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Bonert M, Zafar U, Maung R, El-Shinnawy I, Naqvi A, Finley C, Cutz JC, Major P, Kapoor A. Pathologist workload, work distribution and significant absences or departures at a regional hospital laboratory. PLoS One 2022; 17:e0265905. [PMID: 35333879 PMCID: PMC8956155 DOI: 10.1371/journal.pone.0265905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
Assess the work environment of salaried pathologists via (1) the national workload system (L4E), (2) work distribution among/in three hospital groups, and (3) the frequency of significant absences or departures (SADs).
Methods
Automated analysis of pathology reports from a regional laboratory (accessioned 2011–2019) using validated computer code.
Results
The study set contained 574,099 pathology reports, reported by 63 pathologists. The average yearly L4E workload units/full-time equivalent for three hospital groups were 8,101.6, 6,906.5 and 4,215.8. The average Gini coefficient for full-time pathologists in the three hospital groups were respectively 0.05, 0.16 and 0.23. The average yearly SADs rates were respectively 13%, 16% and 9%. The group with the highest SADs rate had the intermediate Gini coefficient and intermediate workload.
Conclusions
High individual workload and work maldistribution appear to be associated with SADs. Individual workload maximums and greater transparency may be essential for limiting staff turnover, maintaining high morale, and efficient laboratory function with a high quality of care.
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Affiliation(s)
- Michael Bonert
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, Staff Pathologist—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Uzma Zafar
- Rutgers Health/St Barnabas Medical Center, Livingston, New Jersey, United States of America
| | - Raymond Maung
- Department of Pathology and Laboratory Medicine, Staff Pathologist—Royal Inland Hospital, University of British Columbia, Kamloops, British Columbia, Canada
| | - Ihab El-Shinnawy
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, Staff Pathologist—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Asghar Naqvi
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, Staff Pathologist—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, Staff Thoracic Surgeon—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Claude Cutz
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, Staff Pathologist—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Major
- Division of Medical Oncology, Department of Medicine, Staff Medical Oncologist—Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, Staff Urologist—St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
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Park PC, Kurek KC, DeCoteau J, Howlett CJ, Hawkins C, Izevbaye I, Carter MD, Redpath M, Lo B, Alex D, Yousef G, Yip S, Maung R. CAP-ACP Workload Model for Advanced Diagnostics in Precision Medicine. Am J Clin Pathol 2022; 158:105-111. [PMID: 35195689 DOI: 10.1093/ajcp/aqac012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/14/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In precision medicine, where oncologic management is tailored to the individual's clinical and genetic profiles, advanced diagnostic testing provides prognostic information and guides management in a growing number of malignancies. There is a need to capture the work pathologists perform to meet this demand by providing medically relevant, timely, and accurate testing results. This work includes not only direct patient consults (interpretation of results and issuing reports) but the administrative and medical oversight as well as the research needed to provide the necessary quality assurance, quality control, direction, and framework for the laboratory. METHODS An expert panel of Canadian pathologists involved in advanced diagnostics was convened to establish and beta test a model for workload assessment in advanced diagnostics. RESULTS All aspects of the advanced diagnostics workload were detailed and applied to models based on members' experience, including medical oversight, administration, and the introduction of new testing and platforms. Models for biomarker testing were developed for simple and complex or multiplexed assays, and a detailed model was developed to assess the workload for next-generation sequencing-based assays. CONCLUSIONS This paper provides the first detailed proposal for capturing an advanced diagnostic workload to enable appropriate pathologist allotment for performing all the steps required to run an advanced diagnostic service.
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Affiliation(s)
| | - Kyle C Kurek
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - John DeCoteau
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Christopher J Howlett
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre and Western University, London, Canada
| | | | - Iyare Izevbaye
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | | | - Bryan Lo
- The Ottawa General Hospital, Ottawa, Canada
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Bonert M, Zafar U, Maung R, El-Shinnawy I, Kak I, Cutz JC, Naqvi A, Juergens RA, Finley C, Salama S, Major P, Kapoor A. Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports. PLoS One 2021; 16:e0253876. [PMID: 34185808 PMCID: PMC8241038 DOI: 10.1371/journal.pone.0253876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Quantify changes in workload in relation to the anatomic pathologist workforce. METHODS In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy. RESULTS The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x. CONCLUSIONS Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.
