1201
|
Tjota MY, Pytel P. Educational Case: Pilocytic Astrocytoma With Atypical Features. Acad Pathol 2020; 7:2374289520912498. [PMID: 32284965 PMCID: PMC7119228 DOI: 10.1177/2374289520912498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/20/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
Collapse
Affiliation(s)
| | - Peter Pytel
- Department of Pathology, University of Chicago, IL, USA
| |
Collapse
|
1202
|
Neogi A, Kumar J, Guan Y, Parani M. Genetic counseling education at the undergraduate level: An outreach initiative to promote professional recruitment and support workforce development. J Genet Couns 2020; 29:234-242. [PMID: 32227571 DOI: 10.1002/jgc4.1253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/12/2022]
Abstract
As in many other countries, the field of genetic counseling is in its initial stages of development in India, where there are efforts to streamline the profession and to implement graduate-level training programs. We implemented an elective course on genetic counseling at the undergraduate level in a private university in India to assess students' interest, to provide early exposure for students interested in pursuing the career, and to aid recruitment. To assess satisfaction with the course and recruitment outcomes, we sent a course evaluation survey to 332 students and received 134 responses. Familiarity with genetic counseling topics increased significantly after completing the course. Of the 42 respondents who reported they were planning to pursue formal genetic counseling training, 21% (n = 9/42) became interested in the profession as a result of taking this course. Survey respondents who were prospective applicants to genetic counseling training programs referred mostly to the websites of the National Society of Genetic Counselors and the American Board of Genetic Counseling for information on genetic counseling and training. Barriers to entry into the field included lack of shadowing opportunities, inadequate coursework, and limited opportunities to interact with practicing genetic counselors. Respondents stated that additional case studies as well as observation of patient interactions would elucidate the role of a genetic counselor and help define the scope of the practice in India and other countries. Overall, genetic counseling education at the undergraduate level is a scalable way to improve understanding of genetic counseling topics, increase professional interest in the field, and support workforce development.
Collapse
Affiliation(s)
- Arpita Neogi
- Department of Genetic Engineering, SRM University, Chennai, India.,International Special Interest Group, National Society of Genetic Counselors, Chicago, IL, USA
| | - Jeevan Kumar
- Department of Genetic Engineering, SRM University, Chennai, India
| | - Yue Guan
- International Special Interest Group, National Society of Genetic Counselors, Chicago, IL, USA.,Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madasamy Parani
- Department of Genetic Engineering, SRM University, Chennai, India
| |
Collapse
|
1203
|
Vu P, Khagi Y, Riviere P, Goodman A, Kurzrock R. Total Number of Alterations in Liquid Biopsies Is an Independent Predictor of Survival in Patients With Advanced Cancers. JCO Precis Oncol 2020; 4:1900204. [PMID: 32923910 PMCID: PMC7450932 DOI: 10.1200/po.19.00204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Studies have demonstrated an association between quantity of circulating tumor DNA (ctDNA) and poorer survival. We investigated the relationship between percent ctDNA (%ctDNA), total number of ctDNA alterations, and overall survival (OS) in liquid biopsies. MATERIALS AND METHODS Overall, 418 patients with blood-based next-generation sequencing (54 to 73 genes) were analyzed. Eligible patients included those who had advanced/metastatic solid tumor malignancies and never received immunotherapy treatment, which may alter the survival curve in patients with high mutational burden. RESULTS Patients with a high (≥ 5%) %ctDNA had significantly shorter OS versus those with intermediate (≥ 0.4% to < 5%) or low (< 0.4%) values (median OS, 7.0 v 14.1 v not reached [NR] months, respectively; P < .0001). Patients with a high (≥ 5) total number of alterations had significantly shorter OS versus those with intermediate (≥ 1.46 to < 5), low (< 1.46), or no alterations (median OS, 4.6 v 11.7 v 21.3 v NR months, respectively; P < .0001). The total number of alterations correlated with %ctDNA (r = 0.85; 95% CI, 0.81 to 0.87; P < .0001). However, only an intermediate to high total number of alterations (≥ 1.46) was an independent predictor of worse OS (hazard ratio, 1.96; 95% CI, 1.30 to 2.96; P = .0014; multivariate analysis). CONCLUSION We demonstrate that the total number of alterations and %ctDNA have prognostic value and correlate with one another, but only the total number of alterations was independently associated with survival outcomes. Our findings suggest that the total number of alterations in plasma may be an indicator of more aggressive tumor biology and therefore poorer survival.
Collapse
Affiliation(s)
- Peter Vu
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Yulian Khagi
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Paul Riviere
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Aaron Goodman
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, CA
| |
Collapse
|
1204
|
Manjee K, Sullivan ME. Educational Case: Radiation-Associated Angiosarcoma in Patients With Breast Cancer. Acad Pathol 2020; 7:2374289520912499. [PMID: 32232128 PMCID: PMC7092646 DOI: 10.1177/2374289520912499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/20/2019] [Accepted: 02/08/2020] [Indexed: 11/30/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Kiran Manjee
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Megan E Sullivan
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| |
Collapse
|
1205
|
Kuan K, Reznik SE. Educational Case: Intrauterine Fetal Demise and Intestinal Atresia: An Autopsy Investigation. Acad Pathol 2020; 7:2374289520909498. [PMID: 32232125 PMCID: PMC7092656 DOI: 10.1177/2374289520909498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/19/2020] [Accepted: 02/01/2020] [Indexed: 12/26/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Kevin Kuan
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra E Reznik
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
1206
|
Rubio XB, Kresak J, Zona M, Beal SG, Ross JA. Educational Case: Ectopic Pregnancy. Acad Pathol 2020; 7:2374289520911184. [PMID: 32232127 PMCID: PMC7092664 DOI: 10.1177/2374289520911184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/21/2019] [Accepted: 02/08/2020] [Indexed: 12/04/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Xiomara Brioso Rubio
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jesse Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Melanie Zona
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Julia A Ross
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
1207
|
Manjee K, Gniadek TJ. Educational Case: Granulocyte Transfusion. Acad Pathol 2020; 7:2374289520909500. [PMID: 32232126 PMCID: PMC7092653 DOI: 10.1177/2374289520909500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/18/2020] [Accepted: 02/01/2020] [Indexed: 11/18/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Kiran Manjee
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| |
Collapse
|
1208
|
Vandenberg O, Durand G, Hallin M, Diefenbach A, Gant V, Murray P, Kozlakidis Z, van Belkum A. Consolidation of Clinical Microbiology Laboratories and Introduction of Transformative Technologies. Clin Microbiol Rev 2020; 33:e00057-19. [PMID: 32102900 PMCID: PMC7048017 DOI: 10.1128/cmr.00057-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Clinical microbiology is experiencing revolutionary advances in the deployment of molecular, genome sequencing-based, and mass spectrometry-driven detection, identification, and characterization assays. Laboratory automation and the linkage of information systems for big(ger) data management, including artificial intelligence (AI) approaches, also are being introduced. The initial optimism associated with these developments has now entered a more reality-driven phase of reflection on the significant challenges, complexities, and health care benefits posed by these innovations. With this in mind, the ongoing process of clinical laboratory consolidation, covering large geographical regions, represents an opportunity for the efficient and cost-effective introduction of new laboratory technologies and improvements in translational research and development. This will further define and generate the mandatory infrastructure used in validation and implementation of newer high-throughput diagnostic approaches. Effective, structured access to large numbers of well-documented biobanked biological materials from networked laboratories will release countless opportunities for clinical and scientific infectious disease research and will generate positive health care impacts. We describe why consolidation of clinical microbiology laboratories will generate quality benefits for many, if not most, aspects of the services separate institutions already provided individually. We also define the important role of innovative and large-scale diagnostic platforms. Such platforms lend themselves particularly well to computational (AI)-driven genomics and bioinformatics applications. These and other diagnostic innovations will allow for better infectious disease detection, surveillance, and prevention with novel translational research and optimized (diagnostic) product and service development opportunities as key results.
