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Journal of the American Society of... 2021Primary stakeholders in the Accreditation Council for Graduate Medical Education (ACGME) Milestones Project are: ACGME, Residency Programs, Residents, Fellowship... (Review)
Review
BACKGROUND
Primary stakeholders in the Accreditation Council for Graduate Medical Education (ACGME) Milestones Project are: ACGME, Residency Programs, Residents, Fellowship Programs, Fellows, and Certification Boards. The intent of the Milestones is to describe the educational and professional developmental trajectory of a trainee from the first stages of their postgraduate education through the completion of their clinical training. The Milestones 2.0 project includes changes made based on experience with Milestones 1.0.
METHODS
The ACGME solicited volunteers to participate in the development of subspecialty Milestones 2.0. The workgroup was charged with reviewing/making any additions to the four "Harmonized Milestones", developing subspecialty specific milestones for the Patient Care and Medical Knowledge competencies, and creating a supplemental guide. The Milestones were finalized following review of input from an open comment period.
RESULTS
The Cytopathology Milestones 2.0 will go into effect July 2021. They include additional subcompetencies in the 4 harmonized competency areas and cytopathology-specific edits to the patient care and medical knowledge subcompetencies. Although the number of subcompetencies has increased from 18 to 21, within each subcompetency, the number of milestone trajectories has decreased. Additionally, within each subcompetency, the wording has been streamlined. A supplemental guide was created and Milestones 1.0 were compared to 2.0; however, curriculum mapping has been left to programs to develop.
CONCLUSIONS
The ultimate goal of the Cytopathology Milestones 2.0 is to provide better real-time documentation of the progress of cytopathology fellows. The expected outcome is to produce highly competent cytopathologists, improving the care they provide, regardless of the program at which they trained.
Topics: Biopsy; Cell Biology; Certification; Clinical Competence; Curriculum; Cytological Techniques; Education, Medical, Graduate; Humans; Pathologists; Pathology; Specialization
PubMed: 34167909
DOI: 10.1016/j.jasc.2021.04.003 -
Pathologica Feb 2022Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist's input. Indeed, an accurate and... (Review)
Review
Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist's input. Indeed, an accurate and timely diagnosis is crucial in reporting and grading native liver diseases, evaluating donor liver eligibility and identifying signs of organ injury in the post-transplant follow-up. However, as the procedure is more frequently and widely performed, deceptive and unexplored histopathologic features have emerged with relevant consequences on patient management, particularly when dealing with long-term treatment and weaning of immunosuppression. In this complex and challenging scenario, this review aims to depict the most relevant histopathologic conditions which could be encountered in pediatric liver transplantation. We will tackle the conditions representing the main indications for transplantation in childhood as well as the complications burdening the post-transplant phases, either immunologically ( rejection) or non-immunologically mediated. Lastly, we hope to provide concise, yet significant, suggestions related to innovative pathology techniques in pediatric liver transplantation.
Topics: Child; Humans; Liver Diseases; Liver Transplantation; Living Donors; Pathologists
PubMed: 35212319
DOI: 10.32074/1591-951X-753 -
Modern Pathology : An Official Journal... Jan 2020Inflammatory dermatopathology remains a challenging area for surgical pathologists. Yet every surgical pathologist encounters inflammatory dermatoses as part of routine... (Review)
Review
Inflammatory dermatopathology remains a challenging area for surgical pathologists. Yet every surgical pathologist encounters inflammatory dermatoses as part of routine practice. This review will focus on selected diagnoses that are either commonly encountered in the routine practice of surgical pathology or are critically important. The following entities will be covered: spongiotic dermatoses, lichen simplex chronicus, and early lichen sclerosus in the setting of vulvar biopsies, as well as graft versus host disease, Stevens-Johnson syndrome/toxic epidermal necrolysis, granuloma anulare, pyoderma gangrenosum, and calciphylaxis. Practical points and key histologic features will be emphasized.
