The Role of Artificial Intelligence in Urogynecology: Current Applications and Future Prospects

Artificial intelligence (AI) is the new medical hot topic, being applied mainly in specialties with a strong imaging component. In the domain of gynecology, AI has been tested and shown vast potential in several areas with promising results, with an emphasis on oncology. However, fewer studies have been made focusing on urogynecology, a branch of gynecology known for using multiple imaging exams (IEs) and tests in the management of women's pelvic floor health. This review aims to illustrate the current state of AI in urogynecology, namely with the use of machine learning (ML) and deep learning (DL) in diagnostics and as imaging tools, discuss possible future prospects for AI in this field, and go over its limitations that challenge its safe implementation.

Software solution for integration of frozen section quality assurance into daily practice

OBJECTIVE

Diagnoses rendered using the frozen section (FS) technique during surgical procedures are used to guide intraoperative decisions. Therefore, diagnostic FS errors have the potential to affect patient safety and quality of care. Diagnostic FS errors arise due to both technical and interpretative factors and present a challenge to surgical pathology laboratories to recognize, document, and manage in a timely fashion. Thus, there is a need to monitor discrepancies between FS and permanent diagnoses and effectively communicate with the clinical teams when an error is discovered to ensure an opportunity for timely interventions, if clinically indicated.

METHODS

Our FS practice is complex, with many contributing variables, such as a partially generalized FS pathology practice model among pathology faculty and/or surgeons with specific subspecialty expertise and different physical locations of FS facilities. We implemented a comprehensive frozen section quality assurance (FSQA) program using custom software solutions aimed at improving patient safety by monitoring recognition, increasing documentation, and facilitating communication in cases where there is a discordance between intraoperative and permanent diagnoses.

RESULTS

Our FSQA program allows for categorizing frozen section discrepancies according to the source of error, such as interpretive vs technical errors, to understand how errors arise and to develop appropriate mitigation strategies for reducing errors.

CONCLUSIONS

Overall, our intervention to improve FSQA has engaged pathology faculty in a uniform and systematic manner, and our data show that our new FSQA program led to a markedly shortened time interval of FSQA, allowing for timely management and resolution of errors.

Artificial intelligence and transfusion education, research and practice: The view from the ISBT Clinical Transfusion Working Party

BACKGROUND AND OBJECTIVES

Artificial intelligence (AI) has been gaining increasing interest in healthcare. During the 2024 International Society of Blood Transfusion (ISBT) Congress, the Clinical Transfusion Working Party (CTWP) conducted a session to explore the exciting intersection of AI in transfusion medicine (TM) practice, education and research. We report here the potential applications and the session outcome.

MATERIALS AND METHODS

A pre-workshop survey explored the participants' demographics and areas of use of AI and whether they have had any AI-specific training or education. The workshop included presentations on the regulatory aspects of AI use and its application in TM practice, education and research. These were followed by round-table discussions to explore participants' experience and concerns.

RESULTS

The workshop had 72 attendees, with 38% falling in the 36-45-year age group. A total of 70% indicated the use of AI, but only 12% reported having specific training or education. Participants expressed interest in different potential applications but also shared concerns on over-reliance, potential loss of skills, the accuracy of provided information and content plagiarism.

CONCLUSION

The findings of the workshop highlight the need for training, educational resources, standards and regulatory frameworks to guide the use of AI tools in the field of TM.

Hydrophilic Polymer Embolization-A Scoping Review of the Available Literature with Focus on Organ Involvement and Outcomes

Background: Hydrophilic polymer embolization (HPE) is a scarcely reported complication associated with endovascular procedures where the hydrophilic coating dislodges and disseminates to more distal vascular beds, leading to ischemic complications. The aim of this study is to assess the clinical outcomes associated with HPE in the literature and try to quantify it in a scoping manner. Methods: All reports with regard to HPE in the PubMed database where clinical data were available were included. Reports were excluded if no clinical data were available and only histopathological descriptions are available, if the language of the report was not in English, and if access could not be obtained to that specific report. Results: A total of 60 publications containing 111 patients were identified. The majority (N = 45, 75%) of the publications were "single-patient" case reports. An overwhelming minority of the reports reported underlying hypertension (N = 27, 45.0%) and ischemic heart disease (N = 28, 46.7%). The most common implicated procedures for HPE occurence were cardiac procedures (N = 28, 46.7%), intracranial procedures (N = 13, 21.7%) and aortic procedures (N = 10, 16.7%). Steroids were trialled in nine (15%) of the reports, mainly for HPE to the CNS (7/9), with no mortality in that specific group. However, HPE-related mortality, identified in 48/111 patients, was largely due to HPE with pulmonary and cardiac involvement (combined 36/48 of all deaths). Conclusions: HPE seems to be a rare occurrence, although low-quality evidence (mainly case reports) comprises most of the research on the subject. Fatal outcomes seem relatively common, and steroid therapy may be trialled in select cases. Further research, potentially through prospective registry studies may aid in providing more knowledge on HPE.

Like, share, and follow!: Usage of social media by pathology residency programs in the COVID-19 era

OBJECTIVES

Social media platforms like Facebook, X (formally Twitter), and Instagram bridge pathology programs with other health professionals, prospective students, and the public, but the extent of social media usage by residency programs remains unexplored. This study investigates the current landscape of social media utilization by pathology programs.

METHODS

Using the National Resident Matching Program (NRMP) Match Data from 2022, 139 anatomic and clinical pathology residency programs were analyzed and categorized into 3 prestige tiers based on Doximity ratings. There were 32,067 posts examined between January 2018 and August 2022. Statistical analyses, including analysis of variance and Tukey honestly significant difference post hoc analysis, were performed to evaluate likes/views about post type.

RESULTS

X emerged as the most used platform (68%), focusing on pathology education (27.02%). Instagram centered on resident life (25.84%), while Facebook showcased person-specific posts (35.61%). Notably, there was a correlation between program prestige and the number of posts on X and Instagram, with the most prestigious programs posting more frequently than those considered more intermediate or low in prestige rank.

CONCLUSIONS

Social media is vital in connecting pathology programs with various stakeholders. Despite seasonal fluctuations, the overall utilization of social media continues to rise, underscoring its value as a long-term resource for pathology education and communication.