Collapse
Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, LHUB-ULB, Groupement Hospitalier Universitaire de Bruxelles (GHUB), Université Libre de Bruxelles, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Géraldine Durand
- bioMérieux, Microbiology Research and Development, La Balme Les Grottes, France
| | - Marie Hallin
- Department of Microbiology, LHUB-ULB, Groupement Hospitalier Universitaire de Bruxelles (GHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Andreas Diefenbach
- Department of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Labor Berlin, Charité-Vivantes GmbH, Berlin, Germany
| | - Vanya Gant
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Patrick Murray
- BD Life Sciences Integrated Diagnostic Solutions, Scientific Affairs, Sparks, Maryland, USA
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Alex van Belkum
- bioMérieux, Open Innovation and Partnerships, La Balme Les Grottes, France
| |
Collapse
|
1209
|
Jamshidi P, Taxy JB. Educational Case: Yolk Sac (Endodermal Sinus) Tumor of the Ovary. Acad Pathol 2020; 7:2374289520909497. [PMID: 32206700 PMCID: PMC7079305 DOI: 10.1177/2374289520909497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/03/2020] [Accepted: 01/18/2020] [Indexed: 11/29/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Pouya Jamshidi
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
- Pouya Jamshidi, Department of Pathology and Laboratory Medicine, Northshore University Health System, 2650 Ridge Ave, Evanston, IL 60201, USA.
| | - Jerome B. Taxy
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| |
Collapse
|
1210
|
Church DL, Naugler C. Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model. Crit Rev Clin Lab Sci 2020; 57:323-344. [PMID: 32180485 DOI: 10.1080/10408363.2020.1720591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The laboratory is a vital part of the continuum of patient care. In fact, there are few programs in the healthcare system that do not rely on ready access and availability of complex diagnostic laboratory services. The existing transactional model of laboratory "medical practice" will not be able to meet the needs of the healthcare system as it rapidly shifts toward value-based care and precision medicine, which demands that practice be based on total system indicators, clinical effectiveness, and patient outcomes. Laboratory "value" will no longer be focused primarily on internal testing quality and efficiencies but rather on the relative cost of diagnostic testing compared to direct improvement in clinical and system outcomes. The medical laboratory as a "business" focused on operational efficiency and cost-controls must transform to become an essential clinical service that is a tightly integrated equal partner in direct patient care. We would argue that this paradigm shift would not be necessary if laboratory services had remained a "patient-centric" medical practice throughout the last few decades. This review is focused on the essential role of laboratory physicians in transforming laboratory practice and management to a value-based patient-centric model. Value-based practice is necessary not only to meet the challenges of the new precision medicine world order but also to bring about sustainable healthcare service delivery.
Collapse
Affiliation(s)
- Deirdre L Church
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
1211
|
Jia Y, Samadzadeh S, Cornford M, Ji P, French SW. Educational Case: Incidental Gallbladder Adenocarcinoma. Acad Pathol 2020; 7:2374289520909504. [PMID: 32206701 PMCID: PMC7074493 DOI: 10.1177/2374289520909504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/14/2019] [Accepted: 01/18/2020] [Indexed: 12/29/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040. 1.
Collapse
Affiliation(s)
- Yue Jia
- Department of Pathology, Harbor-UCLA Medical Center, CA, USA
| | - Sara Samadzadeh
- Department of Pathology, Harbor-UCLA Medical Center, CA, USA
| | - Marcia Cornford
- Department of Pathology, Harbor-UCLA Medical Center, CA, USA
| | - Ping Ji
- Department of Pathology, Harbor-UCLA Medical Center, CA, USA
| | - Samuel W French
- Department of Pathology, Harbor-UCLA Medical Center, CA, USA
| |
Collapse
|
1212
|
Kelly M, Soles R, Garcia E, Kundu I. Job Stress, Burnout, Work-Life Balance, Well-Being, and Job Satisfaction Among Pathology Residents and Fellows. Am J Clin Pathol 2020; 153:449-469. [PMID: 32080717 DOI: 10.1093/ajcp/aqaa013] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The study explored job stress, burnout, work-life balance, well-being, and job satisfaction among pathology residents and fellows. The aims were to examine the prevalence and sources of stress and burnout, as well as identify resources to promote work-life balance and well-being and prevent burnout. METHODS The study used a cross-sectional survey deployed online to a large national sample of pathology residents and fellows. RESULTS Job stress and burnout were prevalent, with more than a third of the respondents reporting that they were currently experiencing burnout. The respondents, particularly residents, were struggling with academics, and higher percentages were struggling with work-life balance and emotional well-being. Overall, the majority of respondents who rated their work-life balance indicated that it was poor or fair. Among the factors contributing to job stress and burnout and detracting from work-life balance, workload was the leading factor. CONCLUSIONS The factors contributing to job stress and burnout included organizational factors such as workload, value, and aspects of the learning environment, as well as personal factors such as work-life integration. One of the overarching implications is the need to address a range of interdependent considerations in designing resources to reduce job stress, promote work-life balance, and prevent burnout.
Collapse
Affiliation(s)
- Melissa Kelly
- Evaluation, Measurement, and Assessment Department, Learning and Education Research Division, American Society for Clinical Pathology (ASCP), Chicago, IL
| | - Ryan Soles
- Evaluation, Measurement, and Assessment Department, Learning and Education Research Division, American Society for Clinical Pathology (ASCP), Chicago, IL
| | - Edna Garcia
- Institute for Science, Technology, and Public Policy, ASCP, Washington, DC
| | - Iman Kundu
- Institute for Science, Technology, and Public Policy, ASCP, Washington, DC
| |
Collapse
|
1213
|
Komez A, Buyuksungur A, Antmen E, Swieszkowski W, Hasirci N, Hasirci V. A two-compartment bone tumor model to investigate interactions between healthy and tumor cells. ACTA ACUST UNITED AC 2020; 15:035007. [PMID: 31935707 DOI: 10.1088/1748-605x/ab6b31] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We produced a novel three-dimensional (3D) bone tumor model (BTM) to study the interactions between healthy and tumor cells in a tumor microenvironment, the migration tendency of the tumor cells, and the efficacy of an anticancer drug, Doxorubicin, on the cancer cells. The model consisted of two compartments: (a) a healthy bone tissue mimic, made of poly(lactic acid-co-glycolic acid) (PLGA)/beta-tricalcium phosphate (β-TCP) sponge seeded with human fetal osteoblastic cells (hFOB) and human umbilical vein endothelial cells (HUVECs), and (b) a tumor mimic, made of lyophilized collagen sponge seeded with human osteosarcoma cells (Saos-2). The tumor mimic component was placed into a central cavity created in the healthy bone mimic and together they constituted the complete 3D bone tumor model (3D-BTM). The porosities of both sponges were higher than 85% and the diameters of the pores were 199 ± 52 μm for the PLGA/TCP and 50-150 μm for the collagen scaffolds. The compression Young's modulus of the PLGA/TCP and the collagen sponges were determined to be 4.76 MPa and 140 kPa, respectively. Cell proliferation, morphology, calcium phosphate forming capacity and alkaline phosphatase production were studied separately on both the healthy and tumor mimics. All cells demonstrated cellular extensions and spread well in porous scaffolds indicating good cell-material interactions. Confocal microscopy analysis showed direct contact between the cells present in different parts of the 3D-BTM. Migration of HUVECs from the healthy bone mimic to the tumor compartment was confirmed by the increase in the levels of angiogenic factors vascular endothelial growth factor, basic fibroblast growth factor, and interleukin 8 in the tumor component. Doxorubicin (2.7 μg.ml-1) administered to the 3D-BTM caused a seven-fold decrease in the cell number after 24 h of interaction with the anticancer drug. Caspase-3 enzyme activity assay results demonstrated apoptosis of the osteosarcoma cells. This novel 3D-BTM has a high potential for use in studying the metastatic capabilities of cancer cells, and in determining the effective drug types and combinations for personalized treatments.
Collapse
Affiliation(s)
- Aylin Komez
- Graduate Department of Biotechnology, Middle East Technical University (METU), Ankara, 06800, Turkey. BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, 06800, Turkey
| | | | | | | | | | | |
Collapse
|
1214
|
A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees. J Clin Transl Sci 2020; 4:307-316. [PMID: 33244411 PMCID: PMC7681110 DOI: 10.1017/cts.2020.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: While previous studies have described career outcomes of physician-scientist trainees after graduation, trainee perceptions of research-intensive career pathways remain unclear. This study sought to identify the perceived interests, factors, and challenges associated with academic and research careers among predoctoral MD trainees, MD trainees with research-intense (>50%) career intentions (MD-RI), and MD-PhD trainees. Methods: A 70-question survey was administered to 16,418 trainees at 32 academic medical centers from September 2012 to December 2014. MD vs. MD-RI (>50% research intentions) vs. MD-PhD trainee responses were compared by chi-square tests. Multivariate logistic regression analyses were performed to identify variables associated with academic and research career intentions. Results: There were 4433 respondents (27% response rate), including 2625 MD (64%), 653 MD-RI (15%), and 856 MD-PhD (21%) trainees. MD-PhDs were most interested in pursuing academia (85.8%), followed by MD-RIs (57.3%) and MDs (31.2%). Translational research was the primary career intention for MD-PhD trainees (42.9%). Clinical duties were the primary career intention for MD-RIs (51.9%) and MDs (84.2%). While 39.8% of MD-PhD respondents identified opportunities for research as the most important career selection factor, only 12.9% of MD-RI and 0.5% of MD respondents shared this perspective. Interest in basic research, translational research, clinical research, education, and the ability to identify a mentor were each independently associated with academic career intentions by multivariate regression. Conclusions: Predoctoral MD, MD-RI, and MD-PhD trainees are unique cohorts with different perceptions and interests toward academic and research careers. Understanding these differences may help to guide efforts to mentor the next generation of physician-scientists.
