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Stenzinger A, Vogel A, Lehmann U, Lamarca A, Hofman P, Terracciano L, Normanno N. Molecular profiling in cholangiocarcinoma: A practical guide to next-generation sequencing. Cancer Treat Rev 2024; 122:102649. [PMID: 37984132 DOI: 10.1016/j.ctrv.2023.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Cholangiocarcinomas (CCA) are a heterogeneous group of tumors that are classified as intrahepatic, perihilar, or distal according to the anatomic location within the biliary tract. Each CCA subtype is associated with distinct genomic alterations, including single nucleotide variants, copy number variants, and chromosomal rearrangements or gene fusions, each of which can influence disease prognosis and/or treatment outcomes. Molecular profiling using next-generation sequencing (NGS) is a powerful technique for identifying unique gene variants carried by an individual tumor, which can facilitate their accurate diagnosis as well as promote the optimal selection of gene variant-matched targeted treatments. NGS is particularly useful in patients with CCA because between one-third and one-half of these patients have genomic alterations that can be targeted by drugs that are either approved or in clinical development. NGS can also provide information about disease evolution and secondary resistance alterations that can develop during targeted therapy, and thus facilitate assessment of prognosis and choice of alternative targeted treatments. Pathologists play a critical role in assessing the viability of biopsy samples for NGS, and advising treating clinicians whether NGS can be performed and which of the available platforms should be used to optimize testing outcomes. This review aims to provide clinical pathologists and other healthcare professionals with practical step-by-step guidance on the use of NGS for molecular profiling of patients with CCA, with respect to tumor biopsy techniques, pre-analytic sample preparation, selecting the appropriate NGS panel, and understanding and interpreting results of the NGS test.
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Affiliation(s)
- Albrecht Stenzinger
- Institute of Pathology Heidelberg (IPH), Center for Molecular Pathology, University Hospital Heidelberg, In Neuenheimer Feld 224, 69120 Heidelberg, Building 6224, Germany.
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital Medical Oncology, Princess Margaret Cancer Centre, Schwartz Reisman Liver Research Centre, 200 Elizabeth Street, Office: 9 EB 236 Toronto, ON, M5G 2C4, Canada.
| | - Ulrich Lehmann
- Institute for Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Angela Lamarca
- Department of Medical Oncology, Oncohealth Institute, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain; Department of Medical Oncology, The Christie NHS Foundation Trust, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, IHU RespirERA, Siège de l'Université: Grand Château, 28 Avenue de Valrose, 06103 Nice CEDEX 2, France.
| | - Luigi Terracciano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy.
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202
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Sensu S, Erdogan N. Are We Where We Want to Be in Undergraduate Pathology Education? Turk Patoloji Derg 2024; 40:78-88. [PMID: 38265100 PMCID: PMC11131570 DOI: 10.5146/tjpath.2023.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This review which aims to examine the recent and current status of pathology education in medical schools, and covers the publications related to undergraduate pathology education published between 2010 January and June 2023. MATERIAL AND METHOD A search was performed through PubMed, Google Scholar, Semantic Scholar, and Ulakbim search engines for the Science Citation Index, Science Citation Index Expanded, Emerging Sources Citation Index, Directory of Open Access Journals, Scopus, PubMed as well as TR Dizin indexed articles. The findings are categorized into two periods as 2010 January - 2020 April (pre-COVID-19 pandemic) and May 2020 - 2023 June. A total of 24 reviews/editorials/letters to the editor and 63 research articles in the pre-pandemic period and 11 reviews/ editorials/ letters to the editor and 35 research articles between 2020 May and 2023 June are included in the analysis. RESULTS Currently, medical education generally depends on core education programs with defined learning objectives and outcomes. Moreover, problem-based, case-based, and team-based interactive learning are being used along with traditional didactic courses. Additionally, digital/ web-based/remote education methods have gained prominence after the COVID-19 pandemic. The virtual or augmented reality and 3D drawing applications are offered as a solution for the autopsy and macroscopy courses. A scarce number of publications are found on measuring and evaluating the effectiveness of learning. CONCLUSION Artificial intelligence in pathology education is a topic that looks likely to become important in the near future. National and international comprehensive standardization is a necessity. A joint effort and collective intelligence are needed to achieve the desired goals in undergraduate pathology education.
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Affiliation(s)
- Sibel Sensu
- Department of Pathology, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Nusret Erdogan
- Department of Pathology, İstinye University Faculty of Medicine, Istanbul, Turkey
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203
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Sturgis CD, LeBlanc JB, Smith MA, McNair SA, Hansing KL, Bammert CE, Russell DK, Howell JM, Alperstein SA, Lennen K, Srebotnik-Kirbis I, Paradis VA, van Zuylen-Manders L, Liikanen E, Freund G, Davey DD, Goulart R, Yuil-Valdes A, Vielh P, Brainard JA, Hitchens SW, Donnelly A. Optimizing schools of cytology: Discussions from the 2022 ASC/IAC Cytology Education Symposium, North American Strategies, and European Symbiosis. Cytopathology 2024; 35:2-6. [PMID: 37877689 DOI: 10.1111/cyt.13314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
This report highlights information and outcomes from the November 2022 ASC/IAC joint Cytology Education Symposium, an annual conference organized by the Cytology Programs Review Committee. The manuscript provides information on shared educational opportunities and practices for cytology students and other learners in anatomic pathology, discusses recruitment strategies for schools of cytology, conveys teaching resources, introduces perspectives on virtual microscopy and online learning, and transmits information about wellness of students in schools of cytology.
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Affiliation(s)
| | - Jenna B LeBlanc
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Michele A Smith
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean A McNair
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | | | - Joshua M Howell
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Kelly Lennen
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Gregory Freund
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Diane D Davey
- University of Central Florida, Orlando, Florida, USA
| | - Robert Goulart
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Amber Donnelly
- University of Nebraska Medical Center, Omaha, Nebraska, USA
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204
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Mądziel M. Instantaneous CO 2 emission modelling for a Euro 6 start-stop vehicle based on portable emission measurement system data and artificial intelligence methods. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:6944-6959. [PMID: 38155311 DOI: 10.1007/s11356-023-31022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/07/2023] [Indexed: 12/30/2023]
Abstract
One of the increasingly common methods to counteract the increased fuel consumption of vehicles is start-stop technology. This paper introduces a methodology which presents the process of measuring and creating a computational model of CO2 emissions using artificial intelligence techniques for a vehicle equipped with start-stop technology. The method requires only measurement data of velocity, acceleration of vehicle, and gradient of road to predict the emission of CO2. In this paper, three methods of machine learning techniques were analyzed, while the best prediction results are shown by the gradient boosting method. For the developed models, the results were validated using the coefficient of determination, the mean squared error, and based on visual evaluation of residual and instantaneous emission plots and CO2 emission maps. The developed models present a novel methodology and can be used for microscale environmental analysis.
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Affiliation(s)
- Maksymilian Mądziel
- Faculty of Mechanical Engineering and Aeronautics, Rzeszow University of Technology, 35-959, Rzeszow, Poland.
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205
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Dai H, Klause H, Conran RM. Educational Case: Hepatocellular carcinoma. Acad Pathol 2024; 11:100108. [PMID: 38433777 PMCID: PMC10904914 DOI: 10.1016/j.acpath.2024.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/29/2023] [Accepted: 12/28/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Harrison Dai
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Harrison Klause
- Department of Radiology, Eastern Virginia Medical School, Medical Center Radiologists, Norfolk, VA, USA
| | - Richard M. Conran
- Department of Pathology & Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
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206
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Desouki MM, Hagemann IS, Khoury T, Fadare O, Bhargava R, Clark JL, Deavers MT, Jorns JM, Khan A, Cosar EF, Karabakhtsian RG, Klein ME, Pinto A, Ali M. Selective breast/gynecologic pathology fellowship training in the United States: Experience of program directors. Acad Pathol 2024; 11:100103. [PMID: 38380270 PMCID: PMC10877681 DOI: 10.1016/j.acpath.2023.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/11/2023] [Indexed: 02/22/2024] Open
Abstract
Published data on combined breast and gynecologic [breast/gyn] surgical pathology fellowship training programs are limited. Our study aimed to survey the landscape of such fellowships in the United States (US), including specific information about their characteristics and the educational activities therein. Using web searches, we identified programs offering combined breast/gyn surgical pathology fellowship training. We developed a 26-item questionnaire asking program directors to report on the characteristics of their fellowship training structure. The search revealed 25 academic based programs offering one-year combined breast/gyn fellowship training, predominantly located (40 %) in the Northeast area. The following data was obtained: 44 % of the programs were accredited by the ACGME, 82 % required >19 weeks of breast and gyn service, and 69.6 % accepted the common application, 54.5 % of programs require completion of a research project for graduation. An annual average of 3000 breast and 3000 gyn cases appears to be the usual volume of cases. Interestingly, only 36 % of the program directors are graduates of a combined breast/gyn fellowship program. In conclusion, we present the most comprehensive and up-to-date census of combined breast/gyn pathology fellowships in the US. Our study provides valuable information on the current state of combined breast/gyn pathology fellowship training. The information will be helpful to current and prospective trainees, as well as program leaders.
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Affiliation(s)
- Mohamed Mokhtar Desouki
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA, USA
| | - Jennifer L. Clark
- Department of Pathology, UMass Chan Medical School, Worcester, MA, USA
| | | | - Julie M. Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashraf Khan
- Department of Pathology, UMass Chan Medical School-Baystate, Baystate Health, Springfield, MA, USA
| | - Ediz F. Cosar
- Department of Pathology, UMass Chan Medical School-Baystate, Baystate Health, Springfield, MA, USA
| | - Rouzan G. Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Molly E. Klein
- Department of Pathology, University of Minnesota, Indianapolis, MN, USA
| | - Andre Pinto
- Department of Pathology, University of Miami Health System, Miami, FL, USA
| | - Muhammad Ali
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo General Medical Center, Buffalo, NY, USA
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207
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Jaber O, Ammar K, Sughayer M. Communicating uncertainty in pathology reports: a descriptive study from a specialized cancer center. Acad Pathol 2024; 11:100109. [PMID: 38433775 PMCID: PMC10907152 DOI: 10.1016/j.acpath.2024.100109] [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: 08/02/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024] Open
Abstract
Pathologists use certain terminologies to communicate uncertainty in pathology reports. The message conveyed in pathology reports may be interpreted differently by clinicians leading to possible miscommunication. We aimed to compare the interpretation and impact of uncertainty phrases between pathologists and clinicians. A survey with examples of uncertain diagnoses containing ("suspicious for", "indefinite for", "favor", "cannot exclude", "suggestive of", "compatible with", "cannot rule out", "highly suspicious for" and "consistent with") was sent to pathologists and clinicians. For each diagnosis, participants assigned a level of certainty from 1 to 10 and were asked whether they would recommend treatment based on such phraseology. Thirty-six responses (from 7 pathologists, 10 surgeons, 8 pediatric oncologists, 8 medical oncologists, 2 radiation oncologists and 1 diagnostic radiologist) were received. Pathologists had a narrower range of uncertainty compared to clinicians. Wide variation between both groups was seen for all phrases except "compatible with" and "highly suspicious for". 'Indefinite for' showed the lowest mean of certainty (4.67 for pathologists; 4.00 for clinicians) whereas 'consistent with' had the highest (8.83 for pathologists and 9.38 for clinicians). There was a significant difference in the degree of certainty between both groups for "compatible with" (7.83 for pathologists and 9.06 for clinicians, p = .009). For treatment decisions, pathologists and clinicians agreed on initiating treatment when "consistent with" and "compatible with" were used and gave variable responses for the other terms. They proposed opposing treatment recommendations for "favor". Pathologists and clinicians varied in interpretation of uncertainty phrases which may impact treatment.
