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AMA Journal of Ethics Aug 2016The 2015 Institute of Medicine report on diagnostic error has placed a national spotlight on the importance of improving communication among clinicians and between...
The 2015 Institute of Medicine report on diagnostic error has placed a national spotlight on the importance of improving communication among clinicians and between clinicians and patients [1]. The report emphasizes the critical role that communication plays in patient safety and outlines ways that pathologists can support this process. Despite recognition of communication as an essential element in patient care, pathologists currently undergo limited (if any) formal training in communication skills. To address this gap, we at the University of Washington Medical Center developed communication training with the goal of establishing best practice procedures for effective pathology communication. The course includes lectures, role playing, and simulated clinician-pathologist interactions for training and evaluation of pathology communication performance. Providing communication training can help create reliable communication pathways that anticipate and address potential barriers and errors before they happen.
Topics: Communication; Curriculum; Humans; Interprofessional Relations; Pathologists; Pathology; Physician-Patient Relations; Schools, Medical; Washington
PubMed: 27550564
DOI: 10.1001/journalofethics.2016.18.8.medu1-1608 -
Pathologica Oct 2023The crucial role of pathologists in enhancing our understanding of SARS-CoV-2-related disease, from initial pneumonia manifestations to persistent long COVID lung... (Review)
Review
The crucial role of pathologists in enhancing our understanding of SARS-CoV-2-related disease, from initial pneumonia manifestations to persistent long COVID lung symptoms, is the focus of this review. Pathological explorations have offered unprecedented insights into the early stages of severe COVID-19, shedding light on the interplay between the virus and subsequent complications, thereby shaping clinical approaches. Growing interest is directed to residual lung abnormalities of COVID-19 survivors. Although various radiological studies reported long-lasting pulmonary changes (e.g., ground glass opacities, reticulations, and bronchiectasis), the true incidence of pulmonary fibrosis and corresponding pathological findings in these patients remains largely unknown. There are a few high-impact and knowledgeable works on late complications in COVID-19 survivors, several coming from explant or autopsy cases, and rare cases from in vivo sampling. The study of biopsy samples has further deepened our knowledge of the aftermath of COVID-19 on lung tissue, uncovering alterations at the cellular level and shifts in vascular and epithelial dynamics. Despite the substantial progress made, future research is needed to devise a uniform strategy for interpreting lung biopsies, with a focus on leveraging advanced tools such as molecular and digital pathology techniques, along with artificial intelligence.
Topics: Humans; COVID-19; Post-Acute COVID-19 Syndrome; Artificial Intelligence; Pathologists; SARS-CoV-2; Pneumonia; Lung
PubMed: 38054902
DOI: 10.32074/1591-951X-906 -
La Tunisie MedicaleSocial media are inevitably becoming part of our lives. The increasing popularity of these platforms revolutionized communication among healthcare workers and has...
Social media are inevitably becoming part of our lives. The increasing popularity of these platforms revolutionized communication among healthcare workers and has irrevocably changed the terms of classic learning models. Pathologists all over the world are very active on social media making it a new pedagogical paradigm in pathology education. A virtual community of pathologists is constantly present especially on Twitter and Facebook for sharing and discussing interesting cases, reporting original scientific researcher's results, or simply energizing our field. Tunisian pathologists are not taking advantage of these platforms, some do not master the use of social media, others are reluctant about their use in the health field. However, it is of crucial importance for us Tunisian pathologists, especially in these times of social distancing due to SARS-COV2 pandemic, to join this virtual community and implement new ways of learning. This article aimed primary to assess the popularity of these platforms as a pedagogic tool among Tunisian pathologist. Secondly, we introduced the basic use and rules of social media, benefits and potential risks, and to provided tips for effective social media use in pathology.
Topics: COVID-19; Humans; Pathologists; RNA, Viral; SARS-CoV-2; Social Media
PubMed: 35244924
DOI: No ID Found -
Archives of Pathology & Laboratory... Feb 2024Mast cells are essential components of the immune system and play crucial pathogenetic roles in several digestive diseases, including mastocytic enterocolitis and... (Review)
Review
CONTEXT.—
Mast cells are essential components of the immune system and play crucial pathogenetic roles in several digestive diseases, including mastocytic enterocolitis and eosinophilic gastrointestinal disorders. Pathologists have rarely been asked to evaluate the distribution and density of mast cells in gastrointestinal (GI) biopsy specimens. However, such requests are becoming more common because of an increasing awareness of the role of mast cells in functional GI disease and in both esophageal and nonesophageal eosinophilic gastrointestinal disorders.
OBJECTIVE.—
To provide pathologists with tools to incorporate the assessment of mast cells in the evaluation of esophageal, gastric, and intestinal specimens by developing a systematic approach to their evaluation, counting, and reporting.
DESIGN.—
This study consisted of a review of the literature followed by multiple consensus sessions to decide where to count mast cells and what a countable mast cell is.
