Visualizzazione post con etichetta Best Practice. Mostra tutti i post
Visualizzazione post con etichetta Best Practice. Mostra tutti i post

mercoledì 1 gennaio 2014

Getting Out From Behind the Paraffin Curtain

A must-to-read Editorial on pathologist's career with a focus on the political efforts needed  to achieve a good work quality and the consideration deserved among clinician colleagues and hospital administrators. To get out from behind the paraffin curtain.

Many pathologists, especially those who maintain contracts with hospitals and other providers, possess keen political skills. They have learned how to keep clinicians happy with the accuracy and alacrity of laboratory services, administrators satisfied with efficiency and financial performance, and technical personnel content with working conditions. [...] As pathologists' careers develop, they are often called on to be leaders. Some are uncomfortable in leadership positions, their careers to date having been founded mostly on individual achievement. The reluctant leader should not be dissuaded by lack of leadership experience. Often the best leaders are those who did not seek out the position but developed their own style as they adapted to the demands of the position. [...] Other challenges include learning to delegate (and follow up on delegated tasks), providing encouragement and inspiration to team members (some of whom may be quite hard-boiled and cynical), and occasionally standing up for the team when it is under assault by powerful factions, including clinicians and other clients. This last challenge takes no small measure of courage and equanimity. [...] The pathologist/politician/leader is commonly confronted by ethical issues. We typically serve multiple masters, including patients, administrators, clinicians, and regulatory agencies. We need to be sensitive to their conflicting agendas. Medical ethics is a complex field [...]  Nevertheless, building a reputation for incorruptibility does foster trust, and trust is fertile ground for opportunity.
Edward O. Uthman (2014) Getting Out From Behind the Paraffin Curtain. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 12-13.

Happy New Year 2014.

domenica 29 settembre 2013

International Society of Urological Pathology Consensus Conference on Renal Neoplasia


The International Society of Urological Pathology (ISUP) is the international professional organization dedicated to the subspecialty of urological pathology. [...] In 2011 the Society undertook to review all aspects of the pathology of adult renal malignancy through an international consensus conference [...]. The detailed decisions relating to the consensus conference are presented in 4 reports, included this issue of the journal.
Delahunt B, Egevad L, Montironi R, Srigley JR. International Society of Urological Pathology (ISUP) Consensus Conference on Renal Neoplasia: Rationale and Organization. Am J Surg Pathol. 2013 Oct;37(10):1463-8.

Volume 37(10) pgs. 1463-1633 October 2013

Srigley JR, et al The ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013 Oct;37(10):1469-1489.

Delahunt B,et al, The Members of the ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. Am J Surg Pathol. 2013 Oct;37(10):1490-1504.

Trpkov K, et al; the members of the ISUP Renal Tumor Panel. Handling and Staging of Renal Cell Carcinoma: The International Society of Urological Pathology Consensus (ISUP) Conference Recommendations. Am J Surg Pathol. 2013 Oct;37(10):1505-1517.

Tan PH, et al, The ISUP Renal Tumor Panel. Renal Tumors: Diagnostic and Prognostic Biomarkers. Am J Surg Pathol. 2013 Oct;37(10):1518-1531.

A 69-year-old man, with a history of renal cancer 11 years ago, presented with a 1 cm right lung nodule, which was investigated with fine-needle aspiration under computed tomography guidance. A, Cell block preparation shows tumor cells with pink cytoplasm. B, Higher magnification of tumor cells with pink cytoplasm and nuclei that are vesicular and hyperchromatic. C, Immunohistochemical analysis with RCC marker shows strong cytoplasmic reactivity. D, Pax 2 immunohistochemistry reveals strong nuclear staining, confirming a metastasis to the lung from a primary renal tumor.



Pax 2 and/or Pax 8 were considered to be the most useful markers in the diagnosis of a renal primary.