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Affiliation(s)
- Omar Jaber
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O. Box 1269, Amman, 11941 Jordan
| | - Khawla Ammar
- Survey Research Unit, Center of Research Shared Resources, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O. Box 1269, Amman, 11941 Jordan
| | - Maher Sughayer
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O. Box 1269, Amman, 11941 Jordan
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208
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Gray BM, Lipner RS, Roswell RO, Fernandez A, Vandergrift JL, Alsan M. Adoption of Internal Medicine Milestone Ratings and Changes in Bias Against Black, Latino, and Asian Internal Medicine Residents. Ann Intern Med 2024; 177:70-82. [PMID: 38145569 DOI: 10.7326/m23-1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The 2014 adoption of the Milestone ratings system may have affected evaluation bias against minoritized groups. OBJECTIVE To assess bias in internal medicine (IM) residency knowledge ratings against Black or Latino residents-who are underrepresented in medicine (URiM)-and Asian residents before versus after Milestone adoption in 2014. DESIGN Cross-sectional and interrupted time-series comparisons. SETTING U.S. IM residencies. PARTICIPANTS 59 835 IM residents completing residencies during 2008 to 2013 and 2015 to 2020. INTERVENTION Adoption of the Milestone ratings system. MEASUREMENTS Pre-Milestone (2008 to 2013) and post-Milestone (2015 to 2020) bias was estimated as differences in standardized knowledge ratings between U.S.-born and non-U.S.-born minoritized groups versus non-Latino U.S.-born White (NLW) residents, with adjustment for performance on the American Board of Internal Medicine IM certification examination and other physician characteristics. Interrupted time-series analysis measured deviations from pre-Milestone linear bias trends. RESULTS During the pre-Milestone period, ratings biases against minoritized groups were large (-0.40 SDs [95% CI, -0.48 to -0.31 SDs; P < 0.001] for URiM residents, -0.24 SDs [CI, -0.30 to -0.18 SDs; P < 0.001] for U.S.-born Asian residents, and -0.36 SDs [CI, -0.45 to -0.27 SDs; P < 0.001] for non-U.S.-born Asian residents). These estimates decreased to less than -0.15 SDs after adoption of Milestone ratings for all groups except U.S.-born Black residents, among whom substantial (though lower) bias persisted (-0.26 SDs [CI, -0.36 to -0.17 SDs; P < 0.001]). Substantial deviations from pre-Milestone linear bias trends coincident with adoption of Milestone ratings were also observed. LIMITATIONS Unobserved variables correlated with ratings bias and Milestone ratings adoption, changes in identification of race/ethnicity, and generalizability to Milestones 2.0. CONCLUSION Knowledge ratings bias against URiM and Asian residents was ameliorated with the adoption of the Milestone ratings system. However, substantial ratings bias against U.S.-born Black residents persisted. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Bradley M Gray
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Rebecca S Lipner
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Robert O Roswell
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York (R.O.R.)
| | - Alicia Fernandez
- Department of Medicine, University of California, San Francisco, San Francisco, California (A.F.)
| | - Jonathan L Vandergrift
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Marcella Alsan
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts (M.A.)
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209
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Alcaraz-Mateos E, Exposito-Afonso IJ, Labiano-Miravalles T, Pijuan L, Temprana-Salvador J, Zhao Q, Jiang XS. How do cytopathologists learn fine needle aspiration techniques? An international survey. Cytopathology 2023. [PMID: 38146771 DOI: 10.1111/cyt.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Fine needle aspiration cytology (FNAC) is a widely accepted diagnostic technique, but performance varies according to expertise. Little is known about variation in FNAC training practices worldwide. We surveyed pathologists using social media networks to determine FNAC training practices internationally. DESIGN Pathologists were surveyed on questions related to FNAC simulation training using direct messaging on the Twitter and WhatsApp platforms. Survey responses over a period of 2 weeks were collected. RESULTS In total, 149 pathologists participated (96.1% response rate). The respondents came from 24 countries and 87 institutions. The majority of the pathologists (63.8%) performed FNAC directly on patients for the first time. Only 36.2% of them had simulation instruction during their training. It was performed on food items such as fruit (64.8%), surgical specimens (37.0%), autopsies (13.0%) and others (9.3%), including commercially available phantom simulators for ultrasound-guided FNAC (US-FNAC) (two pathologists). DISCUSSION Most pathologists did not receive formal training in a simulated environment, and of the pathologists who had simulation instruction, food items were commonly used for education. A few participants used a commercial US-FNAC simulator, but since most pathologists perform FNAC by palpation, this method of simulation training is not applicable to many practices. Social media is an effective and efficient way to perform survey research, yielding a very high response rate.
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Affiliation(s)
| | | | | | - Lara Pijuan
- Pathology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | - Qing Zhao
- Faculty of Medicine, Peking Union Medical College, Beijing, China
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210
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Bertram CA, Bartel A, Donovan TA, Kiupel M. Atypical Mitotic Figures Are Prognostically Meaningful for Canine Cutaneous Mast Cell Tumors. Vet Sci 2023; 11:5. [PMID: 38275921 PMCID: PMC10821277 DOI: 10.3390/vetsci11010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Cell division through mitosis (microscopically visible as mitotic figures, MFs) is a highly regulated process. However, neoplastic cells may exhibit errors in chromosome segregation (microscopically visible as atypical mitotic figures, AMFs) resulting in aberrant chromosome structures. AMFs have been shown to be of prognostic relevance for some neoplasms in humans but not in animals. In this study, the prognostic relevance of AMFs was evaluated for canine cutaneous mast cell tumors (ccMCT). Histological examination was conducted by one pathologist in whole slide images of 96 cases of ccMCT with a known survival time. Tumor-related death occurred in 11/18 high-grade and 2/78 low-grade cases (2011 two-tier system). The area under the curve (AUC) was 0.859 for the AMF count and 0.880 for the AMF to MF ratio with regard to tumor-related mortality. In comparison, the AUC for the mitotic count was 0.885. Based on our data, a prognostically meaningful threshold of ≥3 per 2.37 mm2 for the AMF count (sensitivity: 76.9%, specificity: 98.8%) and >7.5% for the AMF:MF ratio (sensitivity: 76.9%, specificity: 100%) is suggested. While the mitotic count of ≥ 6 resulted in six false positive cases, these could be eliminated when combined with the AMF to MF ratio. In conclusion, the results of this study suggests that AMF enumeration is a prognostically valuable test, particularly due to its high specificity with regard to tumor-related mortality. Additional validation and reproducibility studies are needed to further evaluate AMFs as a prognostic criterion for ccMCT and other tumor types.
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Affiliation(s)
- Christof A. Bertram
- Institute of Veterinary Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
| | - Alexander Bartel
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, 14163 Berlin, Germany;
| | - Taryn A. Donovan
- Department of Anatomic Pathology, The Schwarzman Animal Medical Center, New York, NY 10065, USA;
| | - Matti Kiupel
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, MI 48910, USA
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211
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Thomas ET, Withrow DR, Shine B, Gill P, Perera R, Heneghan C. Trends in diagnostic tests ordered for children: a retrospective analysis of 1.7 million laboratory test requests in Oxfordshire, UK from 2005 to 2019. Arch Dis Child 2023; 109:30-36. [PMID: 37949643 PMCID: PMC10803974 DOI: 10.1136/archdischild-2023-325550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK. DESIGN Descriptive study of population-based secondary data. SETTING Oxfordshire University Hospitals National Health Service Trust laboratories. PARTICIPANTS Children aged 0-15 years in Oxfordshire who received at least one blood test. MAIN OUTCOME MEASURES We estimated average annual percentage changes (AAPCs) in test use using joinpoint regression models. Temporal changes in age-adjusted rates in test use were calculated overall and stratified by healthcare setting, sex, and age. RESULTS Between 2005 and 2019, 1 749 425 tests were performed among 113 607 children. Overall test use declined until 2012, when test rates appeared to increase (AAPC 1.5%, 95% CI -0.8% to 3.9%). Most tests were performed in inpatient settings, where testing rates stayed steady (AAPC -0.6%, 95% CI -2.1% to 0.9%). Increases were highest in females, those aged 6-15 years and in the outpatient setting. The greatest increase in testing was for vitamin D (AAPC 26.5%), followed by parathyroid hormone (9.8%), iron studies (9.3%), folate (8.4%), vitamin B12 (8.4%), HbA1c (8.0%), IgA (7.9%) and coeliac (7.7%). CONCLUSIONS After an initial decline, laboratory test use by children in Oxfordshire demonstrated an apparent increase since 2012. Test use increased in outpatient and general practice settings, however remained steady in inpatient settings. Further research should examine the root causes and implications for test increases, and whether these increases are warranted. We encourage clinicians to consider the individual and systemic implications of performing blood tests in children.
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Affiliation(s)
- Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Diana R Withrow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Peter Gill
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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212
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Shin TM, Dodenhoff KA, Pardy M, Wehner AS, Rafla S, McDowell LD, Denizard-Thompson NM. Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11367. [PMID: 38098759 PMCID: PMC10719426 DOI: 10.15766/mep_2374-8265.11367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
Introduction The COVID-19 pandemic has led to a large increase in telemedicine encounters. Despite this rise in virtual visits, patients who speak non-English languages have experienced challenges accessing telemedicine. To improve health equity, medical education on telehealth delivery should include instruction on working with interpreters in telehealth. Methods We developed a 25-minute self-directed module with collective expertise of faculty with experience in medical education, interpreter training, and communication training. The module was delivered online as part of a longitudinal health equity curriculum for third-year medical students. In addition to didactic information, the module contained video examples of interpreter interactions in telehealth. Results Sixty-four third-year medical students participated in the study, and 60 completed a postmodule survey. Students were satisfied with the content of the module, as well as the duration of time required to complete the tasks. Approximately 90% would recommend it to future students. Nearly 80% of students rated the module as being quite effective or extremely effective at increasing their comfort level with visits with patients with non-English language preference. Discussion Our module provides a basic framework for medical students on how to successfully work with interpreters during a language-discordant virtual visit. This format of asynchronous learning could also be easily expanded to resident physicians and faculty seeking more resources around working with interpreters in telemedicine.