Out-of-distribution generalization for segmentation of lymph node metastasis in breast cancer

Pathology provides the definitive diagnosis, and Artificial Intelligence (AI) tools are poised to improve accuracy, inter-rater agreement, and turn-around time (TAT) of pathologists, leading to improved quality of care. A high value clinical application is the grading of Lymph Node Metastasis (LNM) which is used for breast cancer staging and guides treatment decisions. A challenge of implementing AI tools widely for LNM classification is domain shift, where Out-of-Distribution (OOD) data has a different distribution than the In-Distribution (ID) data used to train the model, resulting in a drop in performance in OOD data. This work proposes a novel clustering and sampling method to automatically curate training datasets in an unsupervised manner with the aim of improving model generalization abilities. To evaluate the generalization performance of the proposed models, we applied a novel use of the Two One-sided Tests (TOST) method. This method examines whether the performance on ID and OOD data is equivalent, serving as a proxy for generalization. We provide the first evidence for computing equivalence margins that are data-dependent, which reduces subjectivity. The proposed framework shows the ensembled models constructed from models that generalized across both tumor and normal patches enhanced performance, achieving an F1 score of 0.81 for LNM classification on unseen ID and OOD samples. Interactive viewing of slide-level segmentations can be accessed on PathcoreFlow™ through https://web.pathcore.com/folder/18555?s=QTJVHJuhrfe5 . Segmentation models are available at https://github.com/IAMLAB-Ryerson/OOD-Generalization-LNM .

Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study

OBJECTIVES

This study investigated the autopsy rate of hospital deaths in Shenzhen megacity and identified factors that may impact the decision to perform an autopsy in hospital deaths.

DESIGN

This is a population-based retrospective cohort study.

SETTING

Shenzhen is a megacity in China with a population of more than 17 million and a total of 151 hospitals. The official dataset of the inpatient medical record home page was used. Demographic, clinical and hospital information was extracted.

PARTICIPANTS

All the 35 272 inpatient deaths between 2016 and 2022 with known autopsy status were included to calculate the overall autopsy rate. Among them, a total of 34 577 cases with complete data, classified hospital and Chinese nationality, were included for further multivariable rare events logistic regression and Poisson pseudo maximum likelihood regression.

OUTCOME MEASURES

Whether the inpatient death was autopsied or not.

RESULTS

The autopsy procedure was performed in 0.9% (319/35 272) of hospital deaths. The autopsy decision was significantly and positively associated with being married (OR= 1.60, 95% CI: 1.16 to 2.21), self-paying (OR=1.56, 95% CI: 1.07 to 2.26), death due to external causes of injury and poisoning (OR=1.69, 95% CI: 1.02 to 2.81) and pregnancy (OR=13.58, 95% CI: 4.94 to 37.36), but negatively associated with age (OR=0.97, 95% CI: 0.96 to 0.98), emergency admission (OR=0.66, 95% CI: 0.49 to 0.88), referral (OR=0.47, 95% CI: 0.25 to 0.88), neoplasms (OR=0.35, 95% CI: 0.22 to 0.56), respiratory diseases (OR=0.49, 95% CI: 0.26 to 0.95) and for-profit hospitals (OR=0.45, 95% CI: 0.23 to 0.91). There were no statistically significant differences in autopsy rates between large teaching hospitals and other hospitals.

CONCLUSIONS

The autopsy rate of hospital deaths was extremely low, largely due to healthcare providers. Even large teaching hospitals do not request more autopsies compared with other hospitals, after controlling for the patient characteristics. More efforts are urged to encourage hospitals and healthcare providers to proactively request autopsies, helping to revive this important procedure.

Teaching the Laboratory's Role in Diagnostic Stewardship: Engaging Pathology Residents in a Quality Initiative to Improve Autoverification Rates

BACKGROUND

Our institution involves our pathology residents in departmental quality initiatives and in identifying needs for operational improvements. The solutions achieved by these projects have effects beyond the laboratory, and ultimately help to improve diagnostic stewardship by supporting the clinician's ability to obtain necessary biochemical information at the right time. A project highlighting a successful venture is described here in which our investment in new total laboratory automation was not meeting our goals for autoverification rates, resulting in less than expected improvements to turnaround times (TAT).

METHODS

To improve efficiency of the new laboratory automation, our third-year pathology residents examined the limitations to the verification process and current delta checks. They performed a literature review for the most updated evidence-based practices, examined clinical metrics such as TAT. The residents assessed their findings combined with the laboratory's quality goals, and contributed to updating middleware rule modifications. Several chemistry analyte software rules were revised while others were eliminated.

RESULTS

After implementation of the modifications autoverification rates improved from 78% to 89% within 2 months of rule revisions. Average TAT for STAT basic metabolic profile improved from 51 to 46 minutes.

CONCLUSIONS

This study demonstrates the benefits of involving pathology residents in quality improvement initiatives. Residents are skilled resources capable of evaluating laboratory workflow processes in the context of clinical need. In this process, the residents experience the responsibilities of laboratory administration and learn the role of the laboratory in diagnostic stewardship.

Cost-Effective Drug Testing: Analytical Methodology, Best Practices, and Clinical Utility

BACKGROUND

Drug overdose-related deaths continue to increase globally. Testing demands have likewise increased, prompting healthcare facilities to adopt a range of methods, from simple point-of-care immunoassays to comprehensive chromatographic and mass spectrometry-based techniques. Each of these testing methods has trade-offs related to cost, performance, speed, and convenience, requiring healthcare facilities to carefully determine the best options to meet their clinical needs. Unfortunately, current testing practices may result in unnecessary costs and certain methods, such as immunoassays, have significant limitations that affect their clinical utility. As such, the goal of this review is to frame the current state of drug testing and related cost-effectiveness and patient centered approaches to address this evolving public health challenge.

CONTENT

This review discusses the current state of substance use mortality/morbidity, the economic impact of substance use disorders, provides an overview of testing methods and their relative cost-benefit, solutions to improve test utilization and cost-effectiveness, and finally, future threats and new opportunities that can improve the clinical utility of these tests.

SUMMARY

The cost-effectiveness of drugs of abuse testing revolves around proper test utilization, including understanding what test is being ordered, its limitations, understanding results, and ordering testing when it can provide actionable information. Fundamental principles of test utilization such as education, clinical informatics, and optimizing test panels remain essential. Future threats in this space include new compounds and regulatory changes. However, novel solutions such as new noninvasive sample types, automation, and artificial intelligence can play a significant role in improving overall test utilization practices.

What Is Diagnostic Stewardship?

BACKGROUND

Diagnostic stewardship is a set of clinically based changes to the ordering, processing, and reporting of diagnostic tests designed to improve patient outcomes (through decreased inappropriate testing, and reduced patient harm from wrong, delayed, or missed diagnosis). It shares a common philosophy with laboratory stewardship but has some key differences.

CONTENT

Laboratory stewardship focuses primarily on pre- and post-analytical components of the testing process. Laboratory stewardship encourages laboratorians to engage clinical partners in discussion around the impact of pre- and post-analytical components of testing. Diagnostic stewardship extends laboratory stewardship into clinical medicine as it considers the clinician's interaction and experience with the ordering system and attempts to modify clinical thinking, even before a test is ordered. Diagnostic stewardship then goes beyond the post-analytic laboratory interpretation of results to contextualize those results in evidence-based best practice recommendations. Compared to laboratory stewardship, diagnostic stewardship is clinician led vs laboratorian led, utilizes clinician-focused terminology rather than laboratory-specific language, and incorporates clinician decision support and behavioral economics to drive behavior change.