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Affiliation(s)
- Michael Bonert
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Uzma Zafar
- Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Raymond Maung
- Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ihab El-Shinnawy
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ipshita Kak
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Claude Cutz
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Asghar Naqvi
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Christian Finley
- Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Samih Salama
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Major
- Medical Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- Urology, McMaster University, Hamilton, Ontario, Canada
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5
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Bernard C, Chandrakanth SA, Cornell IS, Dalton J, Evans A, Garcia BM, Godin C, Godlewski M, Jansen GH, Kabani A, Louahlia S, Manning L, Maung R, Moore L, Philley J, Slatnik J, Srigley J, Thibault A, Picard DD, Cracower H, Tetu B. Guidelines from the Canadian Association of Pathologists for establishing a telepathology service for anatomic pathology using whole-slide imaging. J Pathol Inform 2014; 5:15. [PMID: 24843826 PMCID: PMC4023030 DOI: 10.4103/2153-3539.129455] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 11/29/2022] Open
Abstract
The use of telepathology for clinical applications in Canada has steadily become more attractive over the last 10 years, driven largely by its potential to provide rapid pathology consulting services throughout the country regardless of the location of a particular institution. Based on this trend, the president of the Canadian Association of Pathologists asked a working group consisting of pathologists, technologists, and healthcare administrators from across Canada to oversee the development of guidelines to provide Canadian pathologists with basic information on how to implement and use this technology. The guidelines were systematically developed, based on available medical literature and the clinical experience of early adopters of telepathology in Canada. While there are many different modalities and applications of telepathology, this document focuses specifically on whole-slide imaging as applied to intraoperative pathology consultation (frozen section), primary diagnosis, expert or second opinions and quality assurance activities. Applications such as hematopathology, microbiology, tumour boards, education, research and technical and/or standard-related issues are not covered.
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Affiliation(s)
| | | | | | | | - James Dalton
- Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Andrew Evans
- University Health Network, Toronto, Ontario, Canada
| | | | - Chris Godin
- Formerly with Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
| | - Marek Godlewski
- Dalhousie University, Saint John Regional Hospital, Horizon Health Network, New-Brunswick, Canada
| | | | - Amin Kabani
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lisa Manning
- Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lisa Moore
- Laboratory Informatics, Vancouver Island Health Authority, British Columbia, Canada
| | - Joanne Philley
- Laboratory Diagnostics and Blood Services Branch, Ministry of Health, British-Columbia, Canada
| | - Jack Slatnik
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - John Srigley
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Alain Thibault
- Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
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Huntsman D, Carneiro F, Lewis F, MacLeod P, Hayashi A, Monaghan K, Maung R, Seruca R, Jackson C, Caldas C. [Prophylactic gastrectomy in patients with deleterious E-cadherin gene mutation]. Gastroenterol Clin Biol 2001; 25:931-2. [PMID: 11852408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- D Huntsman
- Hôpital Européen Georges-Pompidou, Paris, France
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7
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Huntsman DG, Carneiro F, Lewis FR, MacLeod PM, Hayashi A, Monaghan KG, Maung R, Seruca R, Jackson CE, Caldas C. Early gastric cancer in young, asymptomatic carriers of germ-line E-cadherin mutations. N Engl J Med 2001; 344:1904-9. [PMID: 11419427 DOI: 10.1056/nejm200106213442504] [Citation(s) in RCA: 254] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Germ-line truncating mutations in the E-cadherin (CDH1) gene have been found in families with hereditary diffuse gastric cancer. These families are characterized by a highly penetrant susceptibility to diffuse gastric cancer with an autosomal dominant pattern of inheritance, predominantly in young persons. We describe genetic screening, surgical management, and pathological findings in young persons with truncating mutations in CDH1 from two unrelated families with hereditary diffuse gastric cancer. METHODS Mutation-specific predictive genetic testing was performed by polymerase-chain-reaction amplification, followed by restriction-enzyme digestion and DNA sequencing in Family 1 and by heteroduplex analysis in Family 2. A total gastrectomy was performed prophylactically in five carriers of mutations who were between 22 and 40 years old. In each case, the entire mucosa of the stomach was extensively sampled for microscopical analysis. RESULTS Superficial infiltrates of malignant signet-ring cells were identified in the surgical samples from all five persons who underwent gastrectomy. These early diffuse gastric cancers were multifocal in three of the five cases, and in one person infiltrates of malignant signet-ring cells were present in 65 of the 140 tissue blocks analyzed, representing in aggregate less than 2 percent of the gastric mucosa. CONCLUSIONS We recommend genetic counseling and consideration of prophylactic gastrectomy in young, asymptomatic carriers of germ-line truncating CDH1 mutations who belong to families with highly penetrant hereditary diffuse gastric cancer.
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Affiliation(s)
- D G Huntsman
- Hereditary Cancer Program, British Columbia Cancer Agency, Vancouver, Canada.