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Affiliation(s)
- Tiffany M. Shin
- Assistant Professor, Department of Pediatrics, Wake Forest University School of Medicine
| | - Kristen A. Dodenhoff
- Second-Year Resident, Department of Family and Community Medicine, Wake Forest University School of Medicine
| | - Mariana Pardy
- Project Manager, Department of Social Sciences and Health Policy, Wake Forest University
| | - Abigail Smith Wehner
- Third-Year Resident, Department of Emergency Medicine, Wake Forest University School of Medicine
| | - Samuel Rafla
- Third-Year Resident, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai
| | - Leslie Doroski McDowell
- Quality Improvement Specialist and Curriculum Developer, Northwest Area Health Education Center
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213
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Do M, Sanford K, Roseff S, Hovaguimian A, Besche H, Fischer K. Gamified versus non-gamified online educational modules for teaching clinical laboratory medicine to first-year medical students at a large allopathic medical school in the United States. BMC MEDICAL EDUCATION 2023; 23:959. [PMID: 38098014 PMCID: PMC10720092 DOI: 10.1186/s12909-023-04951-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Medical educators seek innovative ways to engage learners efficiently and effectively. Gamification has been explored as one way to accomplish this feat; however, questions remain about which contexts gamification would be most useful. Time constraints and student interest present major barriers for teaching laboratory medicine to students. This study aims to compare two versions of an interactive online module, one gamified and one not, for teaching laboratory medicine concepts to pre-clinical medical students. METHODS First-year medical students reviewed either a gamified or non-gamified version of an interactive online module in preparation for an in-person flipped classroom session on Laboratory Medicine. Learning theory guided the design of the modules and both contained identical content, objectives, and structure. The "gamified" module included the additional elements of personalization, progress meters, points, badges, and story/role play. After reviewing the module, students completed an anonymous knowledge check and optional survey. RESULTS One hundred seventy-one students completed the post module knowledge check as assigned (82 gamified, 89 non-gamified). Knowledge check scores were higher for the students who reviewed the gamified module (p < 0.02), corresponding to an effect size of 0.4 for the gamified module. Eighty-one students completed optional post-module surveys (46 gamified, 35 non-gamified). Instructional efficiency was calculated using task difficulty questions and knowledge check scores, and the resulting instructional efficiency was higher for the gamified module. There was no significant difference in the student-reported time required to complete the modules. Additionally, both versions of the module were well received and led to positive ratings related to motivation and confidence. Finally, examination of open-ended survey results suggested that the addition of game elements added value to the gamified module and enhanced engagement and enjoyment. CONCLUSIONS In this setting, the addition of gamification to an interactive online module enhanced learning outcome, instructional efficiency, student engagement and enjoyment. These results should inspire further exploration of gamification for teaching Laboratory Medicine concepts to pre-clinical medical students.
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Affiliation(s)
- Marie Do
- Department of Pathology, Virginia Commonwealth University, 1101 E. Marshall Street, Box 980662, Richmond, VA, 23298, USA.
| | - Kimberly Sanford
- Department of Pathology, Virginia Commonwealth University, 1101 E. Marshall Street, Box 980662, Richmond, VA, 23298, USA
| | - Susan Roseff
- Department of Pathology, Virginia Commonwealth University, 1101 E. Marshall Street, Box 980662, Richmond, VA, 23298, USA
| | - Alexandra Hovaguimian
- Department of Neurology, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Avenue, Shapiro 8, Boston, MA, 02215, USA
| | - Henrike Besche
- Harvard Medical School, 260 Longwood Avenue TMEC368, Boston, MA, 02115, USA
| | - Krisztina Fischer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 260 Longwood Ave, Rm 160, Boston, MA, 02115, USA
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214
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Wang S, Rong R, Zhou Q, Yang DM, Zhang X, Zhan X, Bishop J, Chi Z, Wilhelm CJ, Zhang S, Pickering CR, Kris MG, Minna J, Xie Y, Xiao G. Deep learning of cell spatial organizations identifies clinically relevant insights in tissue images. Nat Commun 2023; 14:7872. [PMID: 38081823 PMCID: PMC10713592 DOI: 10.1038/s41467-023-43172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
Recent advancements in tissue imaging techniques have facilitated the visualization and identification of various cell types within physiological and pathological contexts. Despite the emergence of cell-cell interaction studies, there is a lack of methods for evaluating individual spatial interactions. In this study, we introduce Ceograph, a cell spatial organization-based graph convolutional network designed to analyze cell spatial organization (for example,. the cell spatial distribution, morphology, proximity, and interactions) derived from pathology images. Ceograph identifies key cell spatial organization features by accurately predicting their influence on patient clinical outcomes. In patients with oral potentially malignant disorders, our model highlights reduced structural concordance and increased closeness in epithelial substrata as driving features for an elevated risk of malignant transformation. In lung cancer patients, Ceograph detects elongated tumor nuclei and diminished stroma-stroma closeness as biomarkers for insensitivity to EGFR tyrosine kinase inhibitors. With its potential to predict various clinical outcomes, Ceograph offers a deeper understanding of biological processes and supports the development of personalized therapeutic strategies.
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Affiliation(s)
- Shidan Wang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Ruichen Rong
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qin Zhou
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donghan M Yang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xinyi Zhang
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiaowei Zhan
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhikai Chi
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Clare J Wilhelm
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Siyuan Zhang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Mark G Kris
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Minna
- Hamon Center for Therapeutic Oncology Research, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yang Xie
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
- Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA.
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215
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Knapke J, Marcum M, Mendell A, Ryan P. Development of an undergraduate certificate in clinical and translational science: improving competence of the clinical research workforce. Front Pharmacol 2023; 14:1294534. [PMID: 38125884 PMCID: PMC10731045 DOI: 10.3389/fphar.2023.1294534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction: Academic research centers often struggle to recruit and retain a well-trained and diverse clinical and translational science (CTS) workforce. In particular, the clinical research professional (CRP) career pathway is not well known to undergraduate students and other individuals outside of academic medicine despite being a potential career route. To address these workforce challenges, the CRP Task Force at the University of Cincinnati (UC) aims to train a competent and diverse CRP workforce through targeted educational programming in the UC undergraduate population. Methods: Using a six-step curriculum development process that included: 1) performing a needs assessment, 2) determining content, 3) writing goals and objectives, 4) selecting the educational strategies, 5) implementing the curriculum, and 6) evaluating the curriculum, we designed an undergraduate certificate program in CTS. Results: The needs assessment included both internal and external data gathering to inform curriculum development and program decisions. Content was determined using the Core Competency Framework for the Clinical Research Professional Version 3.1., and program learning outcomes were written with both the competency framework and local workforce needs in mind. Educational strategies were selected based on optimization of available resources and local expertise with an emphasis on interactive didactics complemented by experiential learning. Implementation is underway and evaluation will follow once students begin enrolling. Discussion: By educating an undergraduate student population about CTS methods and career opportunities, we anticipate increased numbers of well-qualified, diverse applicants who pursue CRP careers locally and regionally.
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Affiliation(s)
- Jacqueline Knapke
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
- Center for Clinical and Translational Science and Training, University of Cincinnati, Cincinnati, OH, United States
| | - Michelle Marcum
- Cancer Center, University of Cincinnati, Cincinnati, OH, United States
| | - Angela Mendell
- Center for Clinical and Translational Science and Training, University of Cincinnati, Cincinnati, OH, United States
| | - Patrick Ryan
- Center for Clinical and Translational Science and Training, University of Cincinnati, Cincinnati, OH, United States
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center/University of Cincinnati, Cincinnati, OH, United States
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216
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Metusela C, Mullan J, Kobel C, Rhee J, Batterham M, Barnett S, Bonney A. CHIME-GP trial of online education for prescribing, pathology and imaging ordering in general practice - how did it bring about behaviour change? BMC Health Serv Res 2023; 23:1346. [PMID: 38042789 PMCID: PMC10693689 DOI: 10.1186/s12913-023-10374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND There is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia's online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future. METHODS This mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework. RESULTS Of the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs' perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions. CONCLUSIONS Our education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).
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Affiliation(s)
- Christine Metusela
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia.
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Conrad Kobel
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Joel Rhee
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, Australia
| | - Stephen Barnett
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Andrew Bonney
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
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217
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Gorania R, Hunter K, Hall G, Brierley DJ. Independent reporting in oral and maxillofacial pathology. J Clin Pathol 2023; 76:822-826. [PMID: 37977652 DOI: 10.1136/jcp-2022-208495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
AIMS To understand the current practice, extent of use and barriers related to independent reporting (IR) in oral and maxillofacial pathology (OMFP) training in the UK. METHODS A questionnaire was created containing questions about the experiences and opinions surrounding IR in OMFP. The target participants were (1) consultants in OMFP who had been involved in training OMFP trainees in the last 5 years and (2) current OMFP trainees. The questionnaire was delivered via Google Forms and disseminated using a link in an invitation email sent to the participants. RESULTS A total of 13 consultant responses (response rate of 81%) and 12 trainee responses (response rate of 92%) were received. Of these, three consultants and five trainees were using IR at the time of the study. Several themes emerged highlighting the perceived benefits and concerns regarding IR. CONCLUSIONS This study suggests that there is a disparity in the way IR is used in OMFP training across the UK. There was shared concern between consultants and trainees regarding the lack of clear guidance and subsequent fear of litigation. These are issues that need to be addressed if trainees are to have a similar experience across the country and be prepared for independent practice on completion of training.
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Affiliation(s)
- Riddhi Gorania
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, Sheffield, UK
| | - Keith Hunter
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, Merseyside, UK
| | - Gillian Hall
- Head and Neck Pathology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Daniel J Brierley
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, Sheffield, UK
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218
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Oermann MH, Waldrop J, Nicoll LH, Peterson GM, Drabish KS, Carter-Templeton H, Owens JK, Moorman T, Webb B, Wrigley J. Research on Predatory Publishing in Health Care: A Scoping Review. Can J Nurs Res 2023; 55:415-424. [PMID: 37138512 DOI: 10.1177/08445621231172621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Predatory publishers and their associated journals have been identified as a threat to the integrity of the scientific literature. Research on the phenomenon of predatory publishing in health care remains unquantified. PURPOSE To identify the characteristics of empirical studies on predatory publishing in the health care literature. METHODS A scoping review was done using PubMed/MEDLINE, CINAHL, and Scopus databases. A total of 4967 articles were initially screened; 77 articles reporting empirical findings were ultimately reviewed. RESULTS The 77 articles were predominantly bibliometric analyses/document analyses (n = 56). The majority were in medicine (n = 31, 40%) or were multidisciplinary (n = 26, 34%); 11 studies were in nursing. Most studies reported that articles published in predatory journals were of lower quality than those published in more reputable journals. In nursing, the research confirmed that articles in predatory journals were being cited in legitimate nursing journals, thereby spreading information that may not be credible through the literature. CONCLUSION The purposes of the evaluated studies were similar: to understand the characteristics and extent of the problem of predatory publishing. Although literature about predatory publishing is abundant, empirical studies in health care are limited. The findings suggest that individual vigilance alone will not be enough to address this problem in the scholarly literature. Institutional policy and technical protections are also necessary to mitigate erosion of the scientific literature in health care.