Collapse
|
1215
|
Current state of Grand Rounds in U.S. pathology training programs. Ann Diagn Pathol 2020; 46:151484. [PMID: 32172216 DOI: 10.1016/j.anndiagpath.2020.151484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
Grand Rounds are held with variable frequency in many academic pathology departments, but their exact goal is uncertain, and the type of subjects covered, and presenters have not been studied. We aimed to gather information about the current state of pathology grand rounds (PGR). We identified all US pathology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and searched their websites for information regarding PGR, extracting data on their existence, frequency and timing. For a representative subgroup of institutions from all US regions and program sizes, we tabulated the 2017-2018 PGR titles and presenters (gender, degree(s), resident/fellow, faculty academic rank). We found that 71 of 142 (50%) ACGME-accredited programs had PGR, more often in programs with >12 residents (53/88, 60%). PGR were scheduled most commonly weekly, on Thursdays, and at noon. We analyzed 1019 PGR presentations from 41 institutions located in 26 US states. Among the 1105 presenters, 183 (16.56%) were trainees, 74 (6.7%) were non-academic, and 848 (76.7%) were faculty, 559 male and 289 female (M/F = 1.93). M/F ratio increased with academic rank, from 1.0 (117/115) for assistant, to 2.0 (135/68) for associate, and 2.9 (307/106) for full professors. Topics covered by PGR belonged to anatomic pathology (357), clinical pathology (209), research (184) or other medical or surgical specialties (149). Our study suggests that trainees are a major intended audience of pathology grand round. Unfortunately, there is a gender gap among pathology grand round presenters that widens with increasing academic rank of presenters.
Collapse
|
1216
|
Brennan N, Price T, Archer J, Brett J. Remediating professionalism lapses in medical students and doctors: A systematic review. MEDICAL EDUCATION 2020; 54:196-204. [PMID: 31872509 DOI: 10.1111/medu.14016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/08/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT A remediation intervention aims to facilitate the improvement of an individual whose competence in a particular skill has dropped below the level expected. Little is known regarding the effectiveness of remediation, especially in the area of professionalism. This review sought to identify and assess the effectiveness of interventions to remediate professionalism lapses in medical students and doctors. METHODS Databases Embase, MEDLINE, Education Resources Information Center and the British Education Index were searched in September 2017 and October 2018. Studies reporting interventions to remediate professionalism lapses in medical students and doctors were included. A standardised data extraction form incorporating a previously described behaviour change technique taxonomy was utilised. A narrative synthesis approach was adopted. Quality was assessed using the Critical Appraisal Skills Programme checklist. RESULTS A total of 19 studies on remediation interventions reported in 23 articles were identified. Of these, 13 were case studies, five were cohort studies and one was a qualitative study; 37% targeted doctors, 26% medical students, 16% residents and 21% involved mixed populations. Most interventions were multifaceted and addressed professionalism issues concomitantly with clinical skills, but some focused on specific areas (eg sexual boundaries and disruptive behaviours). Most used three or more behaviour change techniques. The included studies were predominantly of low quality as 13 of the 19 were case studies. It was difficult to assess the effectiveness of the interventions as the majority of studies did not carry out any evaluation. CONCLUSIONS The review identifies a paucity of evidence to guide best practice in the remediation of professionalism lapses in medical students and doctors. The literature tentatively suggests that remediating lapses in professionalism, as part of a wider programme of remediation, can facilitate participants to graduate from a programme of study, and pass medical licensing and mock oral board examinations. However, it is not clear from this literature whether these interventions are successful in remediating lapses in professionalism specifically. Further research is required to improve the design and evaluation of interventions to remediate professionalism lapses.
Collapse
Affiliation(s)
- Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Peninsula Medical School, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Peninsula Medical School, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Julian Archer
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Joe Brett
- Emergency Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
1217
|
Bains M, Kaliski DZ. An anatomy workshop for improving anatomy self-efficacy and competency when transitioning into a problem-based learning, Doctor of Physical Therapy program. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:39-49. [PMID: 31855453 DOI: 10.1152/advan.00048.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
First-year Doctor of Physical Therapy (DPT) students entering a problem-based learning (PBL) program are faced with a number of pedagogical challenges, including the development of self-directed learning skills, resource unfamiliarity, and group dynamics. These challenges can make learning anatomy in a self-directed manner less efficient. Prematriculation introduction of strategies to improve anatomy learning may help prepare students for a rigorous DPT program and improve anatomy learning efficiency. The present study describes a 2-day anatomy workshop offered to incoming students before a DPT program was initiated. Knowledge acquired during both days of the workshop resulted in statistically significant improvements in anatomy postquiz scores for each corresponding prequiz (P < 0.001 for lower and upper limb quizzes). Workshop participants survey responses demonstrated that anatomy confidence and PBL preparedness increased at distinct intervals following the workshop and was significantly higher than controls after the first semester (P < 0.01 for anatomy confidence and PBL preparedness). Multivariate regression analyses demonstrated statistically significant relationships between semester anatomy practical scores and workshop participation (P = 0.03 for practical 1 and P = 0.049 for practical 2) and undergraduate grade point average (P < 0.001 for practical 1 and P = 0.03 for practical 2). First-year DPT students reported the anatomy workshop to be a valuable experience for learning strategies to improve anatomy self-efficacy. An introductory anatomy workshop is an effective strategy to improve self-directed anatomy learning efficiency before the start of a rigorous DPT program.
Collapse
Affiliation(s)
- Mona Bains
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| | - Debora Z Kaliski
- School of Physical Therapy, The University of the Incarnate Word, San Antonio, Texas
| |
Collapse
|
1218
|
Fishman A, Kenett R, Biron-Shental T. Implementing Personal Mentoring in an Obstetrics and Gynecology Residency Program-3-Year Evaluation. MEDICAL SCIENCE EDUCATOR 2020; 30:293-297. [PMID: 34457670 PMCID: PMC8368510 DOI: 10.1007/s40670-019-00902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To empower residents-in-training through personal mentorship from a senior physician who dedicates time and guidance to their personal development and provides professional and emotional support. METHODS A structured model of personal mentoring for residents was designed and implemented in the Department of Obstetrics & Gynecology. The process was assessed by a special-purpose survey constructed and reviewed by established medical mentors. The survey examined residents' attitudes towards personal aspects associated with their residency. The questionnaires were filled out anonymously before launching and 1 and 3 years after initiating the personal mentoring process. RESULTS The residents' reports showed a distinct trend of increased positive attitudes towards the personal mentoring throughout the process. The residents reported on an improvement in the mentors' availability to address personal aspects within the mentoring relationship (empathy, emotional support in deliberations, career guidance, etc.). The general satisfaction with the residency program improved as well. CONCLUSIONS Mentoring is a significant element in a comprehensive, multi-dimensional process. Integrating personal mentoring into a residency program, with the focus on interpersonal relational characteristics as empathy, availability, open communication, and guidance, led to improvements in residents' professional development and skills. They also received optimal support and guidance in their professional careers and personal deliberations.