Topics: Biopsy; Dermatitis; Diagnosis, Differential; Humans; Pathologists; Predictive Value of Tests; Skin
PubMed: 31676787
DOI: 10.1038/s41379-019-0400-z -
Archives of Pathology & Laboratory... Jun 2022Prostate cancer is a common malignancy, and accurate diagnosis typically requires histologic review of multiple prostate core biopsies per patient. As pathology volumes... (Review)
Review
CONTEXT.—
Prostate cancer is a common malignancy, and accurate diagnosis typically requires histologic review of multiple prostate core biopsies per patient. As pathology volumes and complexity increase, new tools to improve the efficiency of everyday practice are keenly needed. Deep learning has shown promise in pathology diagnostics, but most studies silo the efforts of pathologists from the application of deep learning algorithms. Very few hybrid pathologist-deep learning approaches have been explored, and these typically require complete review of histologic slides by both the pathologist and the deep learning system.
OBJECTIVE.—
To develop a novel and efficient hybrid human-machine learning approach to screen prostate biopsies.
DESIGN.—
We developed an algorithm to determine the 20 regions of interest with the highest probability of malignancy for each prostate biopsy; presenting these regions to a pathologist for manual screening limited the initial review by a pathologist to approximately 2% of the tissue area of each sample. We evaluated this approach by using 100 biopsies (29 malignant, 60 benign, 11 other) that were reviewed by 4 pathologists (3 urologic pathologists, 1 general pathologist) using a custom-designed graphical user interface.
RESULTS.—
Malignant biopsies were correctly identified as needing comprehensive review with high sensitivity (mean, 99.2% among all pathologists); conversely, most benign prostate biopsies (mean, 72.1%) were correctly identified as needing no further review.
CONCLUSIONS.—
This novel hybrid system has the potential to efficiently triage out most benign prostate core biopsies, conserving time for the pathologist to dedicate to detailed evaluation of malignant biopsies.
Topics: Biopsy; Humans; Machine Learning; Male; Pathologists; Prostate; Prostatic Neoplasms
PubMed: 34591085
DOI: 10.5858/arpa.2020-0850-OA -
Advances in Anatomic Pathology Sep 2022Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge,... (Review)
Review
Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge, thorough observation coupled with proper interpretation of subtle additional clinical or histopathologic features provide clues to the correct diagnosis. In this review, we provide updates on emerging entities and develop a systemic approach to establish the pathologic diagnosis, with emphasis on the importance of clinicopathologic correlation.
Topics: Diagnosis, Differential; Humans; Pathologists; Psoriasis
PubMed: 35180737
DOI: 10.1097/PAP.0000000000000333 -
Archives of Pathology & Laboratory... Aug 2023With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of... (Review)
Review
CONTEXT.—
With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case.
OBJECTIVE.—
To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes.
DESIGN.—
We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change.
RESULTS.—
Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month).
CONCLUSIONS.—
Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.
Topics: Humans; Frozen Sections; Pathologists; Pathology, Surgical
PubMed: 36287188
DOI: 10.5858/arpa.2022-0158-OA -
Indian Journal of Pathology &... Jun 2021Newer molecular diagnostics and improved understanding of cancer pathogenesis have identified multiple pathways that can be potentially targeted with the use of novel... (Review)
Review
Newer molecular diagnostics and improved understanding of cancer pathogenesis have identified multiple pathways that can be potentially targeted with the use of novel therapeutics in development. These developments have ushered cancer therapeutics in newer era of personalized medicine. Same is reflected on current management strategies for advanced gastrointestinal malignancies. Molecular profiling for BRAF and RAS is standard for colorectal cancer while Her2 and PDL1 status is needed for planning therapy of advanced gastroesophageal cancers. Tissue agnostic markers like MSI, TMB and NTRK are making headways in therapeutic armamentarium. While newer targeted therapies against FGFR, EGFR, PI3K-AKT, DDR pathways are showing promising results in initial studies. Here we review traditional as well as upcoming molecular markers in field of GI malignancies, methods of testing and evidence for rational use in clinical practice.
Topics: Antineoplastic Agents; Biomarkers, Tumor; Gastrointestinal Neoplasms; Humans; Molecular Targeted Therapy; Mutation; Pathologists; Pathology, Molecular; Precision Medicine
PubMed: 34135137
DOI: 10.4103/IJPM.IJPM_1239_20 -
Journal of the American Society of... 2020Emphasis on the use of small specimens for biomarker testing to provide prognostic and predictive information for guiding clinical management for patients with... (Review)
Review
Emphasis on the use of small specimens for biomarker testing to provide prognostic and predictive information for guiding clinical management for patients with advanced-stage cancer has been increasing. These biomarker tests include molecular analysis, cytogenetic tests, and immunohistochemical assays. Owing to the limited nature of the cellular material procured in these small specimens, which are collected using minimally invasive techniques (ie, fine needle aspiration and core needle biopsy), pathologists have been required to triage these samples judiciously and provide the clinically relevant genomic information required for patient care. Awareness of the advantages and limitations of these specimen preparations and the specific preanalytic requirements for the testing methods will help pathologists to develop optimal strategies to maximize the chances of effectively using these samples for comprehensive diagnostic and relevant biomarker testing.