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Affiliation(s)
| | | | | | - Gabriel M Peterson
- School of Library and Information Sciences, North Carolina Central University, Durham, NC, USA
| | | | | | - Jacqueline K Owens
- Dwight Schar College of Nursing and Health Sciences, Ashland University, Ashland, OH, USA
| | - Teresa Moorman
- Dwight Schar College of Nursing and Health Sciences, Ashland University, Ashland, OH, USA
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219
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Rinck D, Dittmer M, Tinker D, Smith K, Heinecke G. National resident survey in dermatopathology: The role of slide scanners in resident learning. J Cutan Pathol 2023; 50:1078-1082. [PMID: 37749824 PMCID: PMC10843035 DOI: 10.1111/cup.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/07/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Dermatology residents gain exposure to dermatopathology through a variety of educational modalities. While virtual pathology applications have risen dramatically, resident utilization of digital libraries, slide scanner availability, and comfort with virtual slides are not well-known. This study aims to assess the current landscape of educational resources used by dermatology residents. METHODS A 17-question survey was sent to dermatology residents through a national email database. The survey was a self-assessment of their experience in dermatopathology education and the use of departmental slide scanners. RESULTS The use of digital dermatopathology is high among trainees, despite only half of respondents reporting slide scanner access. Residents report using virtual images more often in non-clinical dermatopathology didactics and independent studies compared to clinical dermatopathology rotations. Public slide set use was common, while professional society and departmental slide sets may be underutilized. Over half of respondents report being extremely or very comfortable navigating interactive scanned slides. CONCLUSIONS Survey data suggests digital slides are currently predominantly used in non-clinical dermatopathology rotations and independent studies. Incorporation of slide scanners into departments may benefit resident education through the development of high-quality, curated departmental slide sets.
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Affiliation(s)
- Danielle Rinck
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Martin Dittmer
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Daniel Tinker
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Kristin Smith
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Gillian Heinecke
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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220
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Venkatesan J, Manickam N, Madasamy B, Rajagopal MD, Karthikeyan AK. The Impact of Patient-Centric Interactive E-Module in Pathology Among Medical Undergraduates. MEDICAL SCIENCE EDUCATOR 2023; 33:1347-1358. [PMID: 38188400 PMCID: PMC10767029 DOI: 10.1007/s40670-023-01869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 01/09/2024]
Abstract
Introduction COVID pandemic shifted healthcare-related education to digital platforms. With the widespread availability of learning management systems like MOODLE, many opportunities exist to create innovative e-modules. Its success depends on the interactive multimedia resources and structural framework. The present study aims to create two patient-centric e-modules on Diabetes and Alcoholic liver disease in Pathology by a medical undergraduate facilitated by faculty and to assess its impact on learning outcomes and learners' perceptions in relation to student seminars. Methodology This mixed-method intervention study combines quantitative and qualitative research methods to gain deeper insight into learners' experiences. By random allocation, half of the second-year medical undergraduates (n = 60) attended an e-module, and the other half listened to a student seminar on the same topic with the same specific learning objectives. Pre- and post-test scores and feedback questionnaires were quantitatively analysed. Student-led focus group discussions (FGD) for learners' experiences underwent thematic analysis. Results Pre- and post-tests for both learning techniques were statistically significant, while the feedback questionnaire's responses favoured e-module. Four focus group discussions yielded six themes for the e-module: Patient-driven holistic learning experience, Inquiry-based learning, Immersive learning, Higher level cognitive skills, Flexibility, repeatability and accessibility, and No human involvement. The five themes for the seminar were: Peer-driven camaraderie learning dynamic, Teacher-centric synchronous learning, Active vs passive listening, Basic learning, and Teacher-student interaction. Conclusion While both learning techniques had comparable effects on test scores, they have merits and demerits. Hence, blending both techniques where seminars impart basic knowledge and e-module for deeper reinforcement will benefit the students.
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221
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He WY, Pinni SL, Karius A, Chen J, Landford WN, Kraenzlin F, Cooney CM, Broderick KP. Evaluating Diversity Promotion on Integrated Plastic Surgery Residency Program Websites and Instagram Accounts. Ann Plast Surg 2023; 91:644-650. [PMID: 37830505 DOI: 10.1097/sap.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Medical students applying to residency, including those from underrepresented groups, strongly value cultural fit and program diversity. Program websites and social media are thus an influential information source for prospective applicants and recruitment tool for residencies. We evaluated whether and how integrated plastic surgery residency program websites and social media display commitments to diversity online. METHODS We evaluated program websites for 8 predetermined diversity elements, (1) nondiscrimination and (2) diversity statements, (3) community resources, (4) faculty and (5) resident biographies, (6) faculty and (7) resident photographs, and (8) resident resources, and assessed Instagram accounts for diversity-related images, captions, and hashtags. Our analysis used Mann-Whitney U , chi-squared, and t tests; significance level was P < 0.05. RESULTS We reviewed 82 program websites with a mean of 3.4 ± 1.4 diversity elements. Resident (n = 76, 92.7%) and faculty photographs (n = 65, 79.3%) and resident biographies (n = 43, 52.4%) were the most common. Seventy programs (85.4%) had Instagram accounts, the majority of which (n = 41, 58.6%) shared content related to diversity in race, ethnicity, gender, and/or sexual orientation. Programs located in smaller cities were more likely to have ≥4 website diversity elements ( P = 0.014) and mention diversity on Instagram ( P = 0.0037). Programs with women chairs/chiefs were more likely to mention diversity on Instagram ( P = 0.007). CONCLUSIONS In the age of virtual recruitment, program websites and social media should provide sufficient information, described in our diversity element checklist, to help prospective applicants determine fit from a diversity perspective. Residents, who often contribute to program social media, and women chairs/chiefs may be critical to driving diversity promotion.
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Affiliation(s)
| | - Sai L Pinni
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Alex Karius
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonlin Chen
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wilmina N Landford
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Franca Kraenzlin
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Ramala SR, Chandak S, Chandak MS, Annareddy S. A Comprehensive Review of Breast Fibroadenoma: Correlating Clinical and Pathological Findings. Cureus 2023; 15:e49948. [PMID: 38179396 PMCID: PMC10765224 DOI: 10.7759/cureus.49948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Breast fibroadenomas, common benign conditions, exhibit distinct clinical and histopathological features. This review highlights clinical presentation and histology correlations, providing insights for healthcare providers. Palpable masses, pain, and changes in breast appearance align with glandular and stromal components, emphasizing accurate diagnosis. Mammography, ultrasound, and MRI guide tailored treatment decisions. Challenges in differentiating atypical fibroadenomas highlight the need for meticulous histopathological evaluation. Clinical implications stress patient-centered care, shared decision-making, and ongoing follow-up. Future research focuses on genetic investigations and long-term studies. A multidisciplinary approach to breast fibroadenomas ensures comprehensive care for improved outcomes in both medical and emotional aspects.
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Affiliation(s)
- Sandeep Reddy Ramala
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meenakshi S Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasulareddy Annareddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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223
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Yoda RA, Cimino PJ. Classification and Grading of Central Nervous System Tumors According to the World Health Organization 5th Edition. Semin Neurol 2023; 43:833-844. [PMID: 37949117 DOI: 10.1055/s-0043-1776793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The World Health Organization (WHO) released the 5th edition of its classification of central nervous system (CNS) tumors in 2021. Advances in the landscape of molecular tumor pathophysiology prompted major revisions to the previous edition released in 2016, some of which were first introduced by the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (cIMPACT-NOW). The 2021 classification system integrates newly gained molecular insights to guide changes in tumor taxonomy and nomenclature, introduces several new types of tumors, and expands the use of molecular testing for diagnosis and grading, with a particular impact on adult-type and pediatric-type gliomas, ependymomas, and embryonal tumors. These updates aim to promote clear and accurate diagnoses, yield more reliable prognostic information, and enable the selection of optimal therapies. Familiarity with these changes will be of great importance for clinicians involved in the management of CNS tumor patients.
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Affiliation(s)
- Rebecca A Yoda
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Patrick J Cimino
- Neuropathology Unit, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Chang CH, Suri K, Huang R, Machiorlatti M, Bartl M, Mifuji R. An innovative approach to comprehensive communication skills training for residents: A resident-led communication curriculum. J Investig Med 2023; 71:813-820. [PMID: 37485964 DOI: 10.1177/10815589231190562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Innovations to enhance residency training in interpersonal and communication skills are needed and a resident-led strategy has not been well-described. In this study, we explored a resident-led comprehensive communication skills curriculum for internal medicine residents. Residents and faculty prepared the curriculum as part of an Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside Project and with "The language of caring guide for physicians." Employing active learning techniques, three residents led 43 internal medicine residents in seven 1 h sessions from 2019 to 2020. Using a 35-question survey, we assessed pre and post self-reported competence in: mindful practice, collaboration and teamwork, effective openings and closing, communicating with empathy, effective explanations, engaging patients and families as partners, and hard conversations. A Wilcoxon signed rank test was employed to explore differences in median scores after matching each person's pretest and posttest score. The median score for aggregate communication and the scores for all seven competencies assessed improved from pre to post (p < 0.05). This indicates that residents reported higher incidences of performing patient-centered communication skills after the curriculum compared to before. Using a five-point Likert scale, 100% of participants agreed the program improved their communication skills and improved confidence in bedside patient-centered communications. A resident-led comprehensive communication skills curriculum for internal medicine residents was implemented showing improvement in skills over the course of the curriculum. The curriculum was well-accepted by post-survey evaluation and was feasible with motivated resident-leaders, use of an existing guide to communication, and reserved didactic time to implement the program.
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Affiliation(s)
- Chelsea Hook Chang
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Krishna Suri
- Palliative Medicine, Washington Township Medical Foundation, Freemont, CA, USA
| | - Rex Huang
- Yale New Haven Health, Trumbull, CT, USA
| | - Michael Machiorlatti
- Department of Population Health and Biostatistics, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Mery Bartl
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Roque Mifuji
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
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225
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Poudel A, Sedain P, Pokhrel B, Sapkota A, Chamlagain A, Sharma N, Rajbhandary S, Khaniya B, Ojha N. A large yolk sac malignancy in a girl, an uncommon yet challenging ovarian tumor: A case report. Clin Case Rep 2023; 11:e8335. [PMID: 38125622 PMCID: PMC10731108 DOI: 10.1002/ccr3.8335] [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: 11/06/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Key Clinical Message Yolk sac tumors are rare and malignant germ cell tumors of the ovary occurring in children and young women. Fertility-sparing surgical intervention with adjuvant chemotherapy has shown to improve prognosis. Abstract We present a case of a 14-year-old girl who presented with the complaints of lower abdominal pain and distention. Her tumor markers were increased, and radiological investigation suggested the diagnosis of malignant left ovarian mass. Histopathology confirmed the diagnosis of Yolk sac tumor. She was subsequently managed with fertility-sparing surgery and adjuvant chemotherapy.
