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PubMed1981

Personal usage of medical radiological procedures by radiologists, pathologists, and their families.

The Radiation Registry of Physicians was established to study the biologic effects of prolonged occupational exposure to low levels of ionizing radiation. Questionnaire responses from radiologists and a comparable group of medical specialists, pathologists, provided information about personal and familial exposure to medical radiation. This first report from the 1973 survey of radiologists and pathologists (5077 and 2914 respondents, respectively) shows that a significantly greater percentage of male radiologists, their spouses and their children reported diagnostic and therapeutic radiographic procedures than did male pathologists and their immediate family members. Responses from female physicians show similar relationships but the number of such specialists is too small for meaningful analysis. The exposure differential between radiologists and pathologists suggests that personal medical radiation exposure is an important component of the total x-ray exposure of radiologists.

Data Collection↗

PubMed1998

The role of the pathologist in the diagnosis of melanoma.

The pathologist plays a vital role in patients with malignant melanoma. Dermatologists, surgeons, and oncologists must rely on the pathologist for accurate and complete diagnoses. Although most melanomas can be easily recognized with routine histopathology, special stains, including immunohistochemistry, may be necessary to differentiate melanoma from other cutaneous malignancies. Likewise, there are benign entities that can mimic melanoma microscopically, including Spitz nevi, pigmented spindle cell nevi, deep-penetrating nevi, and Monsel's reaction. Recognition of these entities is important to avoid unnecessary surgery, testing, adjuvant therapy, and unnecessary concern by the patients and their families. In addition to making an accurate diagnosis, the pathologist should report prognostic histologic attributes that may influence therapy and follow-up care for these patients. These histologic features should be recorded in the pathology report. This chapter provides a brief review of the most important histologic attributes that should be identified and reported by the pathologist.

Humans↗

PubMedDate not supplied

Positive economic and diagnostic accuracy impacts of on-site evaluation of fine needle aspiration biopsies by pathologists.

OBJECTIVE: To investigate the impact of pathologists' immediate evaluation of fine needle aspiration biopsy (FNAB) on increasing diagnostic yield and decreasing related expenses. STUDY DESIGN: All FNABs performed at our 420-bed hospital between January 1992 and December 1994 were reviewed. The 1992-1993 FNABs were all performed without pathologist attendance. Smears were wet fixed in 95% alcohol and later stained by the Papanicolaou or hematoxylin and eosin methods. The remaining aspirated material was collected in Saccomano's preservative, and a cell block was made. Nearly all the 1994 FNABs were performed with the pathologist present; he examined air-dried, Diff-Quik-stained smears for preliminary evaluation of the aspirate. An average of three passes were done. The rest of the procedure was as usual. RESULTS: The total number of 1992-1993 FNABs was 227 (108 + 119); of them, 104 (46%) were inadequate for diagnosis. In contrast, the 1994 FNABs totaled 169, with only 40 (24%) inadequate for diagnosis. The vast majority of the aspirates were done on deep-seated lesions under computed tomography (CT) guidance. CONCLUSION: The results of our experience indicate that on-site evaluation by a pathologist greatly increases the diagnostic yield. Another advantage is the significant financial savings as compared to excisional tissue biopsy. In general, the expenses of a CT-guided FNAB (e.g., pancreas) average around $1,400, while charges for excisional biopsy under general anesthesia with a subsequent two- to three-day hospitalization average about $7,720.

Biopsy↗

PubMedDate not supplied

Legal responsibilities of the pathologist.

Pharmaceutical companies exist today in a hostile legal and regulatory environment. The threat of product liability in the pharmaceutical industry has risen to the point where it stifles research and development, especially for contraceptive and psychotropic drugs. Regulatory sanctions against the industry are more likely now than in the past since the Food and Drug Administration (FDA) has placed significant emphasis on regulatory inspection and enforcement. Industrial pathologists play a critical role in defending their company in product liability litigation and from regulatory sanctions. In-house and contract pathologists should be prepared to give expert testimony in court and ensure that an effective document retention policy is implemented. Pathologists should know the limits of the FDA's inspection authority and be aware of the "pitfalls" of the FDA's new Fraud Policy. In addition to keeping abreast of science, industrial pathologists today can best serve the pharmaceutical industry if they maintain an awareness of legal issues that pose a threat to the future success of the industry.

Drug Industry↗

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↗

PubMed1980

International pathologists congruence survey on quantitation of malignant melanoma.

A congruence survey of pathologists in Brisbane, Adelaide, Oslo and Paris on classifying and grading histological features such as dermal invasion, cross-sectional profile, mitotic activity and lymphocytic infiltrate was done on 147 cutaneous melanomas. The overall agreement was about 70%, about one pathologist in three or four disagreeing on each feature. Taking into acount also the considerable number of slides in which agreement was less, the results are considered unsatisfactory. Agreement was highest in cross-sectional profile and least in level of invasion. It is evident that the gradings are subjective and indicate the need for detailed histological description in making the criteria and the necessity of collaboration between pathologists to study slides and clarify problems. Experience is important and the slides must be of high technical excellence. Comparisons of results between different pathologists on the histological quantitations of malignant melanoma should take note of the degree of congruence achievable.

