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Pathology, Research and Practice Mar 2021
Topics: Autopsy; COVID-19; Fibroblasts; Humans; Pathologists; SARS-CoV-2
PubMed: 33561763
DOI: 10.1016/j.prp.2021.153353 -
Indian Journal of Medical Ethics 2020The basic tenets of medical ethics are: autonomy of the patient, beneficence, non-maleficence and justice. These are usually interpreted in the light of the practice of... (Review)
Review
The basic tenets of medical ethics are: autonomy of the patient, beneficence, non-maleficence and justice. These are usually interpreted in the light of the practice of clinical medicine but also apply to pathology and laboratory medicine, a field in which there is often no direct patient contact. We wished to evaluate these basic tenets of medical ethics with respect to laboratory medicine and to provide insights into some of the issues that laboratory physicians, in routine practice and in academia, face on a regular basis. This was done by using the published literature related to the topic of medical ethics, with a special focus on laboratory medicine, as well as the authors' interpretations and opinions, based on their experience. We conclude that the idea of autonomy of the patient or research participant is pertinent with respect to specimens, autopsies and in legal issues such as consent for publication in the media and social media. Beneficence is relevant with respect to laboratory values in reports, financial issues and in research and education. The concept of non-maleficence is important from the point of view of doing no harm, communication with patients and colleagues, reducing/containing error and misdiagnosis in medicine, screening for disease and in over diagnosis. Justice is applicable to issues of distribution of resources and manpower, and their equitable usage. Many of the tenets, however, need to be interpreted in the light of local laws and customs which differ across the world. We conclude with an Oath for pathologists and laboratory physicians. Key words: medical ethics, misconduct, autonomy, beneficence, non-maleficence, justice, informed consent, medical research, oaths.
Topics: Beneficence; Ethics, Medical; Humans; Informed Consent; Laboratories; Pathologists; Personal Autonomy
PubMed: 32103817
DOI: 10.20529/IJME.2020.02 -
Pathologica Feb 2021Inflammatory bowel diseases (IBDs) are lifelong disorders in which an interaction between genetic and environmental factors is involved. IBDs include two entities:... (Review)
Review
Inflammatory bowel diseases (IBDs) are lifelong disorders in which an interaction between genetic and environmental factors is involved. IBDs include two entities: Crohn's disease (CD) and ulcerative colitis (UC); these can be adequately diagnosed and distinguished with a correct methodological approach based on communicating exhaustive clinical, endoscopic and laboratory information to the pathologist and performing adequate bioptic sampling and precise morphological signs including crypt architecture, distribution of inflammation and granulomas, when present. IBD needs to be distinguished from non-IBD colitis, mostly at its onset. Moreover, IBDs are associated with an increased risk of developing colorectal adenocarcinoma. In daily pathological practice, correct diagnosis of IBD and its subclassification as well as a correct detection of dysplasia is imperative to establish the best therapeutic approach.
Topics: Colitis; Humans; Inflammatory Bowel Diseases; Italy; Pathologists
PubMed: 33686309
DOI: 10.32074/1591-951X-235 -
American Journal of Clinical Pathology Oct 2020"Assurance behaviors," a type of defensive medicine, involve physicians' utilization of additional patient services to avoid adverse legal outcomes. We aim to compare...
OBJECTIVES
"Assurance behaviors," a type of defensive medicine, involve physicians' utilization of additional patient services to avoid adverse legal outcomes. We aim to compare the use of clinical behaviors (such as ordering additional tests, services, and consultations) due to malpractice concerns with the same behaviors due to patient safety concerns.
METHODS
A national sample of dermatopathologists (n = 160) completed an online survey.
RESULTS
Participants reported using one or more of five clinical behaviors due to concerns about medical malpractice (95%) and patient safety (99%). Self-reported use of clinical behaviors due to malpractice concerns and patient safety concerns was compared, including ordering additional immunohistochemistry/molecular tests (71% vs 90%, respectively, P < .0001), recommending additional surgical sampling (78% vs 91%, P < .0001), requesting additional slides (81% vs 95%, P < .0001), obtaining second reviews (78% vs 91%, P < .0001), and adding caveats into reports regarding lesion difficulty (85% vs 89%, P > .05).
CONCLUSIONS
Dermatopathologists use many clinical behaviors both as assurance behaviors and due to patient safety concerns, with a higher proportion reporting patient safety concerns as a motivation for specific behaviors.