SUMMARY

There are many complementary principles and activities between laboratory and diagnostic stewardship, and collaboration allows both programs to grow and improve patient overall quality of care.

Survey of Laboratory Stewardship Governance at US Academic Medical Centers

BACKGROUND

Efforts to appropriately utilize laboratory tests have been underway for several decades. However, limited information is available regarding the status of laboratory stewardship at academic medical centers. Prior to initiating a laboratory stewardship committee, a study was initiated to gain insights from peer institutions.

METHODS

An online REDCap survey was created and emailed to US pathology department leaders at 94 academic medical centers.

RESULTS

Response rate was 40%. Sixty-eight percent (n = 26) of respondents indicated that they have a laboratory stewardship committee. There was variability among academic medical institutions regarding governance, committee structure and responsibilities, and assessment of laboratory stewardship committee performance. There was consensus for inclusion of: hospital administration and clinical leadership; informatics (IT) support, and a multidisciplinary clinical team combined with laboratory medicine expertise. Of the 32% (n = 12) without a committee, 4 started one but found it unsustainable, and 6 were unsuccessful at starting a program. Respondents without a current laboratory stewardship program cited lack of leadership support, insufficient management and IT resources, and unclear vision and goals as major factors. Fifty-eight percent of those without a laboratory stewardship committee predicted their hospital would establish one within the next 5 years.

CONCLUSIONS

Survey results provide insights into the status of laboratory stewardship efforts at peer institutions. Awareness of the structural and leadership components critical to successful and sustained initiatives will improve the quality and value of clinical laboratory services.

The Role of the Clinical Laboratory in Diagnostic Stewardship and Population Health

BACKGROUND

As healthcare identifies new opportunities to provide patient services and moves from volume to value payment models, the clinical laboratory is in an ideal position to serve as a catalyst for these changes. In 2017, the Project Santa Fe Foundation (PSFF) was founded to support the clinical laboratory's role to promote the objectives of population health and value-based healthcare. The initiative, known as Clinical Lab 2.0, uses longitudinal laboratory data to create actionable insights that can lead to improved patient and population outcomes, optimize the total cost of care, and reduce financial risk for stakeholders.

CONTENT

The Clinical Lab 2.0 model was developed by a coalition of laboratory leaders to support clinical laboratories in the implementation of this new paradigm that moves beyond the provision of high-specificity and high-accuracy transactional test results and promotes "well care" and population health.To provide leadership for Clinical Lab 2.0 across healthcare, promote dissemination of these concepts to clinical laboratories, and create evidence of laboratory's value; the Foundation has several ongoing initiatives. The first initiative is the conduct of both single-site and multisite demonstration projects at PSFF member sites. The second ongoing initiative for the Foundation is the provision of guidance documents to support clinical laboratories in the implementation of Clinical Lab 2.0 and promote policy development. PSFF has developed 2 types of guidance document tools: Position Statements and Laboratory-Driven Care Models.

SUMMARY

This review summarizes the history, background, and initiatives for Clinical Lab 2.0 supported by the Project Santa Fe Foundation.

Entrustable professional activities for cytopathology fellowship

Entrustable professional activities (EPAs) are an educational tool in the framework of competency-based medical education. EPAs are a relatively new concept in pathology. No studies to date exist on the utilization of EPAs during cytopathology fellowship training. This article reviews the recent literature on this topic and shares our institutional experience with the implementation of an EPA for fine needle aspirations and rapid on-site evaluations. While EPAs allow for tracking the competence of the cytopathology fellow toward independent practice for fine needle aspirations and rapid on-site evaluations, the required amount of documentation may represent a potential barrier for the widespread adoption of this new tool.

Computer-assisted diagnosis to improve diagnostic pathology: A review

ABSTRACT

With an increasing demand for accuracy and efficiency in diagnostic pathology, computer-assisted diagnosis (CAD) emerges as a prominent and transformative solution. This review aims to explore the practical applications, implications, strengths, and weaknesses of CAD applied to diagnostic pathology. A comprehensive literature search was conducted to include English-language studies focusing on CAD tools, digital pathology, and Artificial intelligence (AI) applications in pathology. The review underscores the transformative potential of CAD tools in pathology, particularly in streamlining diagnostic processes, reducing turnaround times, and augmenting diagnostic accuracy. It emphasizes the strides made in digital pathology, the integration of AI, and the promising prospects for prognostic biomarker discovery using computational methods. Additionally, ethical considerations regarding data privacy, equity, and trust in AI deployment are examined. CAD has the potential to revolutionize diagnostic pathology. The insights gleaned from this review offer a panoramic view of recent advancements. Ultimately, this review aims to guide future research, influence clinical practice, and inform policy-making by elucidating the promising horizons and potential pitfalls of integrating CAD tools in pathology.

Trends and Challenges of the Modern Pathology Laboratory for Biopharmaceutical Research Excellence

Pathology, a fundamental discipline that bridges basic scientific discovery to the clinic, is integral to successful drug development. Intrinsically multimodal and multidimensional, anatomic pathology continues to be empowered by advancements in molecular and digital technologies enabling the spatial tissue detection of biomolecules such as genes, transcripts, and proteins. Over the past two decades, breakthroughs in spatial molecular biology technologies and advancements in automation and digitization of laboratory processes have enabled the implementation of higher throughput assays and the generation of extensive molecular data sets from tissue sections in biopharmaceutical research and development research units. It is our goal to provide readers with some rationale, advice, and ideas to help establish a modern molecular pathology laboratory to meet the emerging needs of biopharmaceutical research. This manuscript provides (1) a high-level overview of the current state and future vision for excellence in research pathology practice and (2) shared perspectives on how to optimally leverage the expertise of discovery, toxicologic, and translational pathologists to provide effective spatial, molecular, and digital pathology data to support modern drug discovery. It captures insights from the experiences, challenges, and solutions from pathology laboratories of various biopharmaceutical organizations, including their approaches to troubleshooting and adopting new technologies.

Comparison of Digital Pathology and Light Microscopy Among Dermatology Residents: A Reappraisal Following Practice Changes

BACKGROUND

Following transition to digital pathology for primary diagnosis at our institution, dermatology residents have reduced exposure to light microscopy. This study compares resident competency with light microscopy versus digital pathology following practice changes.

METHODS

Twenty-one dermatology residents were administered a dermatopathology examination composed of 32 diagnoses evaluated using digital slides and 32 with light microscopy. Case difficulty was graded and balanced between modalities. Diagnostic accuracy was measured using the number of correct diagnoses for each modality. Participants were surveyed regarding their experience and preferences.

