DOD Hiring Pathology Informatics Assistant (Bethesda, MD)

Job Title:Pathology Informatics Assistant (Office Automation) Department:Department of Defense Agency:TRICARE Management Activity Job Announcement Number:NCJT12131640751530 SALARY RANGE: $37,983.00 to $49,375.00 / Per Year OPEN PERIOD: Sunday, September 23, 2012 to Saturday, September 29, 2012 SERIES & GRADE: GS-0303-06 POSITION INFORMATION:...

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Health junket for 76 costs taxpayers $200k

DOZENS of Pathology Queensland staff enjoyed the delights of Darwin this week while their union complains cuts could cripple services.

The Courier-Mail can reveal that 76 staff from Queensland Health's pathology arm took off to the Top End for an annual conference, with $200,000 of their costs covered by taxpayers.

The four-day conference comes amid union warnings the LNP Government's plans to cut about 100 pathology staff would impact patients.

Health Minister Lawrence Springborg yesterday described the number of Queensland Health employees attending the one conference as "eye opening".

However, Mr Springborg said he was not aware of any impact the en masse absence of staff had on services.

However, Together Union secretary Alex Scott said it was a "furphy" for Mr Springborg to claim Pathology Queensland would not be impacted by job cuts if it could cater for conferences.

Mr Scott said 76 was just a fraction of the 1600 pathology workforce and more staff should have attended.

"If we had staff cuts we wouldn't have had people at this conference and the health system as a result would be worse off."

Queensland's contingent to the four-day conference included three pathologists, 23 phlebotomists and laboratory assistants and 50 scientists.

Staged by the Australian Institute of Medical Scientists, the conference came complete with a cocktail function and a special dinner at the Darwin Sailing Club.

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Health junket for 76 costs taxpayers $200k

AMP appeals breast cancer gene patent case to US Supreme Court

Public release date: 26-Sep-2012 [ | E-mail | Share ]

Contact: Mary Steele Williams mwilliams@amp.org 301-634-7921 Association for Molecular Pathology

Bethesda, MD, September 26, 2012: The Association for Molecular Pathology (AMP) has petitioned the United States Supreme Court to review the Court of Appeals for the Federal Circuit's (CAFC's) recent ruling in Association for Molecular Pathology v. U.S. Patent and Trademark Office, a case that challenges the validity of patents on two human genes, BRCA1 and BRCA2, that predispose women to hereditary breast and ovarian cancer. The American Civil Liberties Union and the Public Patent Foundation filed the appeal to the High Court on behalf of AMP and other medical and professional organizations representing over 150,000 physicians and scientists. Other plaintiffs in the suit include individual physicians and scientists, genetic counselors, women's groups and patients.

After a district court initially declared the BRCA1 and BRCA2 patents invalid in March 2010, the CAFC reversed. That decision was appealed to the Supreme Court, which remanded the case to the lower court for further consideration in light of its recent decision in Mayo v. Prometheus. In Mayo, the Supreme Court found a method patent on another biological relationship was invalid under section 101 of the Patent Act because it claimed an unpatentable natural phenomenon. Upon reconsideration, the CAFC again upheld the patents on the breast cancer genes, claiming that the patentees had invented a new chemical substance through their identification of the disease-causing genetic mutations.

"AMP is now looking to the Supreme Court to correct this wrong on behalf of patients and their at risk family members. Patents on genes such as BRCA1 and BRCA2 grant diagnostic test monopolies to commercial companies, which often assemble the genetic knowledge acquired through testing in proprietary databases to which the medical community lacks access," stated Mary Steele Williams, Executive Director of the Association for Molecular Pathology.

Iris Schrijver, MD, President of the Association for Molecular Pathology added, "Gene patents prevent pathologists from reading their patients' DNA sequences to assess their risks for disease, their prognoses, or their potential responsiveness to therapy. The result of this lack of competition is increased test costs; decreased patient access; reduced innovation in the development of new test methods; and dramatically reduced knowledge dissemination."