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Affiliation(s)
- Aashish Poudel
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Prajwal Sedain
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Biraj Pokhrel
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Aakash Sapkota
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Anita Chamlagain
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Nisha Sharma
- Department of PathologyTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Sanyukta Rajbhandary
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Bishal Khaniya
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
| | - Neebha Ojha
- Department of Gynecology and ObstetricsTribhuwan University Teaching Hospital, Institute of MedicineKathmanduNepal
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Kashani KB, Awdishu L, Bagshaw SM, Barreto EF, Claure-Del Granado R, Evans BJ, Forni LG, Ghosh E, Goldstein SL, Kane-Gill SL, Koola J, Koyner JL, Liu M, Murugan R, Nadkarni GN, Neyra JA, Ninan J, Ostermann M, Pannu N, Rashidi P, Ronco C, Rosner MH, Selby NM, Shickel B, Singh K, Soranno DE, Sutherland SM, Bihorac A, Mehta RL. Digital health and acute kidney injury: consensus report of the 27th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol 2023; 19:807-818. [PMID: 37580570 DOI: 10.1038/s41581-023-00744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
Acute kidney injury (AKI), which is a common complication of acute illnesses, affects the health of individuals in community, acute care and post-acute care settings. Although the recognition, prevention and management of AKI has advanced over the past decades, its incidence and related morbidity, mortality and health care burden remain overwhelming. The rapid growth of digital technologies has provided a new platform to improve patient care, and reports show demonstrable benefits in care processes and, in some instances, in patient outcomes. However, despite great progress, the potential benefits of using digital technology to manage AKI has not yet been fully explored or implemented in clinical practice. Digital health studies in AKI have shown variable evidence of benefits, and the digital divide means that access to digital technologies is not equitable. Upstream research and development costs, limited stakeholder participation and acceptance, and poor scalability of digital health solutions have hindered their widespread implementation and use. Here, we provide recommendations from the Acute Disease Quality Initiative consensus meeting, which involved experts in adult and paediatric nephrology, critical care, pharmacy and data science, at which the use of digital health for risk prediction, prevention, identification and management of AKI and its consequences was discussed.
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Affiliation(s)
- Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Linda Awdishu
- Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia
- Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia
| | - Barbara J Evans
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital NHS Foundation Trust & Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - Erina Ghosh
- Philips Research North America, Cambridge, MA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sandra L Kane-Gill
- Biomedical Informatics and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jejo Koola
- UC San Diego Health Department of Biomedical Informatics, Department of Medicine, La Jolla, CA, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modelling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Girish N Nadkarni
- Division of Data-Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai; Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Ninan
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Neesh Pannu
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Parisa Rashidi
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Claudio Ronco
- Università di Padova; Scientific Director Foundation IRRIV; International Renal Research Institute; San Bortolo Hospital, Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Benjamin Shickel
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Danielle E Soranno
- Section of Nephrology, Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, USA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA.
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Francis DV, Charles AS, Jacob TM, Ruban A, Premkumar PS, Rabi S. Virtual microscopy as a teaching-learning tool for histology in a competency-based medical curriculum. Med J Armed Forces India 2023; 79:S156-S164. [PMID: 38144628 PMCID: PMC10746824 DOI: 10.1016/j.mjafi.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Histology forms an important component of first-year medical education. Unfortunately, it is limited to the practical laboratory due to the need for a microscope and good quality slides. Virtual microscopy is a recent advancement, which uses computers as an alternative to microscopes. The aim of the study was to compare virtual microscopy (VM)-based practical classes with traditional microscopy (TM)-based practical classes for two cohorts of first-year medical students, by comparing learning achieved using two different test scores as well as a qualitative assessment of student and faculty perspectives regarding the feasibility and usefulness of VM. Methods Each cohort of students was divided into two equal batches and each batch underwent eight histology modules of which, four utilised traditional microscopes and four utilised virtual microscopes. Quantitative analysis was performed using a theory test (which assessed preparation, theory knowledge and understanding) as well as a spotter test (which assessed identification skills, reasoning, and recall). Qualitative analysis was performed using a structured questionnaire and focus group discussions. Results Modules using VM were better when compared with those using TM, showing statistically significant and better grades. Qualitative analysis performed, yielded important information as to how this technology can serve as a good adjunct to traditional histology classes in the competency-based curriculum by increasing student interest, enabling self-study, and reducing students dependence on the tutor. Conclusions VM forms a good adjunct as well as a standalone modality of learning to TM, as it improves accessibility to slides and promotes self-learning.
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Affiliation(s)
| | - Aby S. Charles
- Assistant Professor (Anatomy), Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anand Ruban
- Associate Professor (Biochemistry), Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna S. Premkumar
- Associate Professor (Biostatistics), Christian Medical College, Vellore, Tamil Nadu, India
| | - Suganthy Rabi
- Professor (Anatomy), Christian Medical College, Vellore, Tamil Nadu, India
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228
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Jumaniyazova E, Lokhonina A, Dzhalilova D, Kosyreva A, Fatkhudinov T. Role of Microenvironmental Components in Head and Neck Squamous Cell Carcinoma. J Pers Med 2023; 13:1616. [PMID: 38003931 PMCID: PMC10672525 DOI: 10.3390/jpm13111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Head and neck squamous cell cancer (HNSCC) is one of the ten most common malignant neoplasms, characterized by an aggressive course, high recurrence rate, poor response to treatment, and low survival rate. This creates the need for a deeper understanding of the mechanisms of the pathogenesis of this cancer. The tumor microenvironment (TME) of HNSCC consists of stromal and immune cells, blood and lymphatic vessels, and extracellular matrix. It is known that HNSCC is characterized by complex relationships between cancer cells and TME components. TME components and their dynamic interactions with cancer cells enhance tumor adaptation to the environment, which provides the highly aggressive potential of HNSCC and resistance to antitumor therapy. Basic research aimed at studying the role of TME components in HNSCC carcinogenesis may serve as a key to the discovery of both new biomarkers-predictors of prognosis and targets for new antitumor drugs. This review article focuses on the role and interaction with cancer of TME components such as newly formed vessels, cancer-associated fibroblasts, and extracellular matrix.
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Affiliation(s)
- Enar Jumaniyazova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia; (A.L.); (A.K.); (T.F.)
| | - Anastasiya Lokhonina
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia; (A.L.); (A.K.); (T.F.)
- Avtsyn Research Institute of Human Morphology of FSBSI Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997 Moscow, Russia
| | - Dzhuliia Dzhalilova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia; (A.L.); (A.K.); (T.F.)
- Avtsyn Research Institute of Human Morphology of FSBSI Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Anna Kosyreva
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia; (A.L.); (A.K.); (T.F.)
- Avtsyn Research Institute of Human Morphology of FSBSI Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
| | - Timur Fatkhudinov
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, 117198 Moscow, Russia; (A.L.); (A.K.); (T.F.)
- Avtsyn Research Institute of Human Morphology of FSBSI Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418 Moscow, Russia
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Ngene NC. Teaching Philosophy in a Teaching Portfolio: Domain Knowledge and Guidance. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:1231-1248. [PMID: 38028366 PMCID: PMC10640830 DOI: 10.2147/amep.s428897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023]
Abstract
Background Teaching philosophy defines the beliefs and ideas that guide practices in teaching and learning. Writing teaching philosophy statements for promotion or employment is daunting for inexperienced new faculty members. Aim This article aims to discuss the principles of relevant educational domains that academics need to know to be well informed when writing their teaching philosophy. It also provides a new perspective on how to write the personal statements. Methods Journal articles published in English language between 2018 and 2023 (as well as important older ones) in electronic databases (Google Scholar, MEDLINE, PubMed, and SCOPUS) were searched, sifted, reviewed and used for this narrative literature review. Additionally, the websites of educational organisations such as higher education institutions were selected using convenience sampling method and searched to ascertain practices. Results Educators need to link teaching philosophy statements to the literature about teaching. However, there is a scarcity of literature that provides a comprehensive overview of the required domain knowledge. These domains are Supervision, Curriculum development, Assessment, Mentorship, Pedagogy, and Scholarship of teaching and learning (S-CAMPS domains). Conclusion Using various teaching practices and models to achieve the best quality learning and valued transformation is crucial in achieving a comprehensive Scholarship of Teaching and Learning. Therefore, developing a personal philosophy provides the opportunity for reflection on utilizing the theory-practice-philosophy perspective best to serve the students, academic institution, and society.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jerez-Roig J, Bezerra de Souza DL, Cambra-Badii I, March-Amengual JM, Comella A, Masó-Aguado M, Ramon-Aribau A, Luque-Suárez A, Feito Grande L, Terribas N, Vivanco L, Busquets-Alibés E. Change in demand for health-related undergraduate studies in Spain during 2015-2021: a temporal series study. PeerJ 2023; 11:e16353. [PMID: 37953777 PMCID: PMC10638917 DOI: 10.7717/peerj.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The expansion of higher education is a worldwide phenomenon. To our knowledge, there are no studies analyzing the trends in demands of enrollment in health-related studies in Spain. Therefore, the objective was to analyze the change in demand (the number of requests for enrollment divided by the number of offered places) for undergraduate health-related studies in Spain during the period 2015-2021 as well as compare the change by region in the pre (2015-2019) and pandemic (2020-2021) period. Methods This is an observational (ecological type) study with temporal series analyses using data from public (non-for-profit) higher education institutions from the Integrated University Information System. For the analysis by region, we calculated the demand of all twelve undergraduate health-related degrees and the percentages of change between both periods using the Wilcoxon test. The Joinpoint Regression program was used to analyze the trends in demand for each degree during the 7-year period. Results Significant (p < 0.001) increases in demand during the pandemic period were observed in all regions. During the pandemic, medicine, biomedicine, nursing, odontology and pharmacy presented a higher demand in comparison with data collected before the pandemic started. In contrast, this pattern was not confirmed in the following cases: physiotherapy, occupational therapy, podiatry, psychology, social work, human nutrition and dietetics. By regions, Navarra, Asturias, and La Rioja presented the most drastic changes. In regions with the biggest number of universities, such as Catalonia, Andalusia and Madrid, the change observed was smaller.
