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PubMed2000

Her Majesty's coroners and home office forensic pathologists perception of the nurses' role in the coroner's enquiry.

A study was performed to elicit the perceived role of the registered nurse in the coroner's enquiry from Her Majesty's coroners and Home Office forensic pathologists viewpoint. A qualitative small sample study of unstructured interviews was performed followed by a quantitative and qualitative survey of all 134 coroners and 44 forensic pathologists practising in England and Wales. 72 (53.5%) coroners and 26 (59.1%) forensic pathologists finally participated in the study of which 51% perceived that there was a role for the nurse in the coroner's enquiry. Roles identified included: actual i. e. keeping records, being conversant with nursing policies and "knowing" ("Knowing" means having knowledge about coroners' enquiries); potential i.e. resource provider, communicator, supporter, presencing, evidence giver and stewardship; and future i. e. certifying the fact of death and being an expert witness. Possible action by the registered nurse to embrace the outcome of this study is put forward.

Attitude of Health Personnel↗

PubMed1980

The general pathologist's role in forensic medicine: the Massachusetts scene.

The Commonwealth of Massachusetts medicolegal system is discussed. The current situation necessitates active participation by general pathologists. The rudimentary skills needed in forensic pathology are delineated. It is emphasized that since medicolegal cases are nationally increasing and since recent comprehensive studies confirm the present shortage of full time forensic pathologists, it is imperative that general pathologists become more involved.

Autopsy↗

PubMed1998

Arthur Purdy Stout (1885-1967), a pioneer of surgical pathology: a survey of his Notes on the Education of an "Oncological" Surgical Pathologist.

Arthur Purdy Stout (1885-1967) started his medical career as a surgical intern and house surgeon at institutions that were to join the Columbia-Presbyterian Medical Center. With virtualy no formal training in pathology and little supervision, he was given the opportunity to work in a laboratory of surgical pathology. He focused his attention on neoplasms and tumor-like conditions, and authored Human Cancer in 1932. This book was organized according to topography of lesions and set a model for the Atlas of Tumor Pathology project. In addition to his many articles and slide seminars, Stout embarked during his "postretirement" years, with the help of residents and fellows, on a systematic study of soft tissue tumors in children. In 1950, he also began his Notes on the Education of an "Oncological" Surgical Pathologist. This manuscript of 427 typewritten pages offers candid details on his development as a surgical pathologist from rather primitive and chaotic beginnings, and on the post-World War II rise of surgical pathology. Notes provides interesting glimpses of his rapidly changing world, particularly of New York, the College of Physicians and Surgeons of Columbia University, and other pathologists. It also portrays an individual absorbed by his work and intent on leaving behind the legacy of a pioneer in the field of surgical pathology.

Academic Medical Centers↗

PubMed2000

Ubiquitin immunochemistry as a diagnostic aid for community pathologists evaluating patients who have dementia.

Alzheimer's disease is the most common cause of dementia It is associated with genetic risk factors and at least three autosomal dominant mutations. Community pathologists are frequently asked by families to evaluate autopsy material for Alzheimer's disease. Neuropathologic diagnosis is based on technically difficult silver impregnation stains that may not be readily available to community-based pathologists. Because immunohistochemical techniques are more widely accessible, we evaluated the practical utility of using a single immunohistochemical stain for diagnosing Alzheimer's disease. The ubiquitin antigen was selected because of its presence in morphologically distinct deposits characteristic of several neurodegenerative diseases. Paraffin blocks were obtained from the Bryan Alzheimer's Disease Research Center Brain Bank, a repository of approximately 900 brains. Tissues from 16 individuals who exhibited the entire range of Alzheimer's-type neuropathology were selected. Ubiquitin immunostains, evaluated blindly and independently by four pathologists ranging from first-year resident trainee to experienced neuropathologist, reliably stained both neuritic plaques and neurofibrillary tangles essential for diagnosing and staging Alzheimer's disease. Nondemented controls with early Alzheimer's-type changes were easily distinguished from cases of definitive Alzheimer's disease. The stains also highlighted characteristic inclusions of Parkinson's disease or Lewy body dementia Ubiquitin immunohistochemistry is a reliable, reproducible, and readily available diagnostic aid for distinguishing Alzheimer's disease from other causes of dementia.

Aged↗

PubMed1982

Speech-language pathologists' connotations of stuttering.

In a study to elicit clinicians' connotative meanings regarding stuttering, 206 practicing speech-language pathologists participated. A semantic differential technique was utilized for gathering responses to seven concepts in the domain of stuttering on five meaning dimensions. The background variables of clinicians' age, academic degree, clinical experience, ASHA certification, and academic coursework in stuttering were also measured. Results indicated that increasing age, higher degrees, more coursework, or more clinical experience did not produce more positive connotations among speech-language pathologists. Those holding the Certificate of Clinical Competence in Speech-Language Pathology showed more positive connotative responses than the noncertified group. Speech-language pathologists do respond differently on meaning dimensions for concepts in the domain of stuttering. The concept stuttering was evaluated more positively than all others, whereas the concept stuttering therapy was evaluated more negatively than any of the other six. Concepts which referred to individuals who stutter were viewed in a similar negative way regardless of age or sex. The subjects did not respond to the concept parents of stutters as negatively as they did toward those who stutter.