RESULTS.—
We reviewed 135 papers addressing the content of mast cells in the digestive tract, selected 21 that detailed how cells were counted (microscope lens, area of high-power fields, locations evaluated, type of cells considered as countable), and summarized their data in a table. Then, drawing from both the acceptable literature and our own extensive experience, we reached a tentative consensus on: (1) the normal numbers in the different segments of the GI tract; (2) the morphology of countable mast cells; and (3) the locations and strategies for counting them.
CONCLUSIONS.—
The result is a set of suggestions for reporting mast cell counts, their distribution, and their location in a way clinicians can understand and use for management decisions.
Topics: Humans; Mast Cells; Pathologists; Gastrointestinal Tract; Mastocytosis; Gastrointestinal Diseases
PubMed: 37450346
DOI: 10.5858/arpa.2023-0070-OA -
Archives of Pathology & Laboratory... Sep 2023Eosinophilic diseases of the gastrointestinal tract (EGIDs), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) are rarely suspected clinically and...
CONTEXT.—
Eosinophilic diseases of the gastrointestinal tract (EGIDs), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) are rarely suspected clinically and infrequently detected by pathologists.
OBJECTIVE.—
To determine whether histories of allergic or eosinophilic disorders and requests to rule out EoG and EoD affect pathologists' awareness of eosinophils in gastrointestinal biopsies.
DESIGN.—
Thirty-one community-based pathologists were given 16 sets of biopsies from gastric and duodenal mucosa with elevated eosinophils, Helicobacter pylori gastritis, atrophic gastritis, normal stomach and duodenum, lymphocytosis, and celiac disease. Participants were assigned to 3 groups: group A did not receive histories of allergic or eosinophilic conditions; group B received similar histories plus a clue of possible allergic or eosinophilic conditions; and group C received the same histories as B and was asked to rule out EoG/EoD. A list of gastric and duodenal diagnoses and a space for comments were provided. Results were analyzed descriptively.
RESULTS.—
Pathologists correctly diagnosed most noneosinophilic gastrointestinal disorders, indicating competence in gastrointestinal pathology. With respect to EoG and EoD, pathologists in group C performed significantly better that those in groups A and B. The combined odds ratio with 95% CI was 12.34 (2.87-53.04), P < .001, for A versus C and 4.02 (1.60-10.09), P < .02, for B versus C.
CONCLUSIONS.—
Most pathologists neither reported gastric/duodenal eosinophilia nor diagnosed EoG/EoD, even when provided histories of eosinophilic disorders. Requests to rule out EoG/EoD resulted in only 4 of 11 participants evaluating and counting eosinophils in some cases. Simple evidence-based histopathologic criteria are needed before pathologists can be expected to consider and diagnose EGIDs.
Topics: Humans; Pathologists; Eosinophilia; Gastritis; Duodenum; Duodenitis
PubMed: 36399607
DOI: 10.5858/arpa.2022-0204-OA -
Cancer Cytopathology Jan 2023Medical errors are a major source of harm to patients. Regulatory bodies mandate and patient safety experts advocate the disclosure of medical errors to patients to...
Medical errors are a major source of harm to patients. Regulatory bodies mandate and patient safety experts advocate the disclosure of medical errors to patients to promote transparency and to create accountability for improving health care processes. Although pathologists regularly report errors-either to pathology or clinical colleagues or via internal safety reporting systems-few pathologists directly disclose those errors to patients. Yet many pathologists are interested in participating in the direct disclosure of medical errors to patients and may even be mandated to do so. When surveyed on why they do not directly disclose errors to patients, pathologists commonly cite a lack of confidence and a lack of training. Another barrier cited is the lack of a preexisting relationship between the pathologist and the patient. With respect to this last barrier, cytopathologists have a distinct advantage over surgical or clinical pathologists, as many cytopathologists regularly interact with and develop a rapport with patients when they are performing fine-needle aspiration (FNA) procedures. To improve the safety culture in pathology, direct error disclosure practices must be developed, supported, and strengthened. It is critical for cytopathologists to be comfortable with disclosing errors to patients. Being comfortable with disclosing an error, however, requires training, practice, and advance reflection. Using a practical, case-based format centered around FNA examples, this article addresses how to disclose a medical error to a patient. It provides a framework, heuristic principles, and structured conversation systems and talking points to guide the inexperienced pathologist to find his or her voice in a challenging disclosure conversation.
Topics: Humans; Male; Female; Truth Disclosure; Communication; Diagnostic Errors; Medical Errors; Pathologists
PubMed: 35904882
DOI: 10.1002/cncy.22627 -
Der Pathologe Sep 2021Diagnostic radiology and diagnostic pathology are medical disciplines that use a variety of morphological analyses with different macroscopic and microscopic... (Review)
Review
Diagnostic radiology and diagnostic pathology are medical disciplines that use a variety of morphological analyses with different macroscopic and microscopic resolutions for diagnosis and staging of cancers. In the clinical setting, radiology and pathology departments are often spatially separated. However, there are examples of increasingly tight cooperation and convergence, for example in the setting of multidisciplinary tumor boards. This article focuses exemplarily on the correlations of radiological and histopathological diagnostics in pancreatic cancer.