Collapse
Affiliation(s)
- Ami Fishman
- Department of Obstetrics & Gynecology, Meir Medical Center, 44281 Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Kenett
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Tal Biron-Shental
- Department of Obstetrics & Gynecology, Meir Medical Center, 44281 Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
1219
|
Mai B, Wahed MA, Chen L, Nguyen ND, Wang XI, Hu Z. Educational Case: Systemic Mastocytosis with an Associated Hematological Neoplasm. Acad Pathol 2020; 7:2374289520906526. [PMID: 32158933 PMCID: PMC7047421 DOI: 10.1177/2374289520906526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/01/2019] [Accepted: 01/01/2020] [Indexed: 11/15/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Brenda Mai
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| | - Md A Wahed
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| | - Lei Chen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| | - Nghia D Nguyen
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| | - Xiaohong Iris Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| | - Zhihong Hu
- Department of Pathology and Laboratory Medicine, The University of Texas Health Center at Houston, TX 77030, USA
| |
Collapse
|
1220
|
Qi YB, Yang W, Si M, Nie L. Wnt/β‑catenin signaling modulates piperine‑mediated antitumor effects on human osteosarcoma cells. Mol Med Rep 2020; 21:2202-2208. [PMID: 32323765 PMCID: PMC7115194 DOI: 10.3892/mmr.2020.11000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
The plant extract piperine is used as a traditional Chinese medicine due to its anti-inflammatory effects and efficacy against numerous types of cancer. The aim of the present study was to investigate the antitumor mechanism of piperine in human osteosarcoma U2OS and 143B cell lines. The effects of piperine on cell apoptosis and invasion of human osteosarcoma cells were assessed using flow cytometry and Transwell assays. Moreover, western blotting was used to measure the effects of piperine on the protein expression levels of the metastasis markers matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF). In addition, the involvement of the Wnt/β-catenin signaling pathway in modulating the effects of piperine was examined via western blot analysis. The results of MTT and Transwell invasion assays indicated that piperine treatment dose-dependently reduced U2OS and 143B cell viability and invasion. Furthermore, a significant reduction was identified in MMP-2, VEGF, glycogen synthase kinase-3β and β-catenin protein expression levels, as well as the expression levels of their target proteins cyclooxygenase-2, cyclin D1 and c-myc, in U2OS cells after piperine treatment. In addition, similar results were observed in 143B cells. Therefore, the present study demonstrated the efficacy of piperine in osteosarcoma, and identified that the Wnt/β-catenin signaling pathway may modulate the antitumor effects of piperine on human U2OS and 143B cells.
Collapse
Affiliation(s)
- Yu-Bin Qi
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Wen Yang
- Department of Spinal Surgery, Heze Municipal Hospital, Heze, Shandong 274031, P.R. China
| | - Meng Si
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Lin Nie
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| |
Collapse
|
1221
|
Kiani A, Uyumazturk B, Rajpurkar P, Wang A, Gao R, Jones E, Yu Y, Langlotz CP, Ball RL, Montine TJ, Martin BA, Berry GJ, Ozawa MG, Hazard FK, Brown RA, Chen SB, Wood M, Allard LS, Ylagan L, Ng AY, Shen J. Impact of a deep learning assistant on the histopathologic classification of liver cancer. NPJ Digit Med 2020; 3:23. [PMID: 32140566 PMCID: PMC7044422 DOI: 10.1038/s41746-020-0232-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 02/06/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) algorithms continue to rival human performance on a variety of clinical tasks, while their actual impact on human diagnosticians, when incorporated into clinical workflows, remains relatively unexplored. In this study, we developed a deep learning-based assistant to help pathologists differentiate between two subtypes of primary liver cancer, hepatocellular carcinoma and cholangiocarcinoma, on hematoxylin and eosin-stained whole-slide images (WSI), and evaluated its effect on the diagnostic performance of 11 pathologists with varying levels of expertise. Our model achieved accuracies of 0.885 on a validation set of 26 WSI, and 0.842 on an independent test set of 80 WSI. Although use of the assistant did not change the mean accuracy of the 11 pathologists (p = 0.184, OR = 1.281), it significantly improved the accuracy (p = 0.045, OR = 1.499) of a subset of nine pathologists who fell within well-defined experience levels (GI subspecialists, non-GI subspecialists, and trainees). In the assisted state, model accuracy significantly impacted the diagnostic decisions of all 11 pathologists. As expected, when the model's prediction was correct, assistance significantly improved accuracy (p = 0.000, OR = 4.289), whereas when the model's prediction was incorrect, assistance significantly decreased accuracy (p = 0.000, OR = 0.253), with both effects holding across all pathologist experience levels and case difficulty levels. Our results highlight the challenges of translating AI models into the clinical setting, and emphasize the importance of taking into account potential unintended negative consequences of model assistance when designing and testing medical AI-assistance tools.
Collapse
Affiliation(s)
- Amirhossein Kiani
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Bora Uyumazturk
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Pranav Rajpurkar
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Alex Wang
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Rebecca Gao
- Stanford University School of Medicine, Stanford, CA USA
| | - Erik Jones
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Yifan Yu
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Curtis P. Langlotz
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Robyn L. Ball
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
| | - Thomas J. Montine
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Brock A. Martin
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Gerald J. Berry
- Department of Pathology, Stanford University, Stanford, CA USA
| | | | | | - Ryanne A. Brown
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Simon B. Chen
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Mona Wood
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Libby S. Allard
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Lourdes Ylagan
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Andrew Y. Ng
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Jeanne Shen
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Pathology, Stanford University, Stanford, CA USA
| |
Collapse
|
1222
|
Mianehsaz E, Tabatabaee SMR, Sharif MR, Gilasi HR, Shojaee Far HR, Nejad Tabrizi B. Professionalism among medical residents in a young second-level university in Iran: a cross-sectional study. J Med Ethics Hist Med 2020; 13:1. [PMID: 32337008 PMCID: PMC7168782 DOI: 10.18502/jmehm.v13i1.2463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
Professionalism is a set of behaviors that build trust in physicians’ relationships with patients and the public. The aim of this study was to assess professionalism among residents in Kashan University of Medical Sciences, Kashan, Iran. This cross-sectional study was conducted on 139 residents recruited through the census method. Data were collected using the American Board of Internal Medicine Professionalism Questionnaire. The first part of the questionnaire was on residents’ personal characteristics, and the second part contained fifteen items in the three domains of professionalism, namely excellence, honor/integrity, and altruism/respect. The mean scores of the questionnaire and its domains were calculated and their relationships with residents’ personal characteristics were evaluated. The mean scores (± SD) of professionalism and its excellence, honor/integrity, and altruism/respect domains were 4.93 ± 2.4, 5.92 ± 1.85, 4.94 ± 3.39, and 4.35 ± 3.27, respectively (in a range of 0-10). Professionalism had significant relationships only with residents’ specialty and gender. The level of professionalism in residents was low, which requires the attention of educational authorities. Moreover, the mean score of professionalism among residents in surgical specialties was significantly lower than non-surgical specialties. Various factors can be considered in this regard and it cannot be concluded that the lower score means worse professional behavior.
Collapse
Affiliation(s)
- Elaheh Mianehsaz
- Assistant Professor, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mohammad Reza Tabatabaee
- Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Sharif
- Professor, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Gilasi
- Associate Professor, Department of Epidemiology and Biostatistics, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Shojaee Far
- Researcher, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Behzad Nejad Tabrizi
- Researcher, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
1223
|
Holland L, Wei D, Olson KA, Mitra A, Graff JP, Jones AD, Durbin-Johnson B, Mitra AD, Rashidi HH. Limited Number of Cases May Yield Generalizable Models, a Proof of Concept in Deep Learning for Colon Histology. J Pathol Inform 2020; 11:5. [PMID: 32175170 PMCID: PMC7047745 DOI: 10.4103/jpi.jpi_49_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Little is known about the effect of a minimum number of slides required in generating image datasets used to build generalizable machine-learning (ML) models. In addition, the assumption within deep learning is that the increased number of training images will always enhance accuracy and that the initial validation accuracy of the models correlates well with their generalizability. In this pilot study, we have been able to test the above assumptions to gain a better understanding of such platforms, especially when data resources are limited. Methods: Using 10 colon histology slides (5 carcinoma and 5 benign), we were able to acquire 1000 partially overlapping images (Dataset A) that were then trained and tested on three convolutional neural networks (CNNs), ResNet50, AlexNet, and SqueezeNet, to build a large number of unique models for a simple task of classifying colon histopathology into benign and malignant. Different quantities of images (10–1000) from Dataset A were used to construct >200 unique CNN models whose performances were individually assessed. The performance of these models was initially assessed using 20% of Dataset A's images (not included in the training phase) to acquire their initial validation accuracy (internal accuracy) followed by their generalization accuracy on Dataset B (a very distinct secondary test set acquired from public domain online sources). Results: All CNNs showed similar peak internal accuracies (>97%) from the Dataset A test set. Peak accuracies for the external novel test set (Dataset B), an assessment of the ability to generalize, showed marked variation (ResNet50: 98%; AlexNet: 92%; and SqueezeNet: 80%). The models with the highest accuracy were not generated using the largest training sets. Further, a model's internal accuracy did not always correlate with its generalization accuracy. The results were obtained using an optimized number of cases and controls. Conclusions: Increasing the number of images in a training set does not always improve model accuracy, and significant numbers of cases may not always be needed for generalization, especially for simple tasks. Different CNNs reach peak accuracy with different training set sizes. Further studies are required to evaluate the above findings in more complex ML models prior to using such ancillary tools in clinical settings.