"The Court of Appeals' decision was disappointing," said Roger D. Klein, MD, JD, Chair of the AMP Professional Relations Committee, "but we are optimistic the High Court will continue to uphold longstanding precedents that prohibit the patenting of natural phenomena. The CAFC's majority opinion failed to acknowledge the reasoning underlying the Mayo decision. Further, it took an extremely narrow approach to the question of patent eligibility of the BRCA1 and BRCA2 genes, considering only whether there were physical changes to the genes' organizational arrangements, not whether these changes altered their fundamental properties. The essence of DNA is its ability to store the blueprints for human life within its code. The CAFC's decision was analogous", he added, "to treating genes as computer hardware, when their essence is really that of software. In this case, of course, the software code was written by nature, not man."

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ABOUT AMP:

The Association for Molecular Pathology (AMP) is an international medical professional association dedicated to the advancement, practice, and science of clinical molecular laboratory medicine and translational research based on the applications of molecular biology, genetics, and genomics. For more information, please visit http://www.amp.org.

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AMP appeals breast cancer gene patent case to US Supreme Court

Book fair raises funds for speech pathology students

By Staff Posted on September 25, 2012 | News | No comment

Last week a book fair was conducted in the Don Morris Center to raise scholarship money for speech pathology students.

The ACU Chapter of the National Student Speech-Language-and Hearing Association (NSSLHA) put on the book fair where a variety of books were offered. Anystudent or faculty member could shop at the fair, but the sale was aimed towards speechpathology and education students.

The communication sciences and disorders students were involvedin running the fair.

Dr. Denise Barnett, assistant professor of communication sciences and disorders,said that the fair was very beneficial for students in her department.

They usethese books a lot with children, and here is a perfect way to acquire them right oncampus, Barnett said.

The money earned will fund scholarships for speech pathology students and assist with the cost to attend a professional convention in the spring.

Denysha Taylor, a junior speech pathology major, said she bought books at the book fair so she can use them in her field where she hopes to work with children.

Books like these are good therapy for kids, she said. They will help me inworking with them and helping them to learn.

Taylor said she was impressed with the fairs selection and was happy to see some of her childhood favorites on the shelves. She said when working with kids, the books cant be too easy or too hard, andthey have to keep the childs interest, so keeping a variety is always a good thing.

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Book fair raises funds for speech pathology students

Hospitals, Healthcare Providers to Benefit from New Premier Agreements for Digital Pathology Systems, Accessories and …

CHARLOTTE, N.C.--(BUSINESS WIRE)--

The Premier healthcare alliance today announced a new agreement for digital pathology systems, accessories and service has been awarded to DigiPath Inc. a small business enterprise, of Henderson, Nev.

Effective August 1, 2012, the agreement is available to acute care and continuum of care members of Premier.

About the Premier healthcare alliance, Malcolm Baldrige National Quality Award recipient

Premier is a performance improvement alliance of more than 2,600 U.S. hospitals and 88,000-plus other sites using the power of collaboration and technology to lead the transformation to coordinated, high-quality, cost-effective care. Owned by hospitals, health systems and other providers, Premier operates a leading healthcare purchasing network with more than $4 billion in annual savings. Premier also maintains the nation's largest clinical, financial and outcomes database with information on 1 in 4 patient discharges. A world leader in delivering measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services. Headquartered in Charlotte, N.C., Premier also has an office in Washington. https://www.premierinc.com. Stay connected on Facebook, Twitter and YouTube.

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Hospitals, Healthcare Providers to Benefit from New Premier Agreements for Digital Pathology Systems, Accessories and ...

How many times, if ever, have you googled a patient?

According to a WSJ blog post two years ago, it mentioned and asked, "By now, it’s well known that almost anyone you meet — from a potential employer to a prospective date — might be searching for information about you online. But would you feel strange knowing that your doctor was Googling you?" The blog post goes on to say "The practice appears to be widespread, according to an essay in the latest edition of the Harvard Review of Psychiatry, and it raises some thorny ethical questions for doctors, particularly those dealing with mental health." 

Some folks actually wrote a paper on this.  I happen to come across this news from KevinMD who made mention of this on his site in April of 2010 in a post entitled "Should doctors Google their patients?"

Point is, apparently I am not the first one to think of this, do it or subsequently write about it, but here is my response.

As a physician/pathologist there are a number of forms of data available to you, specimen requisition information, clinical history, electronic medical records, laboratory tests, radiology studies, operative notes, etc...