RESULTS

Diagnostic accuracy was higher with digital pathology than light microscopy (22/32 vs. 18/32, P < 0.001). Diagnostic accuracy with digital pathology increased with years of training, but accuracy with light microscopy did not. Residents with previous light microscopy experience achieved an average score of 19/32 on glass, as compared with 10/32 for those without experience ( P = 0.039). Digital pathology was preferred over light microscopy (18/21, 85.7%).

CONCLUSIONS

Trainees had better diagnostic proficiency with digital pathology and preferred this modality. Most practices at this time continue to use light microscopy. Therefore, we need to maintain proficiency in microscopy during training while concurrently preparing trainees for a digital future.

TNF-α Expression and Plasma Cell and Macrophage Numbers in Traumatic Ulcers in a Rat Model Treated by Topical or Systemic Probiotic L. casei Shirota

Introduction: Live microorganisms, named probiotics, can improve overall physical well-being, particularly the oral cavity's health. L. casei Shirota, a popular probiotic, can influence the immune response by increasing the number of macrophages and plasma cells that play a role in traumatic ulcer healing. Aims: To determine the expression of tumor necrosis factor-alpha (TNF-α) and the varied number of plasma cells and macrophages on a traumatic ulcer animal model treated with topical or systemic administration of a probiotic L. casei Shirota. Material and Methods: Thirty-six healthy, 2-3-month-old male Rattus norvegicus weighing 175-250 gram, were designed into control and topical and systemic administration probiotic groups. The control group was treated with Aquadest 20 uL/20 gr, while topical probiotic and systemic administration probiotic groups were treated with 10,9x107 cells/kg, respectively. A heated round burnisher tip was used to traumatize the inferior incisive fornix labial area. After 3 or 7 days, the animal models were terminated. Immunohistochemical examination, Hematoxylin eosin staining, and statistical analysis were performed to analyze the expression of TNF-α and the number of plasma cells and macrophages. Results: The Mann-Whitney and Tukey HSD tests indicated significant differences (p < 0.05) in the results for the three groups. It was observed that topical administration provides more remarkable results than systemic administration for the expression of TNF-α, the number of plasma cells, and the number of macrophages. Conclusion: Topical administration of L. casei Shirota demonstrates better results than systemic administration for healing traumatic ulcers.

Ten Years of Pathology on Twitter (X): Landscape and Evolution of Pathology on Twitter From 2012 to 2023

CONTEXT.—

Social media is a powerful tool in pathology education and professional networking that connects pathologists and pathology trainees from around the world. Twitter (X) appears to be the most popular social media platform pathologists use to share pathology-related content and connect with other pathologists. Although there has been some published research on pathology-related activity on Twitter during short time frames, to date there has not been published research examining pathology-related Twitter activity in totality from its earliest days of activity to recently.

OBJECTIVE.—

To comprehensively evaluate the use of pathology on Twitter (X) during the last 10 years.

DESIGN.—

Pathology-related tweets were systematically scraped from Twitter from January 2012 to January 2023 using pathology hashtags as a surrogate measure for all pathology content on Twitter. COVID-related tweets were approximated by tweets containing the term "COVID."

RESULTS.—

There were 591 812 unique pathology-related tweets identified during the time period, with #pathology being the most common hashtag used and #PathTwitter becoming more popular since 2020. There has been positive annual growth of pathology Twitter, with peaks in use during major pathology conferences. During the initial phases of the COVID-19 pandemic, a sustained increase in pathology tweets was observed.

CONCLUSIONS.—

Pathology Twitter has grown during the last 10 years and has become increasingly popular for pathology education and networking. With the changing landscape of social media platforms, this study provides an understanding of how pathology medical education and professional networking uses of social media happen and evolve over time.

Exploring the Impact and Prospects of Social Media in Advancing Pediatric Pathology

Social media has been recently highlighted as a unique and modern virtual force that allows for worldwide connection, collaboration, communication, and engagement between pathologists, trainees, and medical students. Much literature has been focused on the role of social media in recruitment and medical education practices of different pathology subspecialties, such as dermatopathology and hematopathology. However, current literature on pathology social media's status and potential future roles in promoting pediatric pathology is sparse. Herein, this review intends to narrow this knowledge gap by reviewing how social media has been utilized in different pediatric subspecialties, the current use of social media in pathology, and how the future of pediatric pathology social media use may look moving forward regarding education, research, and recruitment. Specific tips and related online resources are provided.

International medical graduates representation in pathology academic workforce, departmental leadership and society leadership

Compared with the overall physician workforce, pathologist workforce in the United States has significant representation of international medical graduates (IMGs). IMG representation in the academic pathology workforce, as well as in departmental and pathology societal leadership, has not been documented. In this cross-sectional study, we surveyed a sample of 20 North American academic pathology departmental publicly available websites. Each faculty was recorded according to the location of their medical school training as either US or Canadian medical graduateor IMG (country of medical school graduation any other than US or Canada). Past and present presidents of four major North American pathology societies [American Society for Clinical Pathology (ASCP), Association for Academic Pathology (AAPath), College of American Pathologists (CAP), United States and Canadian Academy of Pathology (USCAP)] were also recorded. A total of 1455 pathologists were retrieved in our search: 924 (63.5 %) were USCMGs and 531 (36.5 %) IMGs. Likewise, 65 % of pathology chairs were USCMGs and 35 % IMGs. These data mirror the 2022 Association of American Medical Colleges distribution in the pathology workforce (65.6 % USCMGs and 34.4 % IMGs). In contrast, historic data from 1993 to 2024 show that only 8 (8 %) past or current presidents of the major US pathology societies were IMGs (USCAP = 6, ASCP = 1, AAPath = 1, CAP = none). While the academic pathology community has proportional representation of physicians based on location of their medical school training, there is historical underrepresentation of IMGs in societal leadership. Unveiling the causes of this disparity and identifying any potential obstacles for faculty engagement is paramount.

A New Era of Ophthalmology Leadership? A Descriptive and Comparative Analysis of Ophthalmology Department Chairs in 2024

PURPOSE

To (1) characterize and analyze the demographics and scholarly achievements of United States (US) academic ophthalmology department chairs, and (2) to elucidate trends in the academic and demographic profiles of newly hired department chairs.

DESIGN

Cross-sectional study.

METHODS

Online search of publicly available resources conducted January 1, 2024.

PATIENT OR STUDY POPULATION

One hundred seven ophthalmology chairs of accredited US departments.

MAIN OUTCOME MEASURES

Department chair demographic and academic data.