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Affiliation(s)
- Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Dyego L. Bezerra de Souza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Irene Cambra-Badii
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Jaume-Miquel March-Amengual
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Agustí Comella
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Montse Masó-Aguado
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Anna Ramon-Aribau
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Alejandro Luque-Suárez
- Department of Physiotherapy, University of Málaga, Málaga, Spain
- The Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | | | - Núria Terribas
- Grífols Foundation Chair of Bioethics, Universitat de Vic, Vic, Spain
| | - Luis Vivanco
- Platform of Bioethics and Medical Education, Center for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
- National Center of Documentation on Bioethics, Rioja Health Foundation (FRS), Logroño, Spain
| | - Ester Busquets-Alibés
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Grífols Foundation Chair of Bioethics, Universitat de Vic, Vic, Spain
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Narváez-Carrasquilla G, Paternina-Carballo JD, Narváez-Rodríguez G. [Unusual case of pseudotumoral hip injury due to gout: case report]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:895-899. [PMID: 37995660 PMCID: PMC10727767 DOI: 10.5281/zenodo.10064752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/13/2023] [Indexed: 11/25/2023]
Abstract
Background Gout is known as arthropathy due to the deposit of monosodium urate crystals; This pathology comprises a set of clinical and radiographic tests in the context of the intra-articular presence of said crystals. It is a chronic disease associated with other comorbidities such as arterial hypertension, osteoarthritis, diabetes mellitus, etc. The case of a patient with gouty arthritis with consequent hip lesion with a pseudotumoral appearance difficult to diagnose is presented, in order to highlight the importance of this, as well as the appropriate follow-up and treatment for this chronic pathology. Clinical case A 51-year-old male patient, with a history of hip osteoarthritis and gout. The symptoms and signs were pain in the right hip with an 8/10 on an analogue pain scale, associated with functional limitation characterized by reduced range of motion and impossibility of standing. Imaging studies are carried out which are suggestive of a tumor lesion at the proximal femur with malignant characteristics, for which a biopsy and subsequent histopathological diagnosis of gouty tophi is performed. Conclusions Gout is a prevalent disease in the adult population, however, its infrequent joint location can result in a difficult diagnosis, so it is necessary not to rule out this entity and to carry out specific studies for its identification.
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Affiliation(s)
| | - Juan David Paternina-Carballo
- Universidad Libre – Seccional Barranquilla, Departamento de Ortopedia y Traumatología. Barranquilla, ColombiaUniversidad Libre – Seccional BarranquillaColombia
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Lazaro G. When Positive is Negative: Health Literacy Barriers to Patient Access to Clinical Laboratory Test Results. J Appl Lab Med 2023; 8:1133-1147. [PMID: 37681277 PMCID: PMC10756206 DOI: 10.1093/jalm/jfad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Health literacy is a multidimensional set of skills (e.g., narrative, numeracy, digital, medication) that patients need to access and understand health information timely and accurately to make evidence-based informed decisions. CONTENT Multiple barriers prevent patients from effectively interacting with health information. The most salient barriers are poor overall health literacy skills and linguistic proficiency in English. As patients prefer direct access to laboratory test results, especially those of routine tests, contextualization and provider-directed interpretation of results are required to foster shared decision-making to address their healthcare issues and improve health outcomes. SUMMARY The use of systematic approaches that account for poor health literacy skills and include culturally and linguistically appropriate planning and availability of resources is warranted at individual and population health levels (e.g., human-centered design of patient portals).
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Affiliation(s)
- Gerardo Lazaro
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Shipley JH. Finding Relief: Loan Forgiveness for Unmatched Medical Graduates Can Save Lives. Curr Probl Diagn Radiol 2023; 52:586-587. [PMID: 37684187 DOI: 10.1067/j.cpradiol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Jonathan H Shipley
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA..
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234
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Ryou H, Lomas O, Theissen H, Thomas E, Rittscher J, Royston D. Quantitative interpretation of bone marrow biopsies in MPN-What's the point in a molecular age? Br J Haematol 2023; 203:523-535. [PMID: 37858962 PMCID: PMC10952168 DOI: 10.1111/bjh.19154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
The diagnosis of myeloproliferative neoplasms (MPN) requires the integration of clinical, morphological, genetic and immunophenotypic findings. Recently, there has been a transformation in our understanding of the cellular and molecular mechanisms underlying disease initiation and progression in MPN. This has been accompanied by the widespread application of high-resolution quantitative molecular techniques. By contrast, microscopic interpretation of bone marrow biopsies by haematologists/haematopathologists remains subjective and qualitative. However, advances in tissue image analysis and artificial intelligence (AI) promise to transform haematopathology. Pioneering studies in bone marrow image analysis offer to refine our understanding of the boundaries between reactive samples and MPN subtypes and better capture the morphological correlates of high-risk disease. They also demonstrate potential to improve the evaluation of current and novel therapeutics for MPN and other blood cancers. With increased therapeutic targeting of diverse molecular, cellular and extra-cellular components of the marrow, these approaches can address the unmet need for improved objective and quantitative measures of disease modification in the context of clinical trials. This review focuses on the state-of-the-art in image analysis/AI of bone marrow tissue, with an emphasis on its potential to complement and inform future clinical studies and research in MPN.
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Affiliation(s)
- Hosuk Ryou
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Oliver Lomas
- Department of HaematologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Helen Theissen
- Department of Engineering Science, Institute of Biomedical Engineering (IBME)University of OxfordOxfordUK
| | - Emily Thomas
- Department of Engineering Science, Institute of Biomedical Engineering (IBME)University of OxfordOxfordUK
| | - Jens Rittscher
- Department of Engineering Science, Institute of Biomedical Engineering (IBME)University of OxfordOxfordUK
- Ground Truth LabsOxfordUK
- Oxford NIHR Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
- Ludwig Institute for Cancer ResearchUniversity of OxfordOxfordUK
| | - Daniel Royston
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
- Department of PathologyOxford University Hospitals NHS Foundation TrustOxfordUK
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235
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Ghantarchyan H, Abbas N, Lewis A, Chamanadjian C, Kambiz R. A Rare Presentation of Metastatic Breast Cancer Manifesting As Diffuse Nodular Skin Lesions. Cureus 2023; 15:e49633. [PMID: 38161904 PMCID: PMC10755805 DOI: 10.7759/cureus.49633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
We present a 63-year-old African American female with a prior medical history of gastroesophageal reflux disease (GERD) and uterine fibroids whose primary concern was vaginal bleeding. She had no prior medical care established, and the last mammogram was conducted 10 years prior with normal results. She has had multiple ED visits for symptoms of reflux and vaginal bleeding and has been discharged with a primary care follow-up referral each time. On physical exam, there was evidence of nodular skin lesions, tightening of the skin on her face, neck, and back, as well as nodular skin lesions on her neck, back, chest, and abdomen, notably progressing in number, not in size, in a caudal fashion. Further exam findings included telangiectasias predominantly on her right hand. On initial laboratory studies, she was hypercalcemic with an elevated calcium level of 13 mg/dL. Initial imaging included a CT scan of her chest, abdomen, and pelvis, which revealed pulmonary embolism and uterine fibroids, with the largest measuring 5.9 x 4.3 x 5.3 cm, as well as bilateral breast masses noted to be a BI-RADS 3 on ultrasound. A skin biopsy completed early on in the hospitalization revealed metastatic breast cancer, specifically high-grade, poorly differentiated infiltrating mammary carcinoma of the lobular type. Similarly, a right breast mass biopsy illustrated resemblant findings, specifically invasive mammary carcinoma with mixed ductal and lobular features. She was ultimately treated with ribociclib and fulvestrant (KR1) and discharged from the hospital with oncology and primary care follow-up.
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Affiliation(s)
| | - Nia Abbas
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Azaria Lewis
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Raoufi Kambiz
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
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236
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Deville C, Charles-Obi K, Santos PMG, Mattes MD, Hussaini SMQ. Oncology Physician Workforce Diversity: Rationale, Trends, Barriers, and Solutions. Cancer J 2023; 29:301-309. [PMID: 37963363 DOI: 10.1097/ppo.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT This chapter will discuss (1) the rationale for physician workforce diversity and inclusion in oncology; (2) current and historical physician workforce demographic trends in oncology, including workforce data at various training and career levels, such as graduate medical education and as academic faculty or practicing physicians; (3) reported barriers and challenges to diversity and inclusion in oncology, such as exposure, access, preparation, mentorship, socioeconomic burdens, and interpersonal, structural, systemic bias; and (4) potential interventions and evidence-based solutions to increase diversity, equity, and inclusion and mitigate bias in the oncology physician workforce.
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Affiliation(s)
- Curtiland Deville
- From the Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Syed M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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237
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Lakshminrusimha S, Reed AM, Cheng TL, Cunningham JM, Devaskar SU. An Approach to Compensation Plans for Physician Faculty in Academic Pediatric Departments. J Pediatr 2023; 262:113511. [PMID: 37244572 DOI: 10.1016/j.jpeds.2023.113511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC
| | - Tina L Cheng
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John M Cunningham
- Department of Pediatrics and Comer Children's Hospital, University of Chicago, Chicago, IL
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA
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238
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Couser GP, Nation JL, Apker DP, Connaughty SM, Hyde MA. The Evolution of Employee Assistance Programs to Best Support Healthcare Organizations. J Healthc Manag 2023; 68:404-419. [PMID: 37944172 DOI: 10.1097/jhm-d-23-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
GOAL Employee assistance programs (EAPs) have been evolving since they first became prevalent in the 1970s. The important counseling component of EAPs is sometimes lost in discussions about what they do, with many EAPs marketing a broad portfolio of services such as childcare, elder care, legal referral, and other concierge services rather than counseling. The objective of this study was to examine outcomes for the EAP of one organization (Mayo Clinic), compare them to outcomes reported in the literature, and gain insights to help all healthcare organizations best support their employees. METHODS Consistent with customary EAP practice, data for this study was collected through an anonymous survey link distributed by e-mail to users of individual counseling as well as users of organizational consulting services such as advising leaders and supervisors and leading educational sessions. PRINCIPAL FINDINGS All (n = 82) individual counseling respondents indicated they would recommend the EAP, none reported worse symptoms, 90% decreased their stress levels, 92% reduced their feelings of anxiety, 88% enjoyed an overall improvement in mood, and 95% developed new skills. If their concern was work-related, 96% agreed the counselor understood the work culture and was able to provide helpful guidance; of the clients who were feeling burned out, 86% agreed they gained strategies to reduce its symptoms. Thematic analysis of individual counseling services indicated that participants highly valued their counselors. Regarding organizational consulting services, respondents (n = 50) indicated EAP services increased their confidence as leaders, supported their work, and provided tangible guidance. They appreciated having an internal EAP counselor. Thematic analysis of organizational consulting services indicated that EAP supported leaders by listening, coaching, and empowering them to normalize issues. PRACTICAL APPLICATIONS EAPs have evolved into distinct internal, external, and hybrid internal-external models. Internal model counselors are company employees with inside knowledge of company culture, external EAP model counselors are contracted outside of the company, and hybrid models combine a small cadre of internal counselors with the support of outside contractors. Regardless of the model, EAP counselors must collaborate with internal stakeholders, notably the human resources department, to efficiently identify and troubleshoot employee relational issues and allow for customized initiatives to improve mental health. Based upon these findings and the authors' direct experiences with EAP providers, components of an ideal EAP are outlined to show how EAPs can best support employees. Healthcare leaders seeking to add EAP services are advised to focus on offerings that are custom fit to the organization.