(from Tan PH, et al, Diagnostic and Prognostic Biomarkers)

P.S. Post n. 100! 

domenica 7 aprile 2013

Graduated Responsibility for Pathology Residents: No Time for Half Measures

The pathology community is aware of, and has not been idle on, the issue of resident deficiencies. [...] As residency progresses, “[t]he successful trainee develops a very keen sense of dedication, honesty, commitment, intellectual fortitude, integrity, and respect for both patients and colleagues.”Unlike non-pathology residents, who quickly “break the mold formed [in medical school] by being handed a large syllabus containing all of the information that they need to know for an exam and the world of multiple choice questions”… “[i]n contrast, pathology residents may fall into a passive learning style with little or no clinical responsibilities, clinical contact, or accountability…,”leading to “significant deficiencies in confidence, expertise, professionalism, and lifelong learning skills.”
“[a]s the resident progresses over time, the resident may predictate and then give the case to the attending to sign out without sitting with the attending again for sign out. This allows upper level residents to gain additional autonomy”. 
Program directors will need “a clear framework within which to ensure that residents have appropriate opportunities to take responsibility for diagnostic decisions with progressively less oversight.” [...] Program directors will be especially challenged. “[I]t takes a particular combination of high standards, creative thinking, and hard work to manage a training program”; and “time and workload management are critical.” Importantly, “competency-based learning must allow time for remediation for those trainees having inadequate performance…” and “structuring individualized programs for residents in need of remediation falls squarely on the already often overworked residency program director.”


venerdì 29 marzo 2013

Second Opinions: Pathologists' Preventive Medicine

We pathologists have long understood the significance of misdiagnoses and the value of second opinions. Second opinions of pathology diagnoses are routinely used intradepartmentally not only for immediate patient diagnostic accuracy, but also as a tool for peer review, quality assurance, and quality improvement. These may occur as consensus conferences or mandatory second opinions of initial diagnoses of cancers. These measures to assure accuracy of diagnosis are well established in many pathology departments, both private and academic. And directed peer review—selecting specific disease types or particular sites of origin—provides added benefit by targeting latent factors that contribute to diagnostic error.
Da Allen TC. Second Opinions: Pathologists' Preventive Medicine.

Bibliografia:

Allen TC. Second opinions: pathologists' preventive medicine. Arch Pathol Lab Med. 2013 Mar;137(3):310-1.

Landro L. What if the doctor is wrong?: some cancers, asthma, other conditions can be tricky to diagnose, leading to incorrect treatments. Wall Street Journal. January 12,2012 (link) Accessed March 29, 2013.

lunedì 11 marzo 2013

Colorectal cancer: surgical pathology practice guidelines

Caro PATHfinder,

se può essere utile, voglio passarti un piccolo contributo sul cancro del colon.

Ti allego alcuni articoli di Quirke molto didattici che spiegano qual è il metodo e l'obiettivo del patologo nella diagnosi dei tumori del retto. Due articoli spiegano molto chiaramente tutte le possibili lesioni che vanno diagnosticate; un articolo guida nel report macroscopico e microscopico, un altro spiega bene qual è il significato del margine radiale nelle resezioni del retto e come va valutato.
Penso possa essere molto d'aiuto per tutti.

Ciao

Severo Campione, MD.

martedì 13 novembre 2012

Immunohistochemistry: use or abuse?

Il recente post di Mills tratta un argomento sempre più di attualità, soprattutto per gli junior pathologists: l' abuso delle colorazioni immunoistochimiche. Già  avevo affrontato questa tematica in maniera "scherzosa" in un precedente post (LINK), sebbene le conseguenze dell' uso di colorazioni immunoistochimiche non necessarie sono affatto serie. Oggi non possiamo permetterci più di "sprecare" il materiale biologico, perché la diagnosi istopatologica è diventata il punto di partenza di numerose indagini molecolari, da effettuarsi sui nostri sempre più piccoli campioni bioptici ma necessarie per il management clinico del paziente. Come recita un altro blog che tratta questo argomento: "low power lens, high power mind; high power lens, low power mind" e di conseguenza "the diagnostic skills of the surgical pathologist are inversely proportional to the number of IHC stains needed to arrive at the final diagnosis". Quindi, ben venga l' uso della immunoistochimica, ma  non prima della correlazione con i dati clinici e di un accurato e approfondito studio dei criteri morfologici.

Bibliografia:

Mills S. E. Overuse of immunohistochemistry Pn Blog.  Nov. 12, 2012

Wheeler T. Immunohistochemistry: When Do We Have Too Much of a Good Thing? Lab Line by the Doctor’s Doctor Blog. May 6, 2010