RESULTS

Of 107 chairs analyzed, 83% (89/107) are male. The mean age of chairs is 60.9 ± 7.9 years and the mean age at appointment is 51.9 ± 7.6 years. There has been significant turnover in department chairs recently, with 47 (44%) chairs having been newly appointed in the past 7 years. Approximately 40% (n = 41) of current chairs completed ≥1 component of their medical training at the program where they are currently chair. Approximately one-third (33/107 [31%]) of current chairs earned an additional graduate degree, most frequently a PhD (17/107 [16%]), MBA (10/107 [8%]), and MS (8/107 [4%]). More than 96% (n = 103) of chairs completed a clinical fellowship, often in vitreoretinal surgery (30/107 [28%]), cornea (27/107 [25%]), or glaucoma (24/107 [22%]). The average number of peer-reviewed publications among chairs is 214.9 ± 294.7 (range 0-1901), and the mean h-index is 35.0 ± 25.4 (range 0-147). When comparing profiles of newly appointed chairs in the past 7 years to chairs appointed before 2017, there was not a statistically significant difference in gender distribution (21% female vs 13% female, respectively, P = .276). Newly hired chairs were significantly older at the time of their appointment to chair (54 years vs 50 years, respectively, P = .008) and averaged significantly more years from residency completion to appointment as chair (23 years vs 19 years, respectively, P = .005).

CONCLUSIONS

Ophthalmology department chairs remain predominantly fellowship-trained males who have frequently trained at the institution they currently chair. Newly hired chairs have accumulated more experience before their appointment, starting the role later in their careers, with implications for the frequency of future chair turnover. While females compose a higher proportion of newly hired chairs in the past 7 years compared with previous periods of time, females remain underrepresented in ophthalmology chair positions.

#PathArt: from glass slide to canvas; with a mission of enlightening the burdens of life

Pathology requires visual aptitude, pattern, and color recognition as a medical specialty. This can account for the growing PathArt (or #PathArt via social media, or SoMe) movement. For the purpose of this review, the authors define PathArt as any form of art inspired by pathology topics, such as microscopic images (i.e. surgical histology, cytology, hematology, immunohistochemistry), gross pathology, and clinical pathology (including molecular/genetics). Pathologists are well-versed in the use of hashtags and commonly utilize them to tag relevant medical topics to share with colleagues through online platforms, such as Twitter (renamed X in 2023). As the professional laboratory network has expanded virtually, artists within the community have emerged and shared numerous pathology artworks. However, displaying pathology as "beautiful" art pieces gives rise to concerns over portraying cancer light-heartedly given the humanity of disease. For this review, we discuss the history of art and medicine, pathology as a visual and creative specialty, explore the conceptual framework of the hashtag #PathArt is associated with sharing pathology-related art on SoMe, and address the psychological and medico-legal implications that surround PathArt. This article is intended to provide a guide to fostering PathArt and #PathArt in an ethical and positive manner. References were obtained via qualitative review of non-peer-reviewed and peer-reviewed literature pertinent to this topic.

Laboratory Data as a Potential Source of Bias in Healthcare Artificial Intelligence and Machine Learning Models

Artificial intelligence (AI) and machine learning (ML) are anticipated to transform the practice of medicine. As one of the largest sources of digital data in healthcare, laboratory results can strongly influence AI and ML algorithms that require large sets of healthcare data for training. Embedded bias introduced into AI and ML models not only has disastrous consequences for quality of care but also may perpetuate and exacerbate health disparities. The lack of test harmonization, which is defined as the ability to produce comparable results and the same interpretation irrespective of the method or instrument platform used to produce the result, may introduce aggregation bias into algorithms with potential adverse outcomes for patients. Limited interoperability of laboratory results at the technical, syntactic, semantic, and organizational levels is a source of embedded bias that limits the accuracy and generalizability of algorithmic models. Population-specific issues, such as inadequate representation in clinical trials and inaccurate race attribution, not only affect the interpretation of laboratory results but also may perpetuate erroneous conclusions based on AI and ML models in the healthcare literature.

Managing Pneumothorax in Neurofibromatosis Type 1: A Report of a Rare Case

Neurofibromatosis is a rare genetic disorder with variable manifestations, primarily involving neural and connective tissues. Although pulmonary complications such as pneumothorax are uncommon, they can significantly impact patient outcomes. We report the case of a 48-year-old male with a 10-year history of neurofibromatosis who presented with acute thoracic pain and dyspnea. Imaging revealed a pneumothorax requiring urgent thoracic drainage. Subsequent surgical exploration via thoracoscopy revealed apical bullae and vascularized adhesions, along with multiple intact cystic formations in the lung parenchyma. Surgical management included apical bullectomy using a mechanical stapler and talc pleurodesis. The patient's postoperative recovery was uneventful, with complete lung re-expansion confirmed on imaging. This case underscores the importance of tailored surgical intervention in managing rare complications of neurofibromatosis, emphasizing thoracoscopy as a minimally invasive and effective approach.

Pathology in the artificial intelligence era: Guiding innovation and implementation to preserve human insight

The integration of artificial intelligence in pathology has ignited discussions about the role of technology in diagnostics-whether artificial intelligence serves as a tool for augmentation or risks replacing human expertise. This manuscript explores artificial intelligence's evolving contributions to pathology, emphasizing its potential capacity to enhance, rather than eclipse, the pathologist's role. Through historical comparisons, such as the transition from analog to digital in radiology, this paper highlights how technological advancements have historically expanded professional capabilities without diminishing the essential human element. Current applications of artificial intelligence in pathology-from diagnostic standardization to workflow efficiency-demonstrate its potential to augment diagnostic accuracy, expedite processes, and improve consistency across institutions. However, challenges remain in algorithmic bias, regulatory oversight, and maintaining interpretive skills among pathologists. The discussion underscores the importance of comprehensive governance frameworks, evolving educational curricula, and public engagement initiatives to ensure artificial intelligence in pathology remains a collaborative endeavor that empowers professionals, upholds ethical standards, and enhances patient outcomes. This manuscript ultimately advocates for a balanced approach where artificial intelligence and human expertise work in concert to advance the future of diagnostic medicine.

Association of Lambert-Eaton Myasthenic Syndrome and First Episode Psychosis: A Case Report

Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune neuromuscular junction disorder characterized by proximal weakness, autonomic dysfunction, and areflexia associated with antibodies against voltage-gated calcium channels (VGCCs). Psychotic symptoms can occur in many autoimmune neurological disorders but they have rarely been observed in myasthenic syndromes. We report the case of a 21-year-old woman with primary autoimmune LEMS due to anti-VGCC antibodies subtype P/Q, who developed psychotic symptoms 3 years after the onset of motor symptoms. These symptoms decreased after every cycle of monthly intravenous immunoglobulin therapy. Different causes of reversible psychosis were excluded, such as autoimmune encephalitis. Due to a worsening of the patient's muscle strength, and the psychotic episodes, the patient received several treatments including an admission to a neurology unit. To our knowledge, this is the first described case of psychotic symptoms associated with LEMS. We speculate that VGCC antibodies could have a role in the development of mental symptoms, although additional hypotheses are also discussed.