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Daich Varela M, Sen S, De Guimaraes TAC, Kabiri N, Pontikos N, Balaskas K, Michaelides M. Artificial intelligence in retinal disease: clinical application, challenges, and future directions. Graefes Arch Clin Exp Ophthalmol 2023; 261:3283-3297. [PMID: 37160501 PMCID: PMC10169139 DOI: 10.1007/s00417-023-06052-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 05/11/2023] Open
Abstract
Retinal diseases are a leading cause of blindness in developed countries, accounting for the largest share of visually impaired children, working-age adults (inherited retinal disease), and elderly individuals (age-related macular degeneration). These conditions need specialised clinicians to interpret multimodal retinal imaging, with diagnosis and intervention potentially delayed. With an increasing and ageing population, this is becoming a global health priority. One solution is the development of artificial intelligence (AI) software to facilitate rapid data processing. Herein, we review research offering decision support for the diagnosis, classification, monitoring, and treatment of retinal disease using AI. We have prioritised diabetic retinopathy, age-related macular degeneration, inherited retinal disease, and retinopathy of prematurity. There is cautious optimism that these algorithms will be integrated into routine clinical practice to facilitate access to vision-saving treatments, improve efficiency of healthcare systems, and assist clinicians in processing the ever-increasing volume of multimodal data, thereby also liberating time for doctor-patient interaction and co-development of personalised management plans.
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Affiliation(s)
- Malena Daich Varela
- UCL Institute of Ophthalmology, London, UK
- Moorfields Eye Hospital, London, UK
| | | | | | | | - Nikolas Pontikos
- UCL Institute of Ophthalmology, London, UK
- Moorfields Eye Hospital, London, UK
| | | | - Michel Michaelides
- UCL Institute of Ophthalmology, London, UK.
- Moorfields Eye Hospital, London, UK.
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240
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Shaker N, Shilo K, Esnakula AK, Shafi S, Challa B, Patel A, Kellough DA, Hammond S, Javaid S, Satturwar S, Yearsley MM, Li Z, Limbach AL, Lujan G, Parwani AV. Comparison of four different displays for identification of select pathologic features extracted from whole slide images of surgical pathology cases. Pathol Res Pract 2023; 251:154843. [PMID: 37826873 DOI: 10.1016/j.prp.2023.154843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The establishment of minimum standards for display selection for the whole slide image (WSI) interpretation has not been fully defined. Recently, pathologists have increasingly preferred using remote displays for clinical diagnostics. Our study aims to assess and compare the performance of three fixed work displays and one remote personal display in accurately identifying ten selected pathologic features integrated into WSIs. DESIGN Hematoxylin and eosin-stained glass slides were digitized using Philips scanners. Seven practicing pathologists and three residents reviewed ninety WSIs to identify ten pathologic features using the LG, Dell, and Samsung and an optional consumer-grade display. Ten pathologic features included eosinophils, neutrophils, plasma cells, granulomas, necrosis, mucin, hemosiderin, crystals, nucleoli, and mitoses. RESULTS The accuracy of the identification of ten features on different types of displays did not significantly differ among the three types of "fixed" workplace displays. The highest accuracy was observed for the identification of neutrophils, eosinophils, plasma cells, granuloma, and mucin. On the other hand, a lower accuracy was observed for the identification of crystals, mitoses, necrosis, hemosiderin, and nucleoli. Participant pathologists and residents preferred the use of larger displays (>30″) with a higher pixel count, resolution, and luminance. CONCLUSION Most features can be identified using any display. However, certain features posed more challenges across the three fixed display types. Furthermore, the use of a remote personal consumer-grade display chosen according to the pathologists' preference showed similar feature identification accuracy. Several factors of display characteristics seemed to influence pathologists' display preferences such as the display size, color, contrast ratio, pixel count, and luminance calibration. This study supports the use of standard "unlocked" vendor-agnostic displays for clinical digital pathology workflow rather than purchasing "locked" and more expensive displays that are part of a digital pathology system.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashwini K Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Saba Shafi
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bindu Challa
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ankush Patel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Kellough
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Hammond
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sehrish Javaid
- Woody L. Hunt School of Dental Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martha M Yearsley
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Abberly Lott Limbach
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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241
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Ly A, Balassanian R, Alperstein S, Donnelly A, McGrath C, Sohani AR, Stelow EB, Thrall MJ, Zhang ML, Pitman MB. One procedure-one report: the Re-Imagine Cytopathology Task Force position paper on small tissue biopsy triage in anatomic pathology. J Am Soc Cytopathol 2023; 12:395-406. [PMID: 37270328 DOI: 10.1016/j.jasc.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Endoscopic biopsy procedures increasingly generate multiple tissue samples from multiple sites, and frequently retrieve concurrent cytologic specimens and small core needle biopsies. There is currently lack of consensus in subspecialized practices as to whether cytopathologists or surgical pathologists should review such samples, and whether the pathology findings should be reported together or separately. MATERIALS AND METHODS In December 2021, the American Society of Cytopathology convened the Re-Imagine Cytopathology Task Force to examine various workflows that would facilitate unified pathology reporting of concurrently obtained biopsies and improve clinical care. RESULTS AND CONCLUSIONS This position paper summarizes the key points and highlights the advantages, challenges, and resources available to support the implementation of such workflows that result in "one procedure-one report".
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Affiliation(s)
- Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Susan Alperstein
- Department of Pathology, Weill Cornell Medical College, New York, New York
| | - Amber Donnelly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cindy McGrath
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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242
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Schwen LO, Kiehl TR, Carvalho R, Zerbe N, Homeyer A. Digitization of Pathology Labs: A Review of Lessons Learned. J Transl Med 2023; 103:100244. [PMID: 37657651 DOI: 10.1016/j.labinv.2023.100244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
Pathology laboratories are increasingly using digital workflows. This has the potential of increasing laboratory efficiency, but the digitization process also involves major challenges. Several reports have been published describing the individual experiences of specific laboratories with the digitization process. However, a comprehensive overview of the lessons learned is still lacking. We provide an overview of the lessons learned for different aspects of the digitization process, including digital case management, digital slide reading, and computer-aided slide reading. We also cover metrics used for monitoring performance and pitfalls and corresponding values observed in practice. The overview is intended to help pathologists, information technology decision makers, and administrators to benefit from the experiences of others and to implement the digitization process in an optimal way to make their own laboratory future-proof.
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Affiliation(s)
- Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany.
| | - Tim-Rasmus Kiehl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Rita Carvalho
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Norman Zerbe
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - André Homeyer
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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243
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Roy DC, Wang TF, Carrier M, Mallick R, Burger D, Hawken S, Wells PS. Thrombophilia gene mutations predict venous thromboembolism in ambulatory cancer patients receiving chemotherapy. J Thromb Haemost 2023; 21:3184-3192. [PMID: 37536569 DOI: 10.1016/j.jtha.2023.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Inherited thrombophilia and cancer both independently increase the risk of venous thromboembolism (VTE). However, whether the increased VTE risk associated with inherited thrombophilia exists in cancer patients is less clear. OBJECTIVES Our objective was to determine the influence of inherited thrombophilia on VTE and bleeding risk in moderate-to-high-risk ambulatory cancer patients receiving chemotherapy. METHODS We conducted a post hoc analysis using blood samples from patients enrolled in the AVERT trial to determine if previously recognized thrombophilia gene mutations (prothrombin factor [F] II G20210A, FXI, fibrinogen gamma, serpin family A member 10, FV K858R, FXIII, FV Leiden [FVL], and ABO blood) were associated with VTE or bleeding during the 7-months after starting chemotherapy. Logistic regression was used to compare heterozygous and homozygous mutations (combined) to wild-type. VTE rates, bleeding rates, and risk differences for mutations stratified by prophylactic anticoagulation use were calculated. RESULTS Of the 447 patients, there were 39 VTE and 39 bleeding events. The odds of VTE were significantly increased with FVL mutation and non-O blood type (odds ratio [OR]: 5.2; 95% CI: 1.9-14.7 and OR: 2.7; 95% CI: 1.2-6.1, respectively). The use of anticoagulation prophylaxis resulted in complete protection in FVL patients, whereas those not receiving anticoagulation had a VTE rate of 119 per 100 patient-years. Lower VTE rates were also observed in non-O blood type patients taking prophylactic anticoagulation. No other thrombophilia genes tested were significantly associated with VTE or bleeding. CONCLUSION Our results indicate that FVL mutation and ABO blood type may be important VTE predictors in cancer patients starting chemotherapy.
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Affiliation(s)
- Danielle Carole Roy
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Tzu-Fei Wang
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marc Carrier
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dylan Burger
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philip S Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Ardon O, Labasin M, Friedlander M, Manzo A, Corsale L, Ntiamoah P, Wright J, Elenitoba-Johnson K, Reuter VE, Hameed MR, Hanna MG. Quality Management System in Clinical Digital Pathology Operations at a Tertiary Cancer Center. J Transl Med 2023; 103:100246. [PMID: 37659445 PMCID: PMC10841911 DOI: 10.1016/j.labinv.2023.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/11/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
Digital pathology workflows can improve pathology operations by allowing reliable and fast retrieval of digital images, digitally reviewing pathology slides, enabling remote work and telepathology, use of computer-aided tools, and sharing of digital images for research and educational purposes. The need for quality systems is a prerequisite for successful clinical-grade digital pathology adoption and patient safety. In this article, we describe the development of a structured digital pathology laboratory quality management system (QMS) for clinical digital pathology operations at Memorial Sloan Kettering Cancer Center (MSK). This digital pathology-specific QMS development stemmed from the gaps that were identified when MSK integrated digital pathology into its clinical practice. The digital scan team in conjunction with the Department of Pathology and Laboratory Medicine quality team developed a QMS tailored to the scanning operation to support departmental and institutional needs. As a first step, systemic mapping of the digital pathology operations identified the prescan, scan, and postscan processes; instrumentation; and staffing involved in the digital pathology operation. Next, gaps identified in quality control and quality assurance measures led to the development of standard operating procedures and training material for the different roles and workflows in the process. All digital pathology-related documents were subject to regulatory review and approval by departmental leadership. The quality essentials were developed into an extensive Digital Pathology Quality Essentials framework to specifically address the needs of the growing clinical use of digital pathology technologies. Using the unique digital experience gained at MSK, we present our recommendations for QMS for large-scale digital pathology operations in clinical settings.