Collapse
Affiliation(s)
- Lorne Holland
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Dongguang Wei
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Anupam Mitra
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - John Paul Graff
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Andrew D Jones
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Blythe Durbin-Johnson
- Division of Biostatistics, UC Davis Genome Center, Genome and Biomedical Sciences Facility, University of California, Davis, CA, USA
| | - Ananya Datta Mitra
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| | - Hooman H Rashidi
- Department of Pathology and Laboratory Medicine, University of California, Sacramento, CA, USA
| |
Collapse
|
1224
|
Kamarajan C, Ardekani BA, Pandey AK, Kinreich S, Pandey G, Chorlian DB, Meyers JL, Zhang J, Bermudez E, Stimus AT, Porjesz B. Random Forest Classification of Alcohol Use Disorder Using fMRI Functional Connectivity, Neuropsychological Functioning, and Impulsivity Measures. Brain Sci 2020; 10:brainsci10020115. [PMID: 32093319 PMCID: PMC7071377 DOI: 10.3390/brainsci10020115] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/22/2022] Open
Abstract
Individuals with alcohol use disorder (AUD) are known to manifest a variety of neurocognitive impairments that can be attributed to alterations in specific brain networks. The current study aims to identify specific features of brain connectivity, neuropsychological performance, and impulsivity traits that can classify adult males with AUD (n = 30) from healthy controls (CTL, n = 30) using the Random Forest (RF) classification method. The predictor variables were: (i) fMRI-based within-network functional connectivity (FC) of the Default Mode Network (DMN), (ii) neuropsychological scores from the Tower of London Test (TOLT), and the Visual Span Test (VST), and (iii) impulsivity factors from the Barratt Impulsiveness Scale (BIS). The RF model, with a classification accuracy of 76.67%, identified fourteen DMN connections, two neuropsychological variables (memory span and total correct scores of the forward condition of the VST), and all impulsivity factors as significantly important for classifying participants into either the AUD or CTL group. Specifically, the AUD group manifested hyperconnectivity across the bilateral anterior cingulate cortex and the prefrontal cortex as well as between the bilateral posterior cingulate cortex and the left inferior parietal lobule, while showing hypoconnectivity in long-range anterior-posterior and interhemispheric long-range connections. Individuals with AUD also showed poorer memory performance and increased impulsivity compared to CTL individuals. Furthermore, there were significant associations among FC, impulsivity, neuropsychological performance, and AUD status. These results confirm the previous findings that alterations in specific brain networks coupled with poor neuropsychological functioning and heightened impulsivity may characterize individuals with AUD, who can be efficiently identified using classification algorithms such as Random Forest.
Collapse
Affiliation(s)
- Chella Kamarajan
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
- Correspondence: ; Tel.: +1-718-270-2913
| | - Babak A. Ardekani
- Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA;
- Department of Psychiatry, NYU School of Medicine, New York, NY 10016, USA;
| | - Ashwini K. Pandey
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Sivan Kinreich
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Gayathri Pandey
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - David B. Chorlian
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Jacquelyn L. Meyers
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Jian Zhang
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Elaine Bermudez
- Department of Psychiatry, NYU School of Medicine, New York, NY 10016, USA;
| | - Arthur T. Stimus
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (A.K.P.); (S.K.); (G.P.); (D.B.C.); (J.L.M.); (J.Z.); (A.T.S.); (B.P.)
| |
Collapse
|
1225
|
Strain AK, Sullivan MM. Strengthening Laboratory Partnerships, Enhancing Recruitment, and Improving Retention Through Training and Outreach Activities: The Minnesota Experience. Public Health Rep 2020; 134:11S-15S. [PMID: 31682561 DOI: 10.1177/0033354919874085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
1226
|
Nam S, Chong Y, Jung CK, Kwak TY, Lee JY, Park J, Rho MJ, Go H. Introduction to digital pathology and computer-aided pathology. J Pathol Transl Med 2020; 54:125-134. [PMID: 32045965 PMCID: PMC7093286 DOI: 10.4132/jptm.2019.12.31] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022] Open
Abstract
Digital pathology (DP) is no longer an unfamiliar term for pathologists, but it is still difficult for many pathologists to understand the engineering and mathematics concepts involved in DP. Computer-aided pathology (CAP) aids pathologists in diagnosis. However, some consider CAP a threat to the existence of pathologists and are skeptical of its clinical utility. Implementation of DP is very burdensome for pathologists because technical factors, impact on workflow, and information technology infrastructure must be considered. In this paper, various terms related to DP and computer-aided pathologic diagnosis are defined, current applications of DP are discussed, and various issues related to implementation of DP are outlined. The development of computer-aided pathologic diagnostic tools and their limitations are also discussed.
Collapse
Affiliation(s)
- Soojeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yosep Chong
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihwan Park
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Jung Rho
- Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
1227
|
Simeon-Dubach D, Roehrl MH, Hofman P, Puchois P. Enhancing Cooperation Between Academic Biobanks and Biomedical Industry: Better Mutual Understanding and New Collaborative Models Are Needed. Biopreserv Biobank 2020; 18:144-149. [PMID: 32043910 DOI: 10.1089/bio.2019.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | | | - Paul Hofman
- University Côte d'Azur, Hospital-Related Biobank (BB-0033-00025) and FHU OncoAge, Nice, France
| | | |
Collapse
|
1228
|
Uljon SN, Simmons DP, Rudolf JW, Baron JM, Dutta S, McEvoy DS, Murali M, Dighe AS. Validation and Implementation of an Ordering Alert to Improve the Efficiency of Monoclonal Gammopathy Evaluation. Am J Clin Pathol 2020; 153:396-406. [PMID: 31776551 DOI: 10.1093/ajcp/aqz180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the use of a provider ordering alert to improve laboratory efficiency and reduce costs. METHODS We conducted a retrospective study to assess the use of an institutional reflex panel for monoclonal gammopathy evaluation. We then created a clinical decision support (CDS) alert to educate and encourage providers to change their less-efficient orders to the reflex panel. RESULTS Our retrospective analysis demonstrated that an institutional reflex panel could be safely substituted for a less-efficient and higher-cost panel. The implemented CDS alert resulted in 79% of providers changing their high-cost order panel to an order panel based on the reflex algorithm. CONCLUSIONS The validated decision support alert demonstrated high levels of provider acceptance and directly led to operational and cost savings within the laboratory. Furthermore, these studies highlight the value of laboratory involvement with CDS efforts to provide agile and targeted provider ordering assistance.
Collapse
Affiliation(s)
- Sacha N Uljon
- Departments of Pathology, Massachusetts General Hospital, Boston
| | - Daimon P Simmons
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Joseph W Rudolf
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
| | - Jason M Baron
- Departments of Pathology, Massachusetts General Hospital, Boston
| | - Sayon Dutta
- Departments of Pathology, Massachusetts General Hospital, Boston
- Emergency Medicine, Massachusetts General Hospital, Boston
| | | | | | - Anand S Dighe
- Departments of Pathology, Massachusetts General Hospital, Boston
- Partners HealthCare, Somerville, MA
| |
Collapse
|
1229
|
Use of Data Analysis Methods in Dental Publications: Is There Evidence of a Methodological Change? PUBLICATIONS 2020. [DOI: 10.3390/publications8010009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate how data analysis methods in dental studies have changed in recent years. Methods: A total of 400 articles published in 2010 and 2017 in five dental journals, Journal of Dental Research, Caries Research, Community Dentistry and Oral Epidemiology, Journal of Dentistry, and Acta Odontologica Scandinavica, were analyzed. The study characteristics and the reporting of data analysis techniques were systematically identified. Results: The statistical intensity of the dental journals did not change from 2010 to 2017. Dental researchers did not adopt the data mining, machine learning, or Bayesian approaches advocated in the computer-oriented methodological literature. The determination of statistical significance was the most generally used method for conducting research in both 2010 and 2017. Observational study designs were more common in 2017. Insufficient and incomplete descriptions of statistical methods were still a serious problem. Conclusion: The stabilization of statistical intensity in the literature suggests that papers applying highly computationally complex data analysis methods have not meaningfully contributed to dental research or clinical care. Greater rigor is required in reporting the methods in dental research articles, given the current pervasiveness of failure to describe the basic techniques used.