LetmegoogleyouIn some cases, the information may not be available (brunt of work-up, radiology, pre-operative visit, etc...) performed outside your institution where these impressions and results may normally be available to you.  The specimen requisition may simply state "change in bowel habits" or "liver mass" without much more than patient name, age, sex and a MRN of little value beyond appropriate patient ID.  No radiology, laboratories, physical examination findings, incomplete operative note and/or a clinician/surgeon who did not perform anything beyond the endoscopy or operation and does not recall by phone 2 or 3 days after the "case" anything about medication history, social history, radiology from outside hospital or post-operative course (assumingly these are all "negative", "non-contributory" or "not worth remembering".  When one calls for additional information the question is usually answered in the form of another question "Is it cancer?", "Is the margin negative?", or "How many lymph nodes are involved?"

A recent "liver tumor" submitted by a private physician at our hospital, where the work-up was largely done elsewhere, including pre-operative screening and imaging had an unusual histology.  No additional information was available.  A call to the surgeon about occupation, social history and medication history was met with one response "Is the margin negative?"  If I didn't tell him the patient's first name he would not have known that either. 


DnacredithistoryGoogle did.  And where he worked (irrelevant) what his "Likes" were, hobbies, interests and favorite TV shows.  The data I saw did not necessarily help to replace the normally present clinical data (assuming accurate when it is available), did not make the diagnosis less or more likely by itself, assuming the infomation online was accurate (i.e. did I have the right "John Doe") but it did help to substantiate the findings, albeit given circumstantial data.

As KevinMD and the WSJ blog notes and reader comments mention, there are many issues with this.   For some physicians apparently, using Google and the Internet to find publicly available information about their patients may shed some light into their diagnoses or management.  

One physician commented "I've done it, and it yielded invaluable info on a sick non-psych patient. Nailed the diagnosis."

What if there is something "out there" about an overtly litiginous patient?  Or one who smokes, is an admitted alcoholic, brags about excessive BMI, has started a blog on his/her personal battle with cancer, could any of these influence your diagnosis or approach after finding out?  

Perhaps in some cases and that is the point - shouldn't you know to help the patient and providers?

I have yet to meet a hepatologist who has not googled the name of a drug, prescription, over-the-counter or "other" health food store variety to look up any reports of hepatotoxicity or chemical compunds in those drugs that have been associated with hepatotoxicity.  

An old cardiologist (older now) told me as a first-year medical student, "Keith, there are two keys to practicing medicine; 1.  Do everything the same way, everytime.  This lowers the likelihood you will miss something. Whether it is a taking a clinical history, physical exam, reading an EKG, reading a chest x-ray (from outside in, or inside out, top-down, down-up), however you choose to do it, do it the same way everytime. And 2.  Cheat.  Cheat all the time.  Meaning get as much information as you possibly can.  MD stands for medical detective.  Get information from as many sources as possible.

This was shortly before Ask Jeeves or Yahoo!

I wonder what he would do if he had Google and an unresponsive patient, missing clinical information, radiology studies, unresponsive surgeon, forgetful clinician, etc...

Does this replace physician communication, documentation, the EMR, solid clinical business practices, actually talking to the patient, looking at his/her medical records, the slide(s) or X-rays?  Of course not.  May it yield information not mentioned and potentially useful? Ask Google.

 

 

 

 

 

 

 

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Can 2007 ASCO/CAP Scoring Guidelines for HER2 Protein Expression and Gene Amplification Be Applied to Gastroesophageal Adenocarcinoma?

Review of: Tafe, LJ, Janjiigian
YY, Zaidinski M, et al.  Human Epidermal
Growth Factor Receptor 2 Testing in Gastroesophageal Cancer Correlation Between
Immunohistochemistry and Fluorescence In Situ Hybridization
Arch Pathol Lab Med; 2011;135:1460-1465.


Nrgastroher2Experienced pathologists are
familiar with the bumpy and often controversial evolution of HER2/neu testing
in breast cancer patients. 

First, there was a breast
cancer drug trial employing a poorly designed trial assay followed by release
of the high demand drug Herceptin into a medical system without a remotely
adequate companion assay.  This was
followed by a confusing application of multiple anti-HER2 antibodies in no
standardized immunohistochemical assays interpreted by a range of pathologists
using different criteria all in parallel with a separate evolution of different
FISH assays. 