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Affiliation(s)
- Orly Ardon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Marc Labasin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Friedlander
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allyne Manzo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lorraine Corsale
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Ntiamoah
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeninne Wright
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kojo Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera R Hameed
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Hanna
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Mu Y, Tizhoosh HR, Dehkharghanian T, Campbell CJV. Whole slide image representation in bone marrow cytology. Comput Biol Med 2023; 166:107530. [PMID: 37837726 DOI: 10.1016/j.compbiomed.2023.107530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
One of the goals of AI-based computational pathology is to generate compact representations of whole slide images (WSIs) that capture the essential information needed for diagnosis. While such approaches have been applied to histopathology, few applications have been reported in cytology. Bone marrow aspirate cytology is the basis for key clinical decisions in hematology. However, visual inspection of aspirate specimens is a tedious and complex process subject to variation in interpretation, and hematopathology expertise is scarce. The ability to generate a compact representation of an aspirate specimen may form the basis for clinical decision-support tools in hematology. In this study, we leverage our previously published end-to-end AI-based system for counting and classifying cells from bone marrow aspirate WSIs, which enables the direct use of individual cells as inputs rather than WSI patches. We then construct bags of individual cell features from each WSI, and apply multiple instance learning to extract their vector representations. To evaluate the quality of our representations, we conducted WSI retrieval and classification tasks. Our results show that we achieved a mAP@10 of 0.58 ±0.02 in WSI-level image retrieval, surpassing the random-retrieval baseline of 0.39 ±0.1. Furthermore, we predicted five diagnostic labels for individual aspirate WSIs with a weighted-average F1 score of 0.57 ±0.03 using a k-nearest-neighbors (k-NN) model, outperforming guessing using empirical class prior probabilities (0.26 ±0.02). We present the first example of exploring trainable mechanisms to generate compact, slide-level representations in bone marrow cytology with deep learning. This method has the potential to summarize complex semantic information in WSIs toward improved diagnostics in hematology, and may eventually support AI-assisted computational pathology approaches.
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Affiliation(s)
- Youqing Mu
- University of Toronto, Toronto, Canada; McMaster University, Hamilton, Canada
| | - H R Tizhoosh
- Rhazes Lab, Artificial Intelligence & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Taher Dehkharghanian
- McMaster University, Hamilton, Canada; University Health Network, Toronto, Canada
| | - Clinton J V Campbell
- McMaster University, Hamilton, Canada; William Osler Health System, Brampton, Canada.
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246
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Sun J, Mi X, Ye X, ShenTu Y, Liu C, Tang D, Yang W, Yang J, Ye X, Ma X, Shi J, Chen G, Gong L. Biliary sepsis complication with congenital hepatic fibrosis: an unexpected outcome. BMC Infect Dis 2023; 23:715. [PMID: 37872485 PMCID: PMC10591346 DOI: 10.1186/s12879-023-08681-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND CHF (Congenital hepatic fibrosis) is a rare hereditary disease characterized by periportal fibrosis and ductal plate malformation. Little is known about the clinical presentations and outcome in CHF patients with an extraordinary complication with biliary sepsis. Our case described a 23-year-old female diagnosed as CHF combined with biliary sepsis. Her blood culture was positive for KP (Klebsiella pneumoniae), and with a high level of CA19-9 (> 1200.00 U/ml, ref: <37.00 U/ml). Meanwhile, her imaging examinations showed intrahepatic bile duct dilatation, portal hypertension, splenomegaly, and renal cysts. Liver pathology revealed periportal fibrosis and irregularly shaped proliferating bile ducts. Whole-exome sequencing identified two heterozygous missense variants c.3860T > G (p. V1287G) and c.9059T > C (p. L3020P) in PKHD1 gene. After biliary sepsis relieved, her liver function test was normal, and imaging examination results showed no significant difference with the results harvested during her biliary sepsis occurred. CONCLUSION The diagnosis of CHF complicated with biliary sepsis in the patient was made. Severely biliary sepsis due to KP infection may not inevitably aggravate congential liver abnormality in young patients. Our case provides a good reference for timely treatment of CHF patients with biliary sepsis.
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Affiliation(s)
- Jiawei Sun
- Hangzhou Normal University, Zhejiang, China
| | - Xiaoxiao Mi
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Zhejiang, China
| | | | - Yiling ShenTu
- Department of Respiratory Medicine, Fuyang First People's Hospital, Hangzhou, China
| | - Chun Liu
- Hangzhou Normal University, Zhejiang, China
| | - Dong Tang
- Department of Medical Imaging (Radiology), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, China
| | - WenJun Yang
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Zhejiang, China
| | - Jie Yang
- Department of Infectious Disease (Liver Diseases), Lishui Municipal Central Hospital, Zhejiang, China
| | - Xiaoping Ye
- Department of Infectious Disease (Liver Diseases), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, 310015, China
| | - Xiaojie Ma
- Department of Infectious Disease (Liver Diseases), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, 310015, China
| | - Junping Shi
- Department of Infectious Disease (Liver Diseases), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, 310015, China
| | - Gongying Chen
- Department of Infectious Disease (Liver Diseases), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, 310015, China
| | - Ling Gong
- Department of Infectious Disease (Liver Diseases), The Affiliated Hospital of Hangzhou Normal University, Zhejiang, 310015, China.
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247
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Xing YL, Panovska D, Petritsch CK. Successes and challenges in modeling heterogeneous BRAF V600E mutated central nervous system neoplasms. Front Oncol 2023; 13:1223199. [PMID: 37920169 PMCID: PMC10619673 DOI: 10.3389/fonc.2023.1223199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Central nervous system (CNS) neoplasms are difficult to treat due to their sensitive location. Over the past two decades, the availability of patient tumor materials facilitated large scale genomic and epigenomic profiling studies, which have resulted in detailed insights into the molecular underpinnings of CNS tumorigenesis. Based on results from these studies, CNS tumors have high molecular and cellular intra-tumoral and inter-tumoral heterogeneity. CNS cancer models have yet to reflect the broad diversity of CNS tumors and patients and the lack of such faithful cancer models represents a major bottleneck to urgently needed innovations in CNS cancer treatment. Pediatric cancer model development is lagging behind adult tumor model development, which is why we focus this review on CNS tumors mutated for BRAFV600E which are more prevalent in the pediatric patient population. BRAFV600E-mutated CNS tumors exhibit high inter-tumoral heterogeneity, encompassing clinically and histopathological diverse tumor types. Moreover, BRAFV600E is the second most common alteration in pediatric low-grade CNS tumors, and low-grade tumors are notoriously difficult to recapitulate in vitro and in vivo. Although the mutation predominates in low-grade CNS tumors, when combined with other mutations, most commonly CDKN2A deletion, BRAFV600E-mutated CNS tumors are prone to develop high-grade features, and therefore BRAFV600E-mutated CNS are a paradigm for tumor progression. Here, we describe existing in vitro and in vivo models of BRAFV600E-mutated CNS tumors, including patient-derived cell lines, patient-derived xenografts, syngeneic models, and genetically engineered mouse models, along with their advantages and shortcomings. We discuss which research gaps each model might be best suited to answer, and identify those areas in model development that need to be strengthened further. We highlight areas of potential research focus that will lead to the heightened predictive capacity of preclinical studies, allow for appropriate validation, and ultimately improve the success of "bench to bedside" translational research.
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Affiliation(s)
| | | | - Claudia K. Petritsch
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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248
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Rashidi HH, Fennell BD, Albahra S, Hu B, Gorbett T. The ChatGPT conundrum: Human-generated scientific manuscripts misidentified as AI creations by AI text detection tool. J Pathol Inform 2023; 14:100342. [PMID: 38116171 PMCID: PMC10727991 DOI: 10.1016/j.jpi.2023.100342] [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: 07/28/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023] Open
Abstract
AI Chat Bots such as ChatGPT are revolutionizing our AI capabilities, especially in text generation, to help expedite many tasks, but they introduce new dilemmas. The detection of AI-generated text has become a subject of great debate considering the AI text detector's known and unexpected limitations. Thus far, much research in this area has focused on the detection of AI-generated text; however, the goal of this study was to evaluate the opposite scenario, an AI-text detection tool's ability to discriminate human-generated text. Thousands of abstracts from several of the most well-known scientific journals were used to test the predictive capabilities of these detection tools, assessing abstracts from 1980 to 2023. We found that the AI text detector erroneously identified up to 8% of the known real abstracts as AI-generated text. This further highlights the current limitations of such detection tools and argues for novel detectors or combined approaches that can address this shortcoming and minimize its unanticipated consequences as we navigate this new AI landscape.
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Affiliation(s)
- Hooman H. Rashidi
- Pathology and Laboratory Medicine Institute (PLMI), Cleveland Clinic, Cleveland, OH, United States
- PLMI’s Center for Artificial Intelligence & Data Science, Cleveland Clinic, Cleveland, OH, United States
| | - Brandon D. Fennell
- University of California, San Francisco – Department of Medicine, San Francisco, CA, United States
| | - Samer Albahra
- Pathology and Laboratory Medicine Institute (PLMI), Cleveland Clinic, Cleveland, OH, United States
- PLMI’s Center for Artificial Intelligence & Data Science, Cleveland Clinic, Cleveland, OH, United States
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
- PLMI’s Center for Artificial Intelligence & Data Science, Cleveland Clinic, Cleveland, OH, United States
| | - Tom Gorbett
- Pathology and Laboratory Medicine Institute (PLMI), Cleveland Clinic, Cleveland, OH, United States
- PLMI’s Center for Artificial Intelligence & Data Science, Cleveland Clinic, Cleveland, OH, United States
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249
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Karthik N, Greenfield M, Otteson T. The perceived impact of curricular and non-curricular factors on specialty interests and choice during medical school at a single center in the United States. BMC MEDICAL EDUCATION 2023; 23:730. [PMID: 37803398 PMCID: PMC10559574 DOI: 10.1186/s12909-023-04731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Limited information exists regarding how medical students' specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. Our objective was to identify medical students' specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice. METHODS An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact). RESULTS 102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact. CONCLUSIONS Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.
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Affiliation(s)
- Naveen Karthik
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Marjorie Greenfield
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Todd Otteson
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
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McCall SJ, Lubensky IA, Moskaluk CA, Parwani A, Radin K, Ramirez NC, Von Menchhofen Z, Washington MK, LiVolsi VA. The Cooperative Human Tissue Network of the National Cancer Institute: Supporting Cancer Research for 35 Years. Mol Cancer Ther 2023; 22:1144-1153. [PMID: 37523711 PMCID: PMC10626893 DOI: 10.1158/1535-7163.mct-22-0714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
The Cooperative Human Tissue Network was created by the NCI in 1987 to support a coordinated national effort to collect and distribute high quality, pathologist-validated human tissues for cancer research. Since then, the network has expanded to provide different types of tissue samples, blood and body fluid samples, immunohistologic and molecular sample preparations, tissue microarrays, and clinical datasets inclusive of biomarkers and molecular testing. From inception through the end of 2021, the network has distributed 1,375,041 biospecimens. It served 889 active investigators in 2021. The network has also taken steps to begin to optimize the representation of diverse communities among the distributed biospecimens. In this article, the authors review the 35-year history of this network, describe changes to the program over the last 15 years, and provide operational and scientific highlights from each of the divisions. Readers will learn how to engage with the network and about the continued evolution of the program for the future.
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Affiliation(s)
- Shannon J McCall
- Department of Pathology, Duke University School of Medicine and Duke Cancer Institute, Durham, North Carolina
| | | | | | - Anil Parwani
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | | | | | | | - Mary K Washington
- Department of Pathology, Vanderbilt University, Nashville, Tennessee
| | - Virginia A LiVolsi
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
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