Topics: Biomarkers, Tumor; Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Health Knowledge, Attitudes, Practice; Humans; Molecular Diagnostic Techniques; Mutation; Neoplasm Staging; Neoplasms; Pathologists; Prognosis; Triage
PubMed: 32507626
DOI: 10.1016/j.jasc.2020.05.001 -
Folia Phoniatrica Et Logopaedica :... 2021Speech-language pathologists (SLPs) work with patients after total laryngectomy (TL) to regain verbal communication. The influence of the quality of the therapeutic...
INTRODUCTION
Speech-language pathologists (SLPs) work with patients after total laryngectomy (TL) to regain verbal communication. The influence of the quality of the therapeutic relationship on the success of TL voice rehabilitation in terms of speech intelligibility is not known. Finding each other likeable is an important factor in establishing and maintaining interpersonal relationships in everyday life. The fit of therapist and client is relevant to the therapeutic relationship. The purpose of this study therefore was to assess the association between the degree of SLPs' likeability ratings and postlaryngectomy speech intelligibility.
METHODS
In a multicentre prospective cohort study, participants rated their SLPs' likeability after finishing TL rehabilitation. Speech intelligibility was measured objectively with the Post-Laryngectomy Telephone Intelligibility Test and subjectively with the Questionnaire for Adjustment after Laryngectomy. The association of SLPs' likeability with speech intelligibility was analysed using hierarchical logistic regression, expressed with odds ratios (OR) with corresponding 95% confidence intervals (CI).
RESULTS
Altogether 124 patients from 13 institutions participated. The degree of finding the SLP likeable was not significantly associated with objective speech intelligibility (OR 1.30; 95% CI 0.78-2.18; p = 0.32) or subjective speech intelligibility (OR 1.01; 95% CI 0.60-1.72; p = 0.96) after controlling for age, sex and education factors.
DISCUSSION/CONCLUSION
In this patient cohort, there was no evidence for an association between ratings of SLPs' likeability and speech intelligibility outcomes after rehabilitation. Future studies could consider the use of alternative instruments for measuring likeability.
Topics: Communication Disorders; Humans; Laryngectomy; Pathologists; Prospective Studies; Speech; Speech Intelligibility; Speech-Language Pathology
PubMed: 33626535
DOI: 10.1159/000513928 -
The Journal of Dermatological Treatment Aug 2022Erroneous diagnoses of melanocytic lesions (benign, atypical, and malignant types) result in inappropriate surgical treatment plans.
BACKGROUND
Erroneous diagnoses of melanocytic lesions (benign, atypical, and malignant types) result in inappropriate surgical treatment plans.
OBJECTIVE
To propose a deep learning (DL)-based fully automated diagnostic method using whole slide images (WSIs) for melanocytic lesions.
METHODS
The method consisted of patch prediction using a DL model and patient diagnosis using an aggregation module. The method was developed with 745 WSIs and evaluated using internal and external testing sets comprising 182 WSIs and 54 WSIs, respectively. The results were compared with those of the classification by one junior and two senior pathologists. Furthermore, we compared the performance of the three pathologists in the classification of melanocytic lesions with and without the assistance of our method.
RESULTS
The method achieved an accuracy of 0.963 and 0.930 on the internal and external testing sets, respectively, which was significantly higher than that of the junior pathologist (0.419 and 0.535). With assistance from the method, all three pathologists achieved higher accuracy on the internal and external testing sets; the accuracy of the junior pathologist increased by 39.0% and 30.2%, respectively ( < .05).
CONCLUSION
This generalizable method can accurately classify melanocytic lesions and effectively improve the diagnostic accuracy of pathologists.
Topics: Deep Learning; Humans; Pathologists
PubMed: 35112978
DOI: 10.1080/09546634.2022.2038772