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Robertson DI, Maung R, Duggan MA. Verrucous carcinoma of the genital tract: is it a distinct entity? Can J Surg 1993; 36:147-51. [PMID: 8472225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Between 1974 and 1985, 16 patients (7 men, 9 women) with a diagnosis of genital verrucous carcinoma were identified from the cancer registry of the Tom Baker Cancer Centre in Calgary. All the men had lesions on the penis. In the women, five lesions were on the vulva, four were on the cervix and two were on the vagina (two women each had two involved sites). The histologic slides from the surgically excised specimens were reviewed, and, by applying strict criteria, all cases could be reclassified as giant condyloma (five cases), intraepithelial neoplasia with or without condylomatous features (eight cases) or invasive squamous cell carcinoma (five cases). The authors believe that, in genital lesions associated with the human papillomavirus, a diagnosis of verrucous carcinoma is nonspecific and may lead to inappropriate clinical management.
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Affiliation(s)
- D I Robertson
- Department of Pathology, Tom Baker Cancer Centre, Foothills Hospital, Calgary, Alta
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Gutberlet T, Dreissig W, Luger P, Bechthold HC, Maung R, Knöchel A. Röntgenstrukturanalyse von diaquadinitratodioxouran(VI)–1,4,7,10,13-pentaoxacyclopentadecan. Acta Crystallogr C 1989. [DOI: 10.1107/s0108270188009771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Abstract
We report a case of intestinal metaplasia and dysplasia (villous adenoma) of the prostatic urethra secondary to stricture of the prostatic portion of the urethra and chronic inflammation. This sequence of events has previously been recognized in the urothelium of the bladder as a precursor of adenocarcinoma of intestinal type. Premalignant dysplasia of glandular type is rare in the urethra, as is adenocarcinoma, and this case suggests that the pathway to some adenocarcinomas of the urethra may be through intestinal metaplasia and dysplasia similar to the process recognized in the stomach, nose, and urinary bladder.
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Affiliation(s)
- R Maung
- Department of Pathology, Foothills Hospital, Calgary, Alberta, Canada
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Maung R, Kelly JK, Schneider MP, Poon MC. Mesenteric venous thrombosis due to antithrombin III deficiency. Arch Pathol Lab Med 1988; 112:37-9. [PMID: 3337617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 19-year-old woman developed gradually worsening abdominal pain, signs of peritonitis, and hematemesis. Laparotomy revealed peritonitis due to segmental small-bowel infarction, and the underlying pathologic condition was mesenteric vein thrombosis. A primary thrombotic disorder was suggested and antithrombin III deficiency was found. Before anticoagulant therapy could be initiated, she developed hemorrhagic cerebral infarction and died. Her history included three episodes of deep vein thrombosis while taking oral contraceptives. Her father died of spontaneous mesenteric and portal vein thrombosis at age 29 years. This report underlines the importance of careful interpretation of the vascular pathology in cases of intestinal ischemia.
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Affiliation(s)
- R Maung
- Department of Pathology, University of Calgary, Faculty of Medicine, Alberta, Canada
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Abstract
Fibrous hamartoma of infancy is an uncommon fibroproliferative lesion that occurs only in infancy and childhood. The present case is unusual for the presence of two separate lesions, infiltration into the superficial muscle, infiltration and entrapment of nerves, and rapid recurrence after initial surgery. Despite these unusual and suspicious features, follow-up evaluations over the 15 months subsequent to the last resection showed no evidence of recurrence.
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Maung R, Burke RC, Hwang WS. Metastatic renal carcinoma to larynx. J Otolaryngol 1987; 16:16-8. [PMID: 3560301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The larynx is a most unusual site for metastatic cancer. A case of metastatic renal cell carcinoma of the larynx is presented to illustrate the following features: its exceptional indolent course; the difficulty in arriving at a correct diagnosis, and the good result following local excision.
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Maung R, Pinto A, Robertson DI, Stuart GC, Klassen JK, Hons RB. Development of ovarian carcinoma in a cyclosporin A immunosuppressed patient. Obstet Gynecol 1985; 66:89S-92S. [PMID: 3895086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This is the first report of an ovarian carcinoma developing in a patient immunosuppressed by Cyclosporin A. Thirteen months before the diagnosis of malignancy, the patient received a living related donor kidney transplant whose rejection was controlled by Cyclosporin A and prednisone. The tumor was rapidly fatal five weeks from diagnosis. The literature on malignant transformation in the immunosuppressed patient is reviewed with emphasis on a gynecologic perspective.
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