Challenges in autopsy training for pathology residents: A survey of autopsy directors

Resident training in autopsy provides a foundation of knowledge and skills for forensic pathologists and anatomic pathologists, but obstacles are present in ensuring quality training. A survey of US autopsy service directors at sites with pathology residency programs was used to identify common challenges in resident autopsy training. Respondents (n = 29) largely believed that negative attitudes from residents, faculty, training programs, and/or the medical system at large (34%) and time limitations (34%) were the most significant challenges for residency autopsy training. Regarding the Accreditation Council for Graduate Medical Education's decreased autopsy requirements from 50 to 30 required cases, respondents noted decreased difficulty (38% to 7%) for residents to achieve the minimum of cases but increased concerns regarding competency at this minimum (7% to 76%). Other impacts of this reduced requirement included decreased interest from residents after meeting minimum requirements, shortened autopsy rotations, increased resident-free autopsies, and increased use of pathologist assistants. Two programs (7%) described a decreased need for residents to share cases, but no other potential benefit was described. In addition to the value provided to the community through autopsies, autopsy training during residency provides knowledge and skills relevant to anatomic pathologists generally and forms a necessary foundation on which forensic pathology fellows and future autopsy attendings can develop proficiency. Continued effort is needed to promote the importance of autopsies to pathology residents and others and to provide sufficient training to produce pathologists competent in autopsy pathology.

Enhancing Professionalism Online (Netiquette) in Medical Schools: A Systematic Scoping Review

Background

The relaxing of COVID-19 pandemic restrictions has not seen the return to previous in-person teaching formats. As blended training continues to be used, there is emphasis on the need to better appreciate the expectations, etiquette, and professional code of conduct ("netiquette") surrounding online learning, especially in light of evidence that poor online professionalism compromises learning and clinical practice.

Objectives

This review seeks to map regnant netiquette guidelines in medical schools that will inform and provide preliminary recommendations for a clinically relevant framework.

Design

This study is a systematic scoping review (SSR).

Methods

Krishna's Systematic Evidence-Based Approach (SEBA)'s Constructivist ontological and Relativist epistemological lens was used to guide this SSR. The SEBA process involves 6 stages, including the Systematic Approach, Split Approach, Jigsaw Perspective, Funneling, Analysis of evidence-based and non-data-driven literature, and Synthesis of the SSR in SEBA.

Results

In total, 7941 abstracts were reviewed, 198 full text articles were evaluated, and 83 articles were included. The analysis of the results revealed 4 key domains: (1) current guidelines, (2) manifestations, (3) contributing factors, and (4) implications. This SSR in SEBA highlights variability and gaps in current guidelines and reveals the impact of sociocultural factors on breaches in netiquette. Unsurprisingly, contextual and clinical considerations shape the contributory factors impacting lapses in netiquette and their implications.

Conclusions

Based on the data accrued, this article proposes basic guidelines on netiquette and measures to support their effective employment. This includes curricular adaptations, methods of teaching and enhancing engagement with the students and faculty training. Drawing on prevailing studies, it also recommends methods of assessing netiquette, online professionalism, and the learning environment. Suggestions are also made for future areas of study.

Implementation and Retrospective Examination of a Lung Cancer Survivorship Clinic in a Comprehensive Cancer Center

PURPOSE

The number of early-stage lung cancer survivors (LCS) is increasing, yet few survivorship programs address their specific needs. We developed a workflow to transition early-stage LCS to dedicated lung survivorship care and comprehensively identify and address their needs using electronic patient-reported outcomes (ePROs).

METHODS

A lung cancer multidisciplinary team developed a workflow (eg, referrals, survivorship care plan delivery, documentation, orders, tracking, ePROs, and surveillance) for a survivorship clinic staffed by Advanced Practice Providers (APPs). ePROs included the NCCN Distress Thermometer, PROMIS-29, and investigator-developed patient satisfaction items. Patient characteristics, ePROs, and referrals are described; chi-square and t-tests examined ePRO completion by patient characteristics and compared PROMIS-29 domains by treatment modality and to a national sample.

RESULTS

From January 2020-March 2023, 315 early-stage LCS completed a survivorship orientation visit. Patient satisfaction was high; 75% completed ePROs. Females were overall less likely to complete ePROs than males; male, age 65+, Black or other race, and rural patients were more likely to complete ePROs in clinic versus online. Patients reported lower symptom burden compared to a general population of early-stage LCS in the United States; scores were similar regardless of treatment modality. Rates of moderate-severe symptoms ranged from 6% (depression) to 42% (poor physical function); ≤ 20% had a referral placed.

CONCLUSIONS

A referral-based, APP-staffed survivorship clinic model for early-stage LCS which includes ePROs to identify specific needs is acceptable to patients. Future work should include outreach to female LCS and increasing supportive care referrals and acceptability to further address early-stage LCS reported needs.

Is insufficient introspection a reason to terminate residency training? - Scrutinising introspection among residents who disputed dismissal

INTRODUCTION

Insufficient introspection as part of the 4I's model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals.

METHODS

We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed 'insufficient' regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection.

RESULTS

Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents' insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training.

CONCLUSIONS

Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I's model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents' introspection, but further research is needed for effective implementation in medical education.

CDC20 and CCNB1 Overexpression as Prognostic Markers in Bladder Cancer

Background: Bladder cancer (BC) is one of the ten most common cancers worldwide, with a high recurrence rate and significant variation in clinical outcomes based on tumor grade and stage. This study aimed to investigate the gene expression profiles at different cancer stages to assess their potential prognostic value. Methods: RNA was extracted from paraffin-embedded BC tissues and the gene expression levels of CDC20 and CCNB1 were analyzed using qRT-PCR. A total of 54 BC patient samples were included in the analysis and categorized into low-grade (LG) (n = 23) and high-grade (HG) (n = 31) tumors, as well as stages pTa, pT1, and pT2. Results: CDC20 gene expression was significantly higher in the HG group (mean fold-change: 16.1) compared to the LG group (mean fold-change: 10.54), indicating a significant association with tumor grade (p = 0.039). However, no significant differences were observed in CDC20 expression across the cancer stages. For CCNB1, while gene expression was significantly elevated in higher-stage tumors (pT2 vs. pTa; p = 0.038), no significant association was found between CCNB1 expression and tumor grade. Survival analysis revealed that increased CCNB1 expression and advanced cancer stage were associated with poorer overall survival, whereas no significant impact of CDC20 expression or tumor grade on survival was observed. Correlation analysis indicated a positive relationship between CDC20 expression and tumor grade (r = 0.284, p = 0.038) and between CCNB1 expression and tumor stage (r = 0.301, p = 0.027). Conclusions: Our findings suggest that CDC20 overexpression is linked to higher tumor grades, while CCNB1 overexpression is associated with more advanced cancer stages in BC. These results underscore the potential utility of CDC20 and CCNB1 as biomarkers for tumor prognosis and as therapeutic targets. Further studies with larger cohorts are needed to validate these findings and better understand the molecular mechanisms driving BC progression.