Topics: Humans; Magnetic Resonance Imaging; Pancreatic Neoplasms; Pathologists; Radiography; Radiologists; Radiology
PubMed: 33956172
DOI: 10.1007/s00292-021-00949-2 -
Archives of Pathology & Laboratory... Sep 2018- Patients with rare tumors have difficulty finding reliable information about their disease. Facebook patient support groups allow patients to educate one another.
CONTEXT
- Patients with rare tumors have difficulty finding reliable information about their disease. Facebook patient support groups allow patients to educate one another.
OBJECTIVE
- To investigate how these patients perceive the value of pathologists, both in Facebook groups and real-world patient care.
DESIGN
- Survey links were posted in 12 Facebook patient groups: 6 with an active pathologist member (angiosarcoma, epithelioid hemangioendothelioma, epithelioid sarcoma, dermatofibrosarcoma protuberans [×2], and desmoid fibromatosis), and 6 without "active" pathologist involvement (aggressive angiomyxoma, chondrosarcoma, Ewing sarcoma, leiomyosarcoma, liposarcoma, and osteosarcoma).
RESULTS
- A total of 542 people responded (403 were patients): 264 from groups with a pathologist, and 278 from groups without active pathologist involvement. Of groups with an active pathologist, respondents agreed the pathologist's posts helped them better understand their disease (107 of 119; 90%) and relieved some of their disease-related anxiety (92 of 119; 77%). And for these groups 98% (117 of 119) of respondents agreed that having a pathologist in their group was a good thing; 83% (192 of 232) wanted more pathologists involved. More respondents from groups with an active pathologist (219 of 236; 93%) than without one (215 of 252; 85%) agreed: "pathologists are an important part of the patient care team for patients with cancer and other rare tumors" ( P = .008).
CONCLUSIONS
- This study is the first to evaluate the impact of pathologist interaction with Facebook patient support groups and to assess perceptions about the specialty of pathology from a large group of patients with rare tumors. Pathologist involvement in Facebook patient groups appears to positively influence patient perception of the importance of pathologists. We hope these data will encourage more pathologists to participate in Facebook patient support groups.
Topics: Family; Humans; Pathologists; Pathology, Clinical; Patient Education as Topic; Psychosocial Support Systems; Rare Diseases; Sarcoma; Social Media; Surveys and Questionnaires
PubMed: 29377717
DOI: 10.5858/arpa.2017-0408-OA -
Gastroenterology Apr 2021
Topics: Colitis, Ulcerative; Colonoscopy; Humans; Pathologists
PubMed: 33508287
DOI: 10.1053/j.gastro.2021.01.213 -
Modern Pathology : An Official Journal... May 2023The assessment of the expression of programmed cell death ligand-1 (PD-L1) using immunohistochemistry (IHC) has been controversial since its introduction. The methods of...
Multi-Institutional Study of Pathologist Reading of the Programmed Cell Death Ligand-1 Combined Positive Score Immunohistochemistry Assay for Gastric or Gastroesophageal Junction Cancer.
The assessment of the expression of programmed cell death ligand-1 (PD-L1) using immunohistochemistry (IHC) has been controversial since its introduction. The methods of assessment and the range of assays and platforms contribute to confusion. Perhaps the most challenging aspect of PD-L1 IHC is the combined positive score (CPS) method of interpretation of IHC results. Although the CPS method is prescribed for more indications than any other PD-L1 scoring system, its reproducibility has never been rigorously assessed. In this study, we collected a series of 108 gastric or gastroesophageal junction cancer cases, stained them using the Food and Drug Administration-approved 22C3 assay, scanned them, and then circulated them to 14 pathologists at 13 institutions for the assessment of interpretative concordance for the CPS system. We found that higher cut points (10 or 20) performed better than a CPS of <1 or >1. We used the Observers Needed to Evaluate Subjective Tests algorithm to assess how the CPS system might perform in the real-world setting and found that the cut points of <1 or >1 showed an overall percent agreement of only 30% among the pathologist raters, with a plateau occurring at 8 raters. The raters performed better at higher cut points. However, the best cut point of <20 versus that of >20 was still disappointing, with a plateau at an overall percent agreement of 70% (at 7 raters). Although there is no ground truth for CPS, we compared the score with quantitative messenger RNA measurement and showed no relationship between the score (at any cut point) and messenger RNA amount. In summary, we showed that CPS shows high subjective variability among pathologist readers and is likely to perform poorly in the real-world setting. This system may be the root cause of the poor specificity and relatively low predictive value of IHC companion diagnostic tests for PD-1 axis therapies that use the CPS system.
Topics: Humans; Apoptosis; B7-H1 Antigen; Biomarkers, Tumor; Esophageal Neoplasms; Esophagogastric Junction; Immunohistochemistry; Ligands; Pathologists; Reproducibility of Results; Stomach Neoplasms
PubMed: 36889057
DOI: 10.1016/j.modpat.2023.100128