Collapse
|
1230
|
Timmons CF, Black-Schaffer WS, Naritoku WY, Powell SZ, Johnson KA, Brissette MD, Childs JM, Conran RM, Dixon LR, George MR, Gratzinger D, McCloskey CB, Prieto VG, Roberts CA, Rojiani AM, Shyu I, Hoffman RD. Entry of Graduates of US Pathology Residency Programs Into the Workforce: Cohort Data Between 2008 and 2016 Remain Positive and Stable. Acad Pathol 2020; 7:2374289520901833. [PMID: 32083168 PMCID: PMC7005983 DOI: 10.1177/2374289520901833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/01/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Abstract
The pathologist workforce in the United States is a topic of interest to the health-care community as a whole and to institutions responsible for the training of new pathologists in particular. Although a pathologist shortage has been projected, there has been a pervasive belief by medical students and their advisors that there are “no jobs in pathology.” In 2013 and again in 2017, the Program Directors Section of the Association of Pathology Chairs conducted surveys asking pathology residency directors to report the employment status of each of their residents graduating in the previous 5 years. The 2013 Program Directors Section survey indicated that 92% of those graduating in 2010 had obtained employment within 3 years, and 94% of residents graduating in 2008 obtained employment within 5 years. The 2017 survey indicated that 96% of those graduating in 2014 had obtained employment in 3 years, and 97% of residents graduating in 2012 obtained positions within 5 years. These findings are consistent with residents doing 1 or 2 years of fellowship before obtaining employment. Stratification of the data by regions of the country or by the size of the residency programs does not show large differences. The data also indicate a high percentage of employment for graduates of pathology residency programs and a stable job market over the years covered by the surveys.
Collapse
Affiliation(s)
- Charles F Timmons
- The Department of Pathology, UT Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | - W Stephen Black-Schaffer
- MGH Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wesley Y Naritoku
- The Department of Pathology and Laboratory Medicine, Keck School of Medicine at USC, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Suzanne Z Powell
- The Department of Pathology, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - John M Childs
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Richard M Conran
- The Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lisa R Dixon
- The Department of Pathology, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Melissa R George
- The Department of Pathology, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Dita Gratzinger
- The Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindy B McCloskey
- The Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Victor G Prieto
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Amyn M Rojiani
- The Department of Pathology, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Irene Shyu
- The Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert D Hoffman
- The Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
1231
|
Betts EV, Rashidi HH, Olson KA. Educational Case: Gastric High-Grade B-Cell Lymphoma With MYC and BCL2 Gene Rearrangement (Double-Hit Lymphoma). Acad Pathol 2020; 7:2374289520903415. [PMID: 32083169 PMCID: PMC7005970 DOI: 10.1177/2374289520903415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/06/2019] [Accepted: 01/01/2020] [Indexed: 11/18/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Elham Vali Betts
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Hooman H Rashidi
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
1232
|
Narasimhalu T, Olson KA. Educational Case: Infectious Esophagitis. Acad Pathol 2020; 7:2374289520903438. [PMID: 32083170 PMCID: PMC7005969 DOI: 10.1177/2374289520903438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/15/2019] [Accepted: 01/01/2020] [Indexed: 11/28/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Tara Narasimhalu
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kristin A Olson
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
1233
|
Abstract
The pressure on healthcare budgets including laboratory medicine is relentless and the focus on activities and costs remains the dominant funding model of laboratory medicine everywhere. The limitations of this model are well documented and for a decade or more laboratory professions worldwide have started looking at alternative models where the value of laboratory medicine and its impact on patient outcomes are the predominant driving force. There are multiple ways to determine the value of a medical test, particularly if one takes into consideration its impact upon the complete clinical pathway. Thus various approaches to value determination are being explored by a number of international organisations. These organisations will be reviewed below, including one which uses the concept of a value proposition that describes in detail how a test should be implemented by measuring its clinical, operational and economic impact. All approaches for determination of value require professional leadership. There is a need for research of varying types including that related to translating global evidence into local practice, a key challenge facing laboratory medicine and healthcare generally. Another challenge is to think and act beyond the silo of the laboratory to achieve greater collaboration with those colleagues more directly involved in patient care.
Collapse
|
1234
|
Lewis LD, Steinert Y. How Culture Is Understood in Faculty Development in the Health Professions: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:310-319. [PMID: 31599755 DOI: 10.1097/acm.0000000000003024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To examine the ways in which culture is conceptualized in faculty development (FD) in the health professions. METHOD The authors searched PubMed, Web of Science, ERIC, and CINAHL, as well as the reference lists of identified publications, for articles on culture and FD published between 2006 and 2018. Based on inclusion criteria developed iteratively, they screened all articles. A total of 955 articles were identified, 100 were included in the full-text screen, and 70 met the inclusion criteria. Descriptive and thematic analyses of data extracted from the included articles were conducted. RESULTS The articles emanated from 20 countries; primarily focused on teaching and learning, cultural competence, and career development; and frequently included multidisciplinary groups of health professionals. Only 1 article evaluated the cultural relevance of an FD program. The thematic analysis yielded 3 main themes: culture was frequently mentioned but not explicated; culture centered on issues of diversity, aiming to promote institutional change; and cultural consideration was not routinely described in international FD. CONCLUSIONS Culture was frequently mentioned but rarely defined in the FD literature. In programs focused on cultural competence and career development, addressing culture was understood as a way of accounting for racial and socioeconomic disparities. In international FD programs, accommodations for cultural differences were infrequently described, despite authors acknowledging the importance of national norms, values, beliefs, and practices. In a time of increasing international collaboration, an awareness of, and sensitivity to, cultural contexts is needed.
Collapse
Affiliation(s)
- Lerona Dana Lewis
- L.D. Lewis was postdoctoral fellow, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada, at the time this work was completed. Y. Steinert is professor of family medicine and health sciences education, director of the Institute of Health Sciences Education, and the Richard and Sylvia Cruess Chair in Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
1235
|
Vanlandingham DM, Hampton W, Thompson KM, Badizadegan K. Modeling Pathology Workload and Complexity to Manage Risks and Improve Patient Quality and Safety. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:421-434. [PMID: 31476083 DOI: 10.1111/risa.13393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 06/10/2023]
Abstract
Anatomic pathology (AP) laboratories provide critical diagnostic information that help determine patient treatments and outcomes, but the risks of AP operations and their impact on patient safety and quality of care remain poorly recognized and undermanaged. Hospital-based laboratories face an operational and risk management challenge because clinical work of unknown quantity and complexity arrives with little advance notice, which results in fluctuations in workload that can push operations beyond planned capacity, leading to diagnostic delays and potential errors. Modeling the dynamics of workload and complexity in AP offers the opportunity to better use available information to manage risks. We developed a stock-and-flow model of a typical AP laboratory operation and identified key exogenous inputs that drive AP work. To test the model, we generated training and validations data sets by combining data from the electronic medical records and laboratory information systems over multiple years. We demonstrate the implementation of 10-day AP work forecast generated on a daily basis, and show its performance in comparison with actual work. Although the model somewhat underpredicts work as currently implemented, it provides a framework for prospective management of resources to ensure quality during workload surges. Although full implementation requires additional model development, we show that AP workload largely depends on few and accessible clinical inputs. Recognizing that level loading of work in a hospital is not practical, predictive modeling of work can empower laboratories to triage, schedule, or mobilize resources more effectively and better manage risks that reduce the quality or timeliness of diagnostic information.
Collapse
Affiliation(s)
- David M Vanlandingham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Wesley Hampton
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | |
Collapse
|
1236
|
Lin CH, Chou PH, Chou W, Chien TW. Using the Kano model to display the most cited authors and affiliated countries in schizophrenia research. Schizophr Res 2020; 216:422-428. [PMID: 31862218 DOI: 10.1016/j.schres.2019.10.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
In order to improve individual research achievements (IRA), this study investigates which affiliated countries and authors earn the most cited IRAs and whether those types of articles are associated with the number of cited papers on schizophrenia from a leading journal in the field. The Kano model was used for displaying the IRAs. Clusters of medical subject headings (MeSH) were applied to explore the core concepts of a given journal. This study aimed to apply social network analysis (SNA) and an authorship-weighted scheme (AWS) to inspect the association between MeSH terms and IRA. About 2,008 abstracts published between 2012 and 2016 in the journal Schizophrenia Research were downloaded from Pubmed Central using the keyword (Schizophr Res)[Journal] on September 20, 2018. The MeSH terms were clustered by using SNA to separate the core concepts and compare the differences in bibliometric indices (i.e., h, Ag, x and author impact factor or AIF). Visual dashboards were shown on Google Maps. Results indicate that (1) the US, the UK, and Canada earn the highest x-index; (2) the top one author from the US has the highest x-index (= 5.73 with x-core at cited = 16.44 and citable = 2); (3) the article type of schizophrenic psychology shows distinctly higher frequencies than others; and (4) article types are associated with the number of cited papers. Four approaches of the Kano model, SNA, MeSH terms, and AWS can be accommodated to display IRAs, classify article types, and quantify coauthor contributions in the article byline, respectively, and applied to other scientific disciplines in the future, not just in this specific journal.