Before arriving at a reasonable
degree of standardization as outlined in the 2007 ASCO CAP guidelines, there
was a relatively prolonged period of sometimes heated consternation over which
assay was best, under what conditions, and using interpretive criteria.  And, during that period, we wrestled with a
lot of published laboratory correlation studies—the vast majority lacking any
clinical outcome data.  It’s not pleasant
to recall all of this controversy associated with HER2 testing in breast cancer
but hopefully it is a reminder of mistakes not to be repeated. 

We should remember these
lessons as we step into a new era of anti-HER2 therapies for gastroesophageal
and almost certainly other cancers from other primary sites.  The combination of Herceptin and chemotherapy
was very recently proven effective against HER2 positive advanced gastric and
gastroesophageal junction carcinomas in the TOGA clinical trial. 


Gastricher2Of great importance, the
standardized HER2 scoring systems used for breast cancer were not used in this
trial.  Instead, a body of preceding work
suggested that an alternative scoring system was needed for gastroesophageal cancers.  Basically, the traditional breast scoring
requirement for complete circumferential staining was modified to score
incomplete basal lateral membrane staining of gastric cancers as positive. 

In the trial,
immunohistochemistry was slightly more powerful than FISH in predicting drug
response with therapeutic responses in IHC 3+ tumors as well as IHC 2+ FISH
amplified tumors but not in FISH amplified tumors with lower
immunohistochemical scores 1 and 2. 

As a result, in Europe patients
with advanced gastroesophageal adenocarcinoma who are HER2 3 positive by
immunohistochemistry or IHC 2 positive with FISH amplification are eligible for
Herceptin therapy.  Slightly differently
in the United States, metastatic tumors that are IHC 3+ or HER2 amplified by FISH
are eligible. 

Some investigators have not
bought into the modified HER2 scoring system and hope to justify a more uniform
application of the existing breast cancer scoring system across different tumor
types.  Reporting in the November 2011
issue of Archives of Pathology and Laboratory Medicine [provide reference],
senior author Violetta Barbashina and co-authors measure concordance between
immunohistochemistry and FISH for evaluating HER2 status in gastroesophageal
carcinomas. 

Notably, in contrast to the
clinically validated scoring criteria for gastroesophageal carcinoma
established by the TOGA trial for Herceptin therapy, these authors deliberately
applied more traditional HER2 scoring criteria that are established for breast
cancer. 

They evaluated 135 paraffin
embedded advanced gastroesophageal carcinomas from the pathology files of
Memorial Sloan Kettering Cancer Center by HER2 automated immunohistochemistry
using PATHWAY Rabbit Monoclonal Antibody 4B5 on a Ventana BenchMark stainer
and, by HER2 FISH using the Path Vision dual probe procedure. 

Again, in this study, both ICH
and FISH were interpreted using criteria for breast cancer per the 2007 ASCO
CAP scoring guidelines.  By ASCO CAP
guidelines, 16 of 16 or 100% of the IHC 3+ tumors were FISH amplified; 16 of 20
or 80% of FISH amplified tumors were IHC 3+. 

Overall, IHC FISH concordance
was 97% for IHC 0 tumors, 93% for IHC 1+ tumors and 100% for IHC 3+ tumors—all
very high concordance rates—but note, that I have not described the FISH IHC
concordance rate for equivocal IHC 2+ tumors. 
Among this group of 8 equivocal IHC 2+ tumors, three were amplified,
four unamplified, and one equivocal indicating a roughly 50% concordance
rate. 

Finally, the authors
reclassified their IHC and FISH scoring using modified TOGA clinical trial criteria
and obtained a similar but no identical concordance rate.  From this, the authors conclude that HER2
testing in gastroesophageal cancers can be performed using 2007 ASCO CAP
scoring guidelines for breast cancer. 
Think about it.  I do not think
that such a bold conclusion is supported by this work. 

In their discussion, the
authors also state that for gastroesophageal cancers IHC 1+ and 2+ results should
be resolved by what they call definitive FISH testing.  Both this statement and the conclusion that
we can apply breast cancer scoring criteria are not supported by any clinical
evidence. 

In fact, the TOGA clinical
trial data contradict the notion that FISH results are in any way more
definitive or more predictive than IHC results. 
The TOGA clinical trial data actually suggests that for gastroesophageal
cancers, IHC results are more predictive of drug response. 

The authors have done a large
amount of work and report very good correlation between PATHWAY Ventana
immunohistochemistry HER2 testing and Path