Adult↗

PubMed1997

The speech-language pathologist's role in stuttering self-help groups.

This article reviews definitions of self-help and support groups, describes some basic views that speech-language pathologists and self-help groups have of each other, then comments on ways in which professionals are relating to self-help groups. These comments are based on answers to a questionnaire distributed to a sample of speech-language pathologists who interact with self-help groups. It is recommended that speech-language pathologists should relate to the self-help movement in stuttering as consultants.

Cooperative Behavior↗

PubMed1995

Surgical pathology examination of lymph nodes. Practice survey by American Society of Clinical Pathologists.

The American Society of Clinical Pathologists surveyed 363 pathologists to determine practices used in processing and reporting lymph node specimens submitted for surgical pathology examination. This topic is of interest because lymph nodes are some of the more common organs biopsied for diagnostic purposes and the constant change in and diversity of classification systems in the past 30 years. The definition of newly recognized entities and the use of sophisticated diagnostic tools also have made it difficult for there to be a solid consensus of pathologists in diagnosing lymphoproliferative disorders for correlation with clinical behavior and response to therapy. The survey, conducted in November 1992, contained 79 questions. Participants were selected to represent a variety of practice settings and 179 (49%) responses were received.

Biopsy, Needle↗

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↗

PubMed1993

The reliability of autopsy diagnostics: inter-observer variation between pathologists, a preliminary report.

The aim of the study was to analyse the agreement between pathologists regarding macroscopic autopsy diagnostics. Four pathologists examined 35 autopsies and determined the principal disease and its complications, the immediate cause of death, other major diseases and their complications, and minor diseases. The participants were paired and their diagnoses were analysed by using kappa statistics for interobserver variation. The agreement on the principal disease was almost perfect between the participants (kappa values between 0.83 and 0.97), whereas that on the immediate cause of death was moderate/substantial (kappa values between 0.43-0.75). The list of all other major diseases and their complications was almost complete for each observer, but that of the minor diseases showed a more considerable variation. In spite of the high level of agreement it is recommended that the autopsy findings be discussed among pathologists if the clinical picture cannot be explained satisfactorily, and that the cause of death be determined by the clinicians after the demonstration of the autopsy.

Autopsy↗

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↗

PubMed2001

Survey of forensic pathologists.

A survey of board-certified forensic pathologists (from a list of board-certified forensic pathologists supplied by the American Board of Pathology) was conducted to determine their current practice situations. The purpose of the survey was to provide information useful to the public in general and to those organizations that represent forensic pathologists in particular to better understand and meet the needs of the forensic pathology community. A total of 773 surveys were mailed, and 18 were returned as undeliverable. There were 337 replies (45%). Responses were as follows: In terms of age, 7% were in their 30s; 32% were in their 40s; 29% were in their 50s; 19% were in their 60s; and 13% were 70 years of age or older. In terms of gender, 79% were male and 21% were female. For pathology practice status, 72% worked more than 30 hours per week; 11% between 5 and 30 hours per week; 5% less than 5 hours per week; and 12% no longer practice pathology. For percentage of pathology practice that is forensic pathology, 69% of respondents were more than 80%; 6% were 50%-80%; 5% were 25%-50%; 8% were 5%-25%; and 12% were less than 5%. In terms of forensic pathology practice setting, 54% were employed by medical examiner or coroner systems; 13% worked under contract to medical examiner or coroner systems; 27% worked in private practice or consultation; and 6% responded as "other."

Adult↗

PubMed1999

Evaluation of gastric biopsies for neoplasia: differences between Japanese and Western pathologists.

Cited variations in the evaluation of gastric endoscopic biopsies for neoplasms between pathologists in Japan and those in the United States and Europe (the West) may have stemmed from several causes. The five-tiered group classification of the Japanese Research Society for Gastric Cancer (JRSGC) for interpretation of biopsies is not used in the West. Some differences may also exist in the morphologic criteria to reach a diagnosis of dysplasia or carcinoma. The goals of this study were to test the Western and Japanese classifications of gastric dysplasia and adenocarcinoma and to assess the differences between four Japanese and seven Western pathologists. One hundred biopsies, 20 from each of the five categories of the JRSGC scheme as determined by one observer, were collected. The Japanese observers used the JRSGC system, expressed in Roman numerals, whereas Western pathologists used a five- or six-tiered scheme expressed in diagnostic terms. Pairwise agreement was evaluated using k statistics within both groups. Consensus diagnosis on each biopsy was accepted as the opinion of the majority. The sensitivity and specificity of each reviewer for a certain diagnosis were also assessed. The intragroup agreements were moderate for both the Japanese (mean k = 0.663) and the Westerners (mean k = 0.652). The pairwise agreements between Japanese and Western observers were low (mean k = 0.542). Overall, the sensitivity was low for all Japanese observers for the diagnosis of dysplasia (38.7% vs 92.5%), and the sensitivity for the diagnosis of adenocarcinoma was high in both groups but higher among the Japanese observers (93.9% and 85.2%, respectively). Overall, the Japanese-Western interobserver agreement was moderate. The JRSCG scheme did not translate into higher interobserver agreement among Japanese observers. The sensitivity for the diagnosis of gastric adenocarcinoma was high for both groups, but the specificity was low among the Japanese. The cause seemed to be centered around the diagnosis of dysplasia in the Western system, which was a lesion frequently interpreted as carcinoma in Japan because of the different definitions of carcinoma in each system. Such a discrepancy might be important because it may explain some of the differences in the prevalence and prognosis of early gastric cancer between Japan and the West. An international effort is needed to harmonize morphologic criteria and analyze whether therapeutic consequences may stem from such discrepancies.

Biopsy↗

PubMed1996

Speech outcome following palatoplasty in primary school children: do lay peer observers agree with speech pathologists?

The aim of this study was twofold: (1) to test the ability of normal children to discriminate the speech of children with repaired cleft palate from the speech of unaffected peers and (2) to compare these naive assessments of speech acceptability with the sophisticated assessments of speech pathologists. The study group (subjects) was composed of 21 children of school age (aged 8 to 12 years) who had undergone palatoplasty at a single cleft center and 16 matched controls. The listening team (student raters) was composed of 20 children who were matched to the subjects for age, sex, and other variables. Randomized master audio-tape recordings of the children who had undergone palatoplasty were presented in blinded fashion and random order to student raters who were inexperienced in the evaluation of patients with speech dysfunction. The same sound recordings were evaluated by an experienced panel of extramural speech pathologists whose intrarater and interrater reliabilities were known; they were not direct care providers. Additionally, the master tape was presented in blinded fashion and random order to the velopharyngeal staff at the cleft center for intramural assessment. Comparison of these assessment methodologies forms the basis of this report. Naive raters were insensitive to speech differences in the control and cleft palate groups. Differences in the mean scores for the groups never approached statistical significance, and there was adequate power to discern a difference of 0.75 on a 7-point scale. Expert raters were sensitive to differences in resonance and intelligibility in the control and cleft palate groups but not to other aspects of speech. The expert raters recommended further evaluation of cleft palate patients more often than control patients. Speech pathologists discern differences that the laity does not. Consideration should be given to the utilization of untrained listeners to add real-life significance to clinical speech assessments. Peer group evaluations of speech acceptability may define the morbidity of cleft palate speech in terms that are most relevant to the patients themselves and may safeguard against the possibility of offering treatment that may be unnecessary.

Child↗

PubMed2000

Mammographic densities and the prevalence and incidence of histological types of benign breast disease. Reference Pathologists of the Canadian National Breast Screening Study.

There is now a large amount of evidence indicating that women with extensive areas of mammographic densities are 4-6 times more likely to develop breast cancer than those with little or no density in the mammogram. We have examined one potential biological explanation for this association by estimating the incidence of various histological types of benign breast disease in relation to mammographic density. We studied the large cohort of women taking part in the National Breast Screening Study (NBSS), a randomized trial of screening with mammography. Mammograms from subjects with biopsies (n = 423) and from a comparison group of subjects randomly selected from the NBSS (n = 465) were included. Histological slides from biopsied subjects (n = 353) were classified independently by the pathologists of the NBSS and by a review pathologist (H.M.J.). Mammographic density in more than 75% of the breast area was associated with an increased risk of incidence of hyperplasia without atypia, and of atypical hyperplasia and/or carcinoma in situ. The classifications of the review pathologist showed that, compared to women with no density, the relative risk of incident lesions for women with density in more than 75% of breast was 13.85 (95% CI 2.65-72.49) for hyperplasia, and 9.23 (95% CI 1.66-51.48) for atypical hyperplasia and/or carcinoma in situ. These findings suggest that the association between extensive mammographic density and breast cancer risk may, at least in part, be attributable to biological processes in the breast that give rise to these histological features that are known to be related to breast cancer risk.

Adult↗

PubMed1987

Inter- and intra-pathologist variability in histologic diagnoses of lung cancer.

To estimate variability and reliability in histologic diagnosis (Dx) of lung cancers, lung cancer preparations were divided into eight equal sets and diagnosed independently by an eight-man pathology panel. Majority Dx (Dx affirmed by more than 4 panelists) was regarded as the consensus Dx of each cancer. The consensus rate of each panelist ranged from 78.8% to 96.1% with an average of 89.4%. The consensus rates were not significantly different among the panelists. Relatively high inter-pathologist agreement was observed in squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. However, regarding large cell carcinoma, there was occasional disagreement among the panelists. Forty-seven cancers were reexamined by the same panelists, with no preliminary announcement, 7 months after the first examination to study the intra-pathologist agreement. The rate of the intra-pathologist agreement ranged from 76.6% to 93.3%. Dx of large cell carcinoma was the most intra-changeable. It was concluded that the histologic Dx of large cell carcinoma was the most inter- and intra-changeable, and the most frequent dissenting Dx from it was poorly differentiated squamous cell carcinoma.

Adenocarcinoma↗