Collapse
Affiliation(s)
- Chien-Ho Lin
- Department of Psychiatry, Chi Mei Medical Center, Taiwan.
| | - Po-Hsin Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Taiwan.
| | - Tsair-Wei Chien
- Department of Medical Research, Chi Mei Medical Center, Taiwan.
| |
Collapse
|
1237
|
Tremblay EE, Stewart BD, Beal SG. Educational Case: Identification of Pulmonary Mycobacteria. Acad Pathol 2020; 7:2374289520901827. [PMID: 32110720 PMCID: PMC7001141 DOI: 10.1177/2374289520901827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/21/2019] [Accepted: 01/01/2020] [Indexed: 11/29/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
| | - Brian D Stewart
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
1238
|
Satou A, Feldman AL. Educational Case: ALK-Negative Anaplastic Large Cell Lymphoma. Acad Pathol 2020; 7:2374289520901813. [PMID: 32064308 PMCID: PMC6993148 DOI: 10.1177/2374289520901813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/31/2019] [Accepted: 12/27/2019] [Indexed: 11/23/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.
1
Collapse
Affiliation(s)
- Akira Satou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
1239
|
Toffel S, Velez L, Trejo-Lopez J, Beal SG, Kresak JL. Educational Case: Opportunistic Infections of the Central Nervous System. Acad Pathol 2020; 7:2374289520901809. [PMID: 32064307 PMCID: PMC6993152 DOI: 10.1177/2374289520901809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/08/2019] [Accepted: 01/01/2020] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
Collapse
Affiliation(s)
- Steven Toffel
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Lymaries Velez
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Jorge Trejo-Lopez
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Jesse L Kresak
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| |
Collapse
|
1240
|
Coates D, Makris A, Catling C, Henry A, Scarf V, Watts N, Fox D, Thirukumar P, Wong V, Russell H, Homer C. A systematic scoping review of clinical indications for induction of labour. PLoS One 2020; 15:e0228196. [PMID: 31995603 PMCID: PMC6988952 DOI: 10.1371/journal.pone.0228196] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS 68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence. CONCLUSIONS While for some indications, IOL is clearly recommended, a number of common indications for IOL do not have strong supporting evidence. Overall, few RCTs have evaluated the various indications for IOL. For conditions where clinical equipoise regarding timing of birth may still exist, such as suspected macrosomia and elevated BMI, researchers and funding agencies should prioritise studies of sufficient power that can provide quality evidence to guide care in these situations.
Collapse
Affiliation(s)
- Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Angela Makris
- Department of Medicine, Western Sydney University, Sydney, Australia
- Women’s Health Initiative Translational Unit (WHITU), Liverpool Hospital, Liverpool, Australia
| | - Christine Catling
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Women’s and Children’s Health, St George Hospital, Sydney, Australia
- The George Institute for Global Health, UNSW Medicine, Sydney, Australia
| | - Vanessa Scarf
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Nicole Watts
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Deborah Fox
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Purshaiyna Thirukumar
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Vincent Wong
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Research Science, University of New South Wales, Liverpool, Australia
| | - Hamish Russell
- South Western Sydney Local Health District, Sydney, Australia
| | - Caroline Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
- Maternal and Child Health Program, Burnet Institute, Victoria, Australia
| |
Collapse
|
1241
|
Velez L, Toffel S, Trejo-Lopez J, Kresak JL, Beal SG. Educational Case: Etiologies, Mechanisms, and Treatment of Stroke. Acad Pathol 2020; 7:2374289520901817. [PMID: 32047849 PMCID: PMC6985965 DOI: 10.1177/2374289520901817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/15/2019] [Accepted: 01/01/2020] [Indexed: 11/16/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
Collapse
Affiliation(s)
- Lymaries Velez
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Toffel
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Jorge Trejo-Lopez
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Jesse L Kresak
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| |
Collapse
|
1242
|
Zhao J, Dean DC, Hornicek FJ, Yu X, Duan Z. Emerging next-generation sequencing-based discoveries for targeted osteosarcoma therapy. Cancer Lett 2020; 474:158-167. [PMID: 31987920 DOI: 10.1016/j.canlet.2020.01.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
Osteosarcoma (OS) is the most common primary bone malignancy and is frequently lethal via metastasis to the lung. While surgical techniques and adjuvant chemotherapies have emerged to combat this deadly cancer, the 5-year survival rate has plateaued over the past four decades. Therapeutic progress has been notably poor because past technologies have not been able to reveal obscured OS biomarkers and targets. With the advent and implementation of large-scale next-generation sequencing (NGS) studies, various somatic mutations and copy number changes involved in OS progression and metastasis have surfaced. These findings have significantly expanded the amount of genome-informed pathways and candidate genes suitable for targeting in pre-clinical models. Furthermore, NGS analyses comparing primary and matched pulmonary metastatic tumor tissues have catalogued previously unknown prognostic biomarkers in OS. In this review, we delineate the most recent findings in NGS for OS therapy and how this technology has advanced personalized therapy.
Collapse
Affiliation(s)
- Jie Zhao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, China; Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; Department of Orthopaedic Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250031, China.
| | - Dylan C Dean
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Xiuchun Yu
- Department of Orthopaedic Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250031, China.
| | - Zhenfeng Duan
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| |
Collapse
|
1243
|
Ju JY, Wehrli G. The effect of entrustable professional activities on pathology resident confidence in blood banking/transfusion medicine. Transfusion 2020; 60:912-917. [PMID: 31970781 DOI: 10.1111/trf.15679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education requires milestone reporting of the Six General Core Competencies. Additionally, Graduate Medical Education (GME) is transitioning to adopt competency-based education methodologies including entrustable professional activities (EPAs) for objective, observable, and measurable milestone progression. The College of American Pathologists published 19 EPAs, including one for transfusion-related adverse events. This survey study includes developing EPAs for transfusion reaction evaluation and assessing residents before and after implementing these EPAs. STUDY DESIGN AND METHODS Three transfusion reaction EPAs were developed and implemented in July 2018 for the Postgraduate Year (PGY) 2 pathology residents. An online, anonymous survey was sent to all 21 pathology trainees before and one year after EPA implementation. In July 2018 and August 2019, each survey included the same six multiple-choice, single-response, confidence questions, with a rating scale of extremely, very, slightly, or not at all confident. This study was approved by the hospital's Institutional Review Board for Health Sciences Research and GME Committee. RESULTS Analysis was performed on PGY2-4 residents. In 2018, 13 of 20 participants were analyzed. In 2019, 15 of 19 participants were analyzed. Number and percentage of responses were reported. The results showed an increase in trainee confidence, with the greatest improvement among the first class to use the EPAs. CONCLUSION EPAs provide an effective framework for objective and measurable progression of trainees. One year after the implementation of transfusion reaction EPAs at our site, the trainees showed enhanced confidence levels in handling Blood Bank and Transfusion Medicine Services coverage.
Collapse
Affiliation(s)
- Jennifer Y Ju
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
| | - Gay Wehrli
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
| |
Collapse
|
1244
|
Kresak JL, Kavesh M, Feely M. Educational Case: Esophageal Carcinoma. Acad Pathol 2020; 7:2374289519897383. [PMID: 32030352 PMCID: PMC6977094 DOI: 10.1177/2374289519897383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/23/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Jesse Lee Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark Kavesh
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael Feely
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
1245
|
Pennestrì F, Banfi G. Value-based healthcare: the role of laboratory medicine. Clin Chem Lab Med 2020; 57:798-801. [PMID: 30738014 DOI: 10.1515/cclm-2018-1245] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/27/2018] [Indexed: 01/09/2023]
Abstract
The global increase of health demands pushes administrators and policy makers to provide good quality health care at sustainable costs. Many approaches have been developed, among which value-based health care (VBHC) is one of the most promising: value is given by outcomes achieved per dollar spent. Best value is given by shared benefits between all the stakeholders involved in the process: patients, providers, suppliers, payers and citizens. However, VBHC implementation is a current challenge for hospitals and healthcare providers, that may find it difficult to adapt their organization into a patient-centered clinical pathway based on both classical outcomes and innovative patient-evaluation. If any contribution to improve cost-effectiveness over the full cycle of care is welcome, laboratory medicine is achieving increasing importance, by generating useful knowledge to reduce costs and improve patient care, provided by a biunivocal relationship with clinicians. On the one hand, pathologists have to emphasize the importance of laboratory data to improve diagnostic and prognostic traditional thinking. On the other hand, the same data are useful only when supported by strong evidence. Introducing laboratory medicine professionals to VBHC would be useful to achieve better skills on data outline, comparable methodologies, quality control, cost assessment, multidisciplinary coordination and patient-specific procedures.