Topics: Attitude of Health Personnel; Defensive Medicine; Health Care Surveys; Humans; Malpractice; Pathologists; Patient Safety; Practice Patterns, Physicians'; Skin; Skin Diseases
PubMed: 32651589
DOI: 10.1093/ajcp/aqaa088 -
Pathologie (Heidelberg, Germany) Feb 2024Awards provide their recipients with fame and recognition, and subsequently facilitate publications and acquisition of external funding through increased visibility. We...
BACKGROUND
Awards provide their recipients with fame and recognition, and subsequently facilitate publications and acquisition of external funding through increased visibility. We hypothesize that despite increasing representation in pathology, women are underrepresented as awardees in the German Society of Pathology and consequently there is an associated imbalance between genders.
MATERIAL AND METHODS
Published data from the German Society of Pathology on female awardees during the period from 2000 to 2022 were examined. Only awards specifically dedicated to the field of pathology were considered. In addition, the publicly available data of the German Medical Association on gender and age distribution of pathologists in Germany were considered as reference material.
RESULTS
A total of six different awards were included in the analysis. Among the 143 awardees across 150 individual awards in the period from 2000 to 2022, 55 (38.4%) of the awardees were female compared to an average percentage of 31% of women working in the field of pathology in the 23-year period under consideration. Consequently, female awardees in pathology were not underrepresented when compared to the national figures on the proportion of women in the field of pathology. However, the distribution of female awardees across individual awards suggests that women were increasingly represented in less prestigious research and doctoral awards, while men made up a large proportion of awardees of honorary awards (0% women) and prestigious awards (17% women).
Topics: Humans; Male; Female; Societies, Medical; Physicians; Publications; Awards and Prizes; Pathologists
PubMed: 37861701
DOI: 10.1007/s00292-023-01239-9 -
Archives of Pathology & Laboratory... Jan 2024Clinical management of endometrial carcinoma largely depends on the morphologic parameters ascertained based on the pathologic evaluation of surgical resection... (Review)
Review
CONTEXT.—
Clinical management of endometrial carcinoma largely depends on the morphologic parameters ascertained based on the pathologic evaluation of surgical resection specimens. However, there are numerous controversial and nonstandardized aspects of both the macroscopic and microscopic assessment of surgical specimens, including grossing, adequate sampling, diagnosis, staging, reporting, and ancillary testing.
OBJECTIVE.—
To provide a comprehensive practical review of standardized grossing, key morphologic findings for reporting and staging, and diagnostic and prognostic use of ancillary testing in endometrial carcinomas.
DATA SOURCES.—
The existing literature, recommendations of the International Society of Gynecological Pathologists, and specialty consensus guidelines.
CONCLUSIONS.—
This review article summarizes important aspects of the grossing and sampling of surgical resection specimens for microscopic examination, key morphologic parameters that are required for reporting and staging, and morphologic features and immunoprofiles helpful in the differential diagnosis of low-grade and high-grade endometrial carcinomas, as well as the current status of the molecular classification of endometrial carcinoma and human epidermal growth factor receptor 2 testing in serous carcinoma. The information presented herein can be helpful in overcoming diagnostic challenges and issues related to the pathology reporting of endometrial carcinoma to practicing anatomic pathologists.
Topics: Female; Humans; Endometrial Neoplasms; Gynecology; Prognosis; Societies, Medical; Pathologists
PubMed: 36943242
DOI: 10.5858/arpa.2022-0280-RA -
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 -
ESMO Open Aug 2023Biomarker tests in lung cancer have been traditionally ordered by the treating oncologist upon confirmation of an appropriate pathological diagnosis. The delay this...
Biomarker tests in lung cancer have been traditionally ordered by the treating oncologist upon confirmation of an appropriate pathological diagnosis. The delay this introduces prolongs yet further what is already a complex, multi-stage, pre-treatment pathway and delays the start of first-line systemic treatment, which is crucially informed by the results of such analysis. Reflex testing, in which the responsibility for testing for an agreed range of biomarkers lies with the pathologist, has been shown to standardise and expedite the process. Twelve experts discussed the rationale and considerations for implementing reflex testing as standard clinical practice.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Consensus; Pathologists; Biomarkers, Tumor; Reflex
PubMed: 37356358
DOI: 10.1016/j.esmoop.2023.101587 -
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