The current troubled state of the global pathology workforce: a concise review

The histopathology workforce is a cornerstone of cancer diagnostics and is essential to the delivery of cancer services and patient care. The workforce has been subject to significant pressures over recent years, and this review considers them in the UK and internationally. These pressures include declining pathologist numbers, the increasing age of the workforce, and greater workload volume and complexity. Forecasts of the workforce's future in numerous countries are also not favourable - although this is not universal. Some in the field suggest that the effects of these pressures are already coming to bear, such as the financial costs of the additional measures needed to maintain clinical services. There is also some evidence of a detrimental impact on service delivery, patient care and pathologists themselves. Various solutions have been considered, including increasing the number of training places, enhancing recruitment, shortening pathology training and establishing additional support roles within pathology departments. A few studies have examined the effect of some of these solutions. However, the broader extent of their implementation and impact, if any, remains to be determined. In this regard, it is critical that future endeavours should focus on gaining a better understanding of the benefits of implemented workforce solutions, as well as obtaining more detailed and updated pathology workforce numbers. With a concentrated effort in these areas, the future of the pathology workforce could become brighter in the face of the increased demands on its services.

Horst Oertel and the Russell Sage Institute of Pathology: Impacts on vital statistics and the origins of the short-lived heyday of autopsies in America

Horst Oertel was an early 20th century pathologist who began his career as an instructor of clinical pathology at the New York University and Bellevue Hospital Medical College in 1899. In 1903, he was appointed pathologist for City Hospital, an institution for indigent patients on New York City's Blackwell's Island. In 1907, Oertel became the first director of the Russell Sage Institute of Pathology, a unique new blended public-private entity based at City Hospital, that was named after a wealthy benefactor. The Institute was established to utilize the Island's indigent population to perform anatomical pathology research on diseases of aging. Oertel and the Institute thrived until 1911, when a newly-appointed New York City bureaucrat seeking patronage and graft began meddling in the Institute's governance. After press coverage of a vitriolic one-week-long exchange of charges and counter-charges between the Institute's Board of Directors and the bureaucrat, the Institute imploded. While these events meant that the Institute's tenure on Blackwell's Island would soon be coming to an end, Oertel continued to work and submit articles from the Institute throughout 1912. In May 1913, he published "The Inaccuracy of American Mortality Statistics" in American Underwriter, a bombshell article documenting low autopsy rates and high clinical diagnostic error rates at Bellevue Hospital during 1912. This, along with similar studies by Richard Cabot at Massachusetts General Hospital in Boston, highlighted fundamental problems in hospital care and medical education across America. Simultaneously, Oertel led the Public Health, Hospital and Budget Committee of the New York Academy of Medicine which reported that, in a selected series of large American hospitals, the autopsy percentage when compared to the number of deaths was one-eighth the rates in Canada, Great Britain, Austria, and Germany. This paper addresses how American autopsy rates skyrocketed and then plummeted again during the mid-20th century.

Semi-quantitative scoring criteria based on multiple staining methods combined with machine learning to evaluate residual nuclei in decellularized matrix

The detection of residual nuclei in decellularized extracellular matrix (dECM) biomaterials is critical for ensuring their quality and biocompatibility. However, current evaluation methods have limitations in addressing impurity interference and providing intelligent analysis. In this study, we utilized four staining techniques-hematoxylin-eosin staining, acetocarmine staining, the Feulgen reaction and 4',6-diamidino-2-phenylindole staining-to detect residual nuclei in dECM biomaterials. Each staining method was quantitatively evaluated across multiple parameters, including area, perimeter and grayscale values, to establish a semi-quantitative scoring system for residual nuclei. These quantitative data were further employed as learning indicators in machine learning models designed to automatically identify residual nuclei. The experimental results demonstrated that no single staining method alone could accurately differentiate between nuclei and impurities. In this study, a semi-quantitative scoring table was developed. With this table, the accuracy of determining whether a single suspicious point is a cell nucleus has reached over 98%. By combining four staining methods, false positives caused by impurity contamination were eliminated. The automatic recognition model trained based on nuclear parameter features reached the optimal index of the model after several iterations of training in 172 epochs. The trained artificial intelligence model achieved a recognition accuracy of over 90% for detecting residual nuclei. The use of multidimensional parameters, integrated with machine learning, significantly improved the accuracy of identifying nuclear residues in dECM slices. This approach provides a more reliable and objective method for evaluating dECM biomaterials, while also increasing detection efficiency.

Insights and Trends in Open Note Access: Retrospective Observational Study

BACKGROUND

As of 2021, at least 4 out of every 5 hospitals offered patients access to clinical notes via a web-based patient portal, a number that is expected to grow because of the 21st Century Cures Act. There is limited data on how open note use may have evolved over time or which types of clinical interactions were viewed most in the outpatient setting.

OBJECTIVE

This study aims to analyze trends in outpatient open note access over time; characterize usage in terms of age, sex, and clinical interaction type; and assess the method of access to help uncover areas of improvement in patient engagement and identify further areas of research.

METHODS

A retrospective observational study was conducted at Erie County Medical Center from November 1, 2021, to December 31, 2022, to coincide with the time that open notes went live. Outpatient note access and account logs were downloaded from the portal and combined into a single dataset consisting of 18,384 note accesses by 4615 users, with column headings of the patient index, sex, age, note title that was accessed, clinical interaction type, time stamp of note creation, time stamp of access, and method of access (web vs mobile). A separate table was created with sex data for all 35,273 portal accounts. Microsoft Excel and Microsoft Power Query were used to combine and analyze the data.

RESULTS

During the study period, 4615 portal users viewed 12,150 documents for a total of 18,384 times, averaging 2.6 notes per patient viewed 4 times. Only 13.1% (4615/35,273) of all portal inpatient and outpatient registrants viewed their outpatient notes. There was a female predominance in those who viewed notes (2926/4615, 63.4%; P<.001), while 56.8% (20,047/35,273) of all portal registrants were female. Users in their 30s and 50s accessed more notes than other age groups. The ratio of mobile-to-web access of notes tended to decrease as a function of increasing age, which was not observed in those aged ≥90 years. Notes regarding COVID-19 assessments were the most accessed among all clinical interactions (4725/12,150, 38.9%). Overall, the number of users accessing notes reached a maximum of 1968 before declining to 1027 by the end of the study period.

CONCLUSIONS

Open note access was largely dominated by COVID-19 assessments, and the number of users viewing their notes has declined over time as the pandemic subsided. Furthermore, female patients and those aged in their 30s as well as 50s viewed more notes than other groups. Finally, the percentage of notes viewed via a mobile device tended to decrease as a function of increasing age, showing that web-based access of open notes is an important modality for older patients.