Collapse
Affiliation(s)
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
1246
|
Krasowski MD. Educational Case: Ethylene Glycol Poisoning. Acad Pathol 2020; 7:2374289519900330. [PMID: 31984224 PMCID: PMC6961139 DOI: 10.1177/2374289519900330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/04/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology
Competencies for Medical Education (PCME), a set of national standards for teaching
pathology. These are divided into three basic competencies: Disease Mechanisms and
Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology.
For additional information, and a full list of learning objectives for all three
competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
Collapse
Affiliation(s)
- Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
1247
|
Rashidi HH, Sen S, Palmieri TL, Blackmon T, Wajda J, Tran NK. Early Recognition of Burn- and Trauma-Related Acute Kidney Injury: A Pilot Comparison of Machine Learning Techniques. Sci Rep 2020; 10:205. [PMID: 31937795 PMCID: PMC6959341 DOI: 10.1038/s41598-019-57083-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/16/2019] [Indexed: 12/30/2022] Open
Abstract
Severely burned and non-burned trauma patients are at risk for acute kidney injury (AKI). The study objective was to assess the theoretical performance of artificial intelligence (AI)/machine learning (ML) algorithms to augment AKI recognition using the novel biomarker, neutrophil gelatinase associated lipocalin (NGAL), combined with contemporary biomarkers such as N-terminal pro B-type natriuretic peptide (NT-proBNP), urine output (UOP), and plasma creatinine. Machine learning approaches including logistic regression (LR), k-nearest neighbor (k-NN), support vector machine (SVM), random forest (RF), and deep neural networks (DNN) were used in this study. The AI/ML algorithm helped predict AKI 61.8 (32.5) hours faster than the Kidney Disease and Improving Global Disease Outcomes (KDIGO) criteria for burn and non-burned trauma patients. NGAL was analytically superior to traditional AKI biomarkers such as creatinine and UOP. With ML, the AKI predictive capability of NGAL was further enhanced when combined with NT-proBNP or creatinine. The use of AI/ML could be employed with NGAL to accelerate detection of AKI in at-risk burn and non-burned trauma patients.
Collapse
Affiliation(s)
- Hooman H Rashidi
- Department of Pathology and Laboratory Medicine, 4400 V Street, Sacramento, CA, 95817, USA.
| | - Soman Sen
- Division of Burn Surgery, Department of Surgery, 2221 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Tina L Palmieri
- Division of Burn Surgery, Department of Surgery, 2221 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Thomas Blackmon
- Department of Pathology and Laboratory Medicine, 4400 V Street, Sacramento, CA, 95817, USA
| | - Jeffery Wajda
- UC Davis Health (2315 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, 4400 V Street, Sacramento, CA, 95817, USA.
| |
Collapse
|
1248
|
Dervaux A, Vaysse B, Doutrellot-Philippon C, Couvreur V, Guilain N, Chatelain D. [Pathologist occupational hazards: Results of a survey for the French case]. Ann Pathol 2020; 40:2-11. [PMID: 31928795 DOI: 10.1016/j.annpat.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/20/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The profession of pathologist exposes to various risks, notably infectious, physical and chemical. The objective of this study was to make an inventory of these occupational risks to which pathologists are subjected and to evaluate the pathologies that they presented. A particular attention was given to microscopic and screen work as they can induce musculoskeletal or ophthalmic disorders, and stress-related psychological disorders. METHOD An anonymous online questionnaire containing 54 questions had been sent by mail to pathologists via the French Society of Pathology and the Syndicate of French Pathologists. RESULTS Five hundred and twelve pathologists responded to the survey. Thirty-eight percent reported musculoskeletal disorders in the last 6 months. Visual disturbances concerned 73.4% of respondents. In the last 12 months, 33.3% of pathologists had been injured or had had mucosal projections during macroscopic or autopsy specimens. The frequency of infectious diseases was low (6.2%) as well as that of cancers (3.9%). Psychological disorders such as depression or burnout were reported by 16.7% of respondents. Pathologists seemed happy at work and had a good overall lifestyle. Few doctors had medical follow-up and few had benefited from ergonomic advice and training on the risks of chemicals. CONCLUSION The results of this study showed the interest of a medical surveillance adapted to the pathologies presented by the pathologists. Educational and preventive measures should be introduced early in the career, focusing on ergonomics and learning about chemical and biological hazards.
Collapse
Affiliation(s)
- Alexandra Dervaux
- Service d'anatomie et cytologie pathologiques, centre hospitalier universitaire d'Amiens-Picardie, place Victor-Pauchet, 80054 Amiens cedex 1, France.
| | - Benoît Vaysse
- Département d'information médicale, centre hospitalier universitaire Amiens-Picardie, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France.
| | - Catherine Doutrellot-Philippon
- Souffrance au travail et pathologies professionnelles, centre hospitalier universitaire d'Amiens-Picardie, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France.
| | - Virginie Couvreur
- Service de santé au travail, centre hospitalier universitaire d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France.
| | - Nelly Guilain
- Service d'anatomie et cytologie pathologiques, centre hospitalier universitaire d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France.
| | - Denis Chatelain
- Service d'anatomie et cytologie pathologiques, centre hospitalier universitaire d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France.
| |
Collapse
|
1249
|
Second opinion system for sudden cardiac death cases in forensic practice. Int J Legal Med 2020; 134:1255-1263. [PMID: 31915964 DOI: 10.1007/s00414-019-02225-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/04/2019] [Indexed: 01/17/2023]
Abstract
Sudden cardiac death (SCD) represents a considerable percentage of cardiovascular deaths worldwide. The most frequent pathological substrate of SCD is atherosclerotic coronary artery disease (CAD). The other, less common, pathologies which can cause SCD include cardiomyopathies, congenital diseases (including abnormal anatomy), and arrhythmias such as channelopathies, many of which are genetically determined. Autopsies of SCD victims are generally performed by forensic pathologists. In some cases, a third person responsibility could be invoked. While CAD diagnosis at post-mortem examination is not a major challenge for the forensic pathologist, the other rarer diseases may be. In such instances, referral of the hearts to specialized centers with recognized expertise is recommended, and this is particularly important in cases of SCDs of young people. Moreover, in order to avoid the frequent overdiagnosis of a pathological heart, an expert opinion should be sought for even in the presence of a morphologically normal heart. In cases where retention of the heart is not feasible, it is essential to provide an extensive photographic documentation, with the indication of the sampling sites for histological examination. However, some practical aspects, as the criteria for case selection in routine forensic practice are missing. In this paper, we present the recommendations for heart retention for a second expert opinion and the alternative of documentation and sampling for cases where retention is not possible.
Collapse
|
1250
|
Torralba KD, Jose D, Byrne J. Psychological safety, the hidden curriculum, and ambiguity in medicine. Clin Rheumatol 2020; 39:667-671. [PMID: 31902031 DOI: 10.1007/s10067-019-04889-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
Psychological safety is a feeling that individuals are comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution. It has long been recognized as part of successful patient safety and quality improvement processes. However, in the realm of medical education, psychological safety is a relatively unknown concept to many educators and learners alike. Learners, whether students or postgraduate trainees, are in a phase of cognitive apprenticeship whereby they learn not only skills and knowledge from teachers as part of an explicit and formal curriculum. At the same time, a hidden curriculum is also part of the learning environment in the form of norms, values, and behaviors exhibited by teachers. These norms, values, and behaviors become part of the culture of the clinical learning environment. The vulnerability of learners in this environment is magnified by the hierarchal nature of medicine, and the complexity, uncertainty, and the ambiguity inherent to medical conditions. This is especially true of cognitive specialties such as rheumatology. Educators who engage in unprofessional behaviors that result in learner humiliation and shame may serve to dampen productive discourse and scientific dialog. Therefore, educators must embrace psychological safety to foster learning and facilitate high-performing teams in the clinical learning environment.Key Points• Psychological safety improves communication and teamwork by allowing individuals to be comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution.• Commonly studied in the context of patient safety and quality improvement, psychological safety should extend towards medical education particularly in the context of allowing medical students and postgraduate trainees to be able to voice clinical reasoning in the face of ambiguity.• Educators take on a leadership role when having learners under their supervision; as leaders, educators are the prime movers of psychological safety• Learners in the process of developing their self-identity in the context of their chosen profession adopt not only knowledge and skills within the framework of an explicit and formal curriculum but also norms and values from daily behavior and language educators present in the clinical learning environment of learners; these norms and values are collectively part of the hidden curriculum.
Collapse
Affiliation(s)
- Karina D Torralba
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA.
| | - Donna Jose
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA
| | - John Byrne
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA.,Loma Linda Health Care System, Loma Linda, CA, USA
| |
Collapse
|