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Fetal and Pediatric Pathology Dec 2023Costs for sendout genetic testing on in-patients are billed to the hospital. Turnaround times are several weeks, often extending past the inpatient hospitalization. We...
Costs for sendout genetic testing on in-patients are billed to the hospital. Turnaround times are several weeks, often extending past the inpatient hospitalization. We concurrently reviewed all sendout genetic in-patient test requests over an 18-month period, deferring those that could be obtained as an outpatient, directing the tests to less expensive laboratories with complementary testing profiles, and identifying no-charge sponsored tests. Of 121 test requests, 25 were deferred, alternative less expensive laboratories were identified for 8, 16 requests were directed to sponsored tests, for a 42.3% cost saving. Of the 96 tests sent, 18 (18.8%) identified an explanatory genetic abnormality. Approximately 40% of the sendout genetic testing costs were reduced with prior test review. Deferment, alternative laboratories, and sponsored tests contributed to cost savings. Efficiency of diagnostic inpatient genetic testing was approximately 20%.
Topics: Child; Humans; Genetic Testing; Hospitalization; Laboratories; Pathologists; Pediatrics; Inpatients
PubMed: 37787107
DOI: 10.1080/15513815.2023.2263790 -
Critical Reviews in Clinical Laboratory... Jun 2024No standard tool to measure pathologist workload currently exists. An accurate measure of workload is needed for determining the number of pathologists to be hired,... (Review)
Review
No standard tool to measure pathologist workload currently exists. An accurate measure of workload is needed for determining the number of pathologists to be hired, distributing the workload fairly among pathologists, and assessing the overall cost of pathology consults. Initially, simple tools such as counting cases or slides were used to give an estimate of the workload. More recently, multiple workload models, including relative value units (RVUs), the Royal College of Pathologists (RCP) point system, Level 4 Equivalent (L4E), Work2Quality (W2Q), and the University of Washington, Seattle (UW) slide count method, have been developed. There is no "ideal" model that is universally accepted. The main differences among the models come from the weights assigned to different specimen types, differential calculations for organs, and the capture of additional tasks needed for safe and timely patient care. Academic centers tend to see more complex cases that require extensive sampling and additional testing, while community-based and private laboratories deal more with biopsies. Additionally, some systems do not account for teaching, participation in multidisciplinary rounds, quality assurance activities, and medical oversight. A successful workload model needs to be continually updated to reflect the current state of practice.Awareness about physician burnout has gained attention in recent years and has been added to the World Health Organization's International Classification of Diseases (World Health Organization, WHO) as an occupational phenomenon. However, the extent to which this affects pathologists is not well understood. According to the WHO, burnout syndrome is diagnosed by the presence of three components: emotional exhaustion, depersonalization from one's work (cynicism related to one's job), and a low sense of personal achievement or accomplishment. Three drivers of burnout are the demand for productivity, lack of recognition, and electronic health records. Prominent consequences of physician burnout are economic and personal costs to the public and to the providers.Wellness is physical and mental well-being that allows individuals to manage stress effectively and to thrive in both their professional and personal lives. To achieve wellness, it is necessary to understand the root causes of burnout, including over-work and working under stressful conditions. Wellness is more than the absence of stress or burnout, and the responsibility of wellness should be shared by pathologists themselves, their healthcare organization, and governing bodies. Each pathologist needs to take their own path to achieve wellness.
Topics: Humans; Workload; Burnout, Professional; Pathologists
PubMed: 38809116
DOI: 10.1080/10408363.2023.2285284 -
Clinical Anatomy (New York, N.Y.) Oct 2021William Hunter's writings, lectures and his collection of circa 1,400 pathological specimens at the University of Glasgow show that, within the scientific limitations of...
William Hunter's writings, lectures and his collection of circa 1,400 pathological specimens at the University of Glasgow show that, within the scientific limitations of the 18th Century, he had a sound grasp of the significance of morbid anatomical appearances. Unlike John Hunter's collection at the Royal College of Surgeons of England, few of the Hunterian specimens at Glasgow have an accompanying case history. Within the Special Collections at the Glasgow University Library are a small number of post mortem reports, including four involving William Hunter's aristocratic patients. This article explores these patient cases, and also the only instance recorded by John Hunter of William working with him on a post mortem of an aristocrat, that of the Marquis of Rockingham, Prime Minister, who died in 1782. The study aims to better understand William Hunter's medical practice and his professional connections with other practitioners. The post mortem examinations were carried out by a surgeon/anatomist and observed by the patient's physician(s). For aristocratic post mortems, those attending were senior and well-established practitioners. The notes made were not particularly detailed. The reports show clearly that William Hunter's practice, in the 1760s at least, was not confined to midwifery.