Disentangling faculty development: A scoping review towards a rich description of the concept and its practice

BACKGROUND

There is wide variation in how faculty development (FD) is practiced globally and described in the literature. This scoping review aims to clarify how FD is conceptualised and practiced in health professions education.

METHODOLOGY

Using a systematic search strategy, 418 papers, published between 2015-2023, were included for full text review. We extracted data using closed and open-ended questions. Quantitative data were summarised using descriptive statistics and qualitative data synthesised using content analysis.

RESULTS

Faculty development was the most frequently used term encompassing a range of understandings and practices. Many papers focused on educators' enhanced understanding of teaching, learning, and assessment. Several highlighted the social context of collaborative practice and organisational learning. FD formats included workshops, courses, longitudinal programs, and coaching and mentoring. Dominant conceptual frameworks included Kirkpatrick's model of evaluation, communities of practice theory, adult learning theory, and experiential learning.

CONCLUSIONS

Although FD continues to evolve in response to the dynamic HPE landscape, this growth needs to be accelerated. To facilitate meaningful collaboration across professions, contexts, and countries, attention must be paid to terms used and meanings ascribed to them. Those responsible for FD need to think anew about its purpose and practice, demonstrating flexibility as the ever-changing context demands.

A retrospective multi-site examination of chronic kidney disease using longitudinal laboratory results and metadata to identify clinical and financial risk

BACKGROUND

A retrospective observational study was conducted at 3 health care organizations to identify clinical gaps in care for patients with stage 3 or 4 chronic kidney disease (CKD), and financial opportunity from U.S. risk adjustment payment systems. Lack of evaluation for CKD in patients with diabetes was also assessed.

METHODS

Outpatient longitudinal laboratory results and patient metadata available in the electronic medical record, laboratory information system, and/or laboratory billing or facility claims data for the calendar year 2021 were evaluated. Laboratory results were compared to billing data (ICD-10 codes) and risk adjustment scores including Hierarchical Condition Categories (HCC) to determine if laboratory-identified CKD was coded as a disease condition in the electronic medical record. Adults 18 to 75 years of age were included; inpatient laboratory results and pregnant individuals were excluded.

RESULTS

At the 3 institutions, 12,478 of 16,063 (78%), 487 of 1511 (32%) and 19,433 of 29,277 (66%) of patients with laboratory evidence of stage 3 or 4 CKD did not have a corresponding ICD-10 or HCC code for CKD in the electronic medical record. For patients at the 3 institutions with diabetes on the basis of an HbA1c value of ≥ 6.5%, 34,384 of 58,278 (59%), 2274 of 2740 (83%) and 40,378 of 52,440 (77%) had not undergone guideline-recommended laboratory testing for CKD during the same 12 months. Using publicly available data for calendar year 2021, an estimated 3246 of 32,398 patients (9.9%) at the 3 institutions with undocumented CKD stages 3-4 would be enrolled in Medicare Advantage or Affordable Care Act Marketplace programs. The imputed lost reimbursement under risk-adjusted payment systems for under-documentation of CKD in this subset of patients was $2.85 M for the three institutions combined, representing lost opportunity for both identification and proactive clinical management of these patients, and financial recovery for the costs of providing that care.

CONCLUSIONS

Clinical laboratories can provide value beyond routine diagnostics, helping to close gaps in care for identification and management of CKD, stratifying subgroups of patients to identify risk, and capturing missed reimbursement through risk adjustment factors.

Factors affecting the specialty choice among medical students of Saudi Arabia; an exploratory study

BACKGROUND

Career or specialty choice is one of the crucial steps of a medical student's life. It's a difficult yet important decision that is hard to reverse after getting into the residency program. The recent catastrophic experience of shortage and maldistribution of the health workforce among different specialties during the recent pandemic has made it critical for the authorities to look into the motivators and determinants for the specialty choice from the undergraduate medical student's perspective. Therefore, the study aimed to find out the major factors affecting career choice and the effects of the COVID-19 pandemic on the specialty choice of medical students in Saudi Arabia.

METHOD

This qualitative exploratory study was carried out to explore the factors affecting the specialty choice and effects of COVID-19 on the specialty choice of senior medical students and interns of Saudi Arabia by utilizing semi-structured audio-recoded interviews. Participants of the study were enrolled by convenient sampling after informed written consent. Data were transcribed and thematic analysis was done to extract the themes.

RESULT

A total of 28 medical students and 14 interns participated in the study. The study identified five major themes with 18 relevant subthemes. The subthemes derived from the transcribed data were arranged under the following key themes; recognizing the determinants for specialty choice, financial expectation, gender specificity/stereotype, the impact of COVID-19, and concomitant motivation factors.

CONCLUSION

The right selection of a suitable future career is pivotal and strongly associated with future job success and satisfaction for a medical graduate. The study has provided insight to the regulatory bodies about student's fears and factors affecting them to choose or avoid certain specialties to formulate a future resource management plan accordingly.

Smartphone-Based Pupillometry Using Machine Learning for the Diagnosis of Sports-Related Concussion

Background: Quantitative pupillometry has been proposed as an objective means to diagnose acute sports-related concussion (SRC). Objective: To assess the diagnostic accuracy of a smartphone-based quantitative pupillometer in the acute diagnosis of SRC. Methods: Division I college football players had baseline pupillometry including pupillary light reflex (PLR) parameters of maximum resting diameter, minimum diameter after light stimulus, percent change in pupil diameter, latency of pupil constriction onset, mean constriction velocity, maximum constriction velocity, and mean dilation velocity using a smartphone-based app. When an SRC occurred, athletes had the smartphone pupillometry repeated as part of their concussion testing. All combinations of the seven PLR parameters were tested in machine learning binary classification models to determine the optimal combination for differentiating between non-concussed and concussed athletes. Results: 93 football athletes underwent baseline pupillometry testing. Among these athletes, 11 suffered future SRC and had pupillometry recordings repeated at the time of diagnosis. In the machine learning pupillometry analysis that used the synthetic minority oversampling technique to account for the significant class imbalance in our dataset, the best-performing model was a random forest algorithm with the combination of latency, maximum diameter, minimum diameter, mean constriction velocity, and maximum constriction velocity PLR parameters as feature inputs. This model produced 91% overall accuracy, 98% sensitivity, 84.2% specificity, area under the curve (AUC) of 0.91, and an F1 score of 91.6% in differentiating between baseline and SRC recordings. In the machine learning analysis prior to oversampling of our imbalanced dataset, the best-performing model was k-nearest neighbors using latency, maximum diameter, maximum constriction velocity, and mean dilation velocity to produce 82% accuracy, 40% sensitivity, 87% specificity, AUC of 0.64, and F1 score of 24%. Conclusions: Smartphone pupillometry in combination with machine learning may provide fast and objective SRC diagnosis in football athletes.