Humans↗

PubMed1993

PEIRS: a pathologist-maintained expert system for the interpretation of chemical pathology reports.

Provision of a comprehensive interpretative service is an important challenge facing chemical pathologists. Attempts to automate report interpretation using expert systems have been limited in the past by the difficulties of rule base maintenance. We have applied a novel knowledge acquisition technique, ripple down rules, in the development of PEIRS (Pathology Expert Interpretative Reporting System), a user-maintained expert system for automating chemical pathology report interpretation. We created over 950 rules for thyroid function tests, arterial blood gases and other test sub-groups in 9 mths of operation. A staff pathologist performed all maintenance tasks as part of his routine duties without any need for computer programming skills. No clerical staff involvement was required. Duplication of rule addition for reports requiring multiple comments was the only limitation to coverage of other high volume test groups. PEIRS is the first expert system for the automated interpretation of a range of chemical pathology reports which operates in routine use without extra staffing requirements. PEIRS does not require "knowledge engineering" expertise. Thus, the knowledge base is flexible and can be easily maintained and updated by the pathologist. Expert systems based on ripple down rules should enable pathologists to provide a comprehensive automated interpretative service within the context of the total testing process.

Chemistry, Clinical↗

PubMed2001

National practice characteristics and utilization of pathologists' assistants.

OBJECTIVE: To obtain descriptive information regarding the practice characteristics and utilization of US pathologists' assistants. DESIGN: A self-administered, mailed, voluntary, anonymous questionnaire was distributed to a cross-sectional sample of 515 US pathologists' assistants registered as members of the American Association of Pathologists' Assistants. The questionnaire contained items relating to subject demographics, practice characteristics, specific task performance, and amount of time spent per day on the performance of specific tasks. Descriptive statistics were used to describe the data in terms of measures of central tendency and dispersion. RESULTS: The response rate was 66.8%. The majority of questionnaires sent and received were from East Coast regions. Of all respondents, 46.6% were women, 57.6% were less than 40 years old, and 60.0% had been practicing 10 years or less. Over half (54.0%) had a master's degree. Almost the entire sample reported working 30 or more hours per week, with 43.4% reporting working more than 40 hours per week. The majority reported earning annual salaries between $56 000 and $75 000. Although task analysis of responses revealed a wide range of responses, the majority of the sample reported spending most of their daily time performing surgical specimen gross examinations (median 300 min/d). Approximately half of respondents also reported spending up to 90 minutes per day on nonspecific tasks such as logging specimens and answering the phone. Most respondents reported spending more daily time on such nonspecific tasks than on autopsy prosection or research. CONCLUSIONS: To our knowledge, this national survey provides the first description of pathologists' assistants across the United States. These data provide a useful tool for tracking changes in the profession.

Cross-Sectional Studies↗

PubMed1983

Can the laboratory director find the pathologists he needs?

Is the pathologist seeking a job the kind of pathologist the laboratory director wants to hire? The author of this article emphasizes that all pathologists, not just residency training program directors, must be aware of changing needs if new pathologists are to possess the necessary qualifications for practice in the 1980s and 1990s.

Hospital Departments↗

PubMed2000

A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA.

To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in a more rigorous academic environment adopting advances in medical informatics.

Consultants↗

PubMed2001

Histological classification of gastric adenocarcinoma for epidemiological research: concordance between pathologists.

Epidemiology of gastric adenocarcinoma suggests that intestinal-type and diffuse-type cancers develop through distinct causal pathways. To examine the differences in risk factors and molecular changes between the histological types, reliable data on histological typing are essential. We evaluated the concordance between two pathologists in assessment of 95 gastric adenocarcinomas for Laurén classification and tumor grade. Two pathologists, each blinded to the other's assessment, reviewed H&E-stained slides of gastric tumor. The responses of the two pathologists for histological type were considered as concordant if they fell on one of the three categories (intestinal type, diffuse type, or other). Tumor grade was classified into three categories (well, moderately, or poorly differentiated). The pathologists agreed on the classification of histological type for 71 of 92 (77%) tumors. Kappa coefficient was 0.59 (95% confidence interval, 0.44-0.73). Concordance for tumor grade was 87%, with a kappa coefficient of 0.72 (95% confidence interval, 0.57-0.87). Both observed concordance and kappa coefficient for histological type and tumor grade were similar across three calendar periods of study. Interobserver agreement was virtually identical between tumors with biopsy specimens only and those with surgical specimens. Although the level of disagreement for histological type observed in this study is comparable with that in other studies, the resulting misclassification would lead to the reduction in observed differences in prevalence and odds ratio estimates between two histological types.

Adenocarcinoma↗

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↗