistants' numbers will remain small, and favored a national certification program. Thus, pathologists' assistants are effectively filling a need for ancillary anatomic pathology personnel in selective situations, primarily in larger pathology practices.

Allied Health Personnel↗

PubMed1988

1987 H. P. Smith award lecture. Eyes for the epidemiologist: the pathologist's role in shaping our understanding of the asbestos-associated diseases.

Asbestosis was first recognized as an entity at autopsy by a pathologist in 1900. Pathologists also discovered the unique relationship of mesothelioma and bronchogenic carcinoma with exposure to asbestos. The observations of preceding pathologists have provided insights that have served as the basis for epidemiologic studies associating asbestos with disease in humans.

Asbestos↗

PubMed1989

The virtuous pathologist. An ethical basis for laboratory medicine.

The profession of pathology is a practice in the technical sense used by many philosophers. Such practices have internal goods, which, it is hoped, lead to the attainment of a certain end. The ultimate end of the practice of pathology must be the good of the patient in terms of restoring health. Key internal goods in pathology are technical competence, the proper pathologist-patient relationship, and the proper pathologist-clinician relationship. Virtues are predispositions to act so as to attain the end of the practice and further the internal goods. Technical growth in the practice of pathology must be accompanied by continued attempts to articulate the goals and internal goods of the practice. Only if pathologists are predisposed to act in accordance with proper goals will an ethical practice be assured.

Ethics, Professional↗

PubMed1989

Professional attitudes toward the autopsy. A survey of clinicians and pathologists.

One hundred six clinicians and 20 pathologists at a pediatric hospital and an adult general hospital in Halifax, Nova Scotia, were surveyed by way of a mailed questionnaire on their attitudes toward the autopsy. Approximately two-thirds of both groups rated the overall usefulness of the autopsy as high, but most limited its benefits to ascertaining the cause of death and as a tool for medical education. The autopsy was rated more highly by pathologists; those who worked in the pediatric hospital; medical rather than surgical specialists; and medical staff rather than housestaff. Personal attitudes toward authorization of an autopsy on a member of the respondent's family or on his or her own body did not differ from declared professional attitudes. It is unclear whether clinicians' and pathologists' negative attitudes toward the autopsy are related to lack of knowledge, lack of hospital and community support of the autopsy, or barriers to the practice of autopsy pathology.

Attitude of Health Personnel↗

PubMed1988

Analysis of agreement among findings of pathologists in ED01 experiment.

The ED01 experiment, which involved determination of the effective dose to produce a 1% tumor rate, was carried out by the National Center for Toxicological Research (NCTR). The study involved greater than 20,000 BALB/c female mice exposed to various doses of 2-acetylaminofluorene, a chemical known to produce bladder and liver carcinomas. After death, tissues from each animal were evaluated for the presence of several types of tumors by one of a team of NCTR pathologists. After the ED01 experiment was completed, the Society of Toxicology commissioned another pathologist to carry out an independent review of the bladder and liver specimens from a stratified sample of the mice. There were substantial differences in the diagnoses of both tumor types by the pathologists, but the implications for detection of a dose-response relationship are important only for liver carcinomas.

2-Acetylaminofluorene↗