Topics: Anatomists; Dissection; Forensic Medicine; History, 18th Century; Humans; Obstetrics; Pathologists; Scotland
PubMed: 33580903
DOI: 10.1002/ca.23730 -
Archives of Pathology & Laboratory... Aug 2019
Topics: Career Choice; Humans; Pathologists; Pathology, Clinical; Students, Medical
PubMed: 31339753
DOI: 10.5858/arpa.2019-0020-ED -
Brazilian Oral Research 2022Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a... (Review)
Review
Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a lack of research about communication in diagnostic oral and maxillofacial pathology. This narrative review explores different aspects of the quality of communication between clinicians and oral pathologists, with a focus on the diagnosis of oral and maxillofacial diseases. An electronic search was carried out in MEDLINE through the PubMed, Scopus, and Embase databases up to April 2021. No studies reporting communication, its adequacy or the required skills between clinicians and pathologists in oral diagnosis were found. According to studies published in medicine, strategies for improving communication skills include clinician-pathologist collaboration; a well-formatted, clear and thorough report; training in communication skills; and patient-centered care. Further studies evaluating the current practices and quality in oral and maxillofacial pathology are required to identify barriers and encourage optimal communication to facilitate diagnosis, as well as patient safety.
Topics: Communication; Dentists; Humans; Pathologists; Patient-Centered Care
PubMed: 35081226
DOI: 10.1590/1807-3107bor-2022.vol36.0008 -
Arquivos de Gastroenterologia 2021Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis.
BACKGROUND
Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis.
OBJECTIVE
Evaluate the correlation of anatomopathological findings on ileitis between pathologists and endoscopists.
METHODS
A retrospective, cross-sectional study, between 2013 and 2017. Examination report, indications for colonoscopy, and medical records were evaluated to identify whether the colonoscopic findings were clinically significant. Anatomopathological samples were reviewed by a pathologist expert in gastrointestinal tract. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age and those with previous intestinal resections were excluded. The correlation was assessed using the kappa coefficient index.
RESULTS
A total of 5833 colonoscopies were conducted in the study period and 3880 cases were included. Ileal alterations were observed in 206 cases, with 2.94% being clinically significant. A hundred and sixty three biopsies were evaluated using the kappa index, resulting in agreement among pathologists of 0.067 and among pathologist and endoscopist of 0.141.
CONCLUSION
It was observed that despite the low concordance between pathologists and endoscopists, there was no change in patient outcomes. This study confirms the importance of knowledge of the main anatomopathological changes related to ileitis by pathologists and endoscopists, making the best diagnosis and follow-up.
Topics: Adolescent; Adult; Colonoscopy; Cross-Sectional Studies; Humans; Ileitis; Language; Pathologists; Retrospective Studies
PubMed: 34231660
DOI: 10.1590/S0004-2803.202100000-25 -
Journal of Veterinary Diagnostic... May 2023
Topics: Animals; Humans; Pathologists; Pathology, Veterinary; Longitudinal Studies
PubMed: 37151017
DOI: 10.1177/10406387231157703 -
Der Pathologe Dec 2019The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can... (Review)
Review
The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can lead to increased distress and subsequent mental comorbidity such as depression or anxiety disorders. The responsibility of the pathologist, as the person who first uses the label cancer, is high. The pathologist must be conscious and focus not only on the accuracy of the anatomical pathology, but also on the potential influences the wording may have on the mental health of the patient. The word "carcinoma" should only be used in the case of tumors with the respective biological behavior. The example of non-invasive follicular thyroid neoplasm with papillary-like nuclear features shows that changing a label can lead to an improvement in distress and quality of life.
Topics: Adaptation, Psychological; Humans; Mental Health; Neoplasms; Pathologists; Professional-Patient Relations; Psycho-Oncology; Quality of Life; Stress, Psychological
PubMed: 31705241
DOI: 10.1007/s00292-019-00687-6 -
Kidney International May 2020
Topics: Agriculture; Drug-Related Side Effects and Adverse Reactions; Humans; Nephritis, Interstitial; Pathologists; Renal Insufficiency
PubMed: 32331583
DOI: 10.1016/j.kint.2020.01.023 -
Endocrine Pathology Sep 2020Parathyroid gland excision specimens are common and sometimes underestimated cases that many surgical pathologists encounter regularly. In the vast majority of cases,... (Review)
Review
Parathyroid gland excision specimens are common and sometimes underestimated cases that many surgical pathologists encounter regularly. In the vast majority of cases, these will be spot diagnoses of sporadic primary parathyroid adenomas or, perhaps, hyperplasias commonly in the setting of renal failure. However, a small but significant number of parathyroid gland excisions may be due to heritable disease. In most cases, hereditary disease is suspected by the referring clinicians. Nevertheless, a subset of these are undetected which is significant, particularly in the setting of the multiple endocrine neoplasia (MEN), and the hyperparathyroidism jaw tumour (HPT-JT) syndromes. There have been recent advances in recognition of the morphological and immunohistochemical characteristics of these tumours and hyperplasias. While hereditary kindreds are over-represented at specialist referral centres, with awareness of the characteristic clinical and morphological features, the general surgical pathologist is frequently able to suggest the possibility of hereditary parathyroid disease. We therefore provide a succinct guide for pathologists to increase the recognition of hereditary parathyroid disease.
Topics: Diagnosis, Differential; Diagnostic Techniques, Endocrine; Genetic Diseases, Inborn; Humans; Hyperparathyroidism, Primary; Immunohistochemistry; Parathyroid Diseases; Parathyroid Glands; Pathologists; Practice Patterns, Physicians'
PubMed: 32468209
DOI: 10.1007/s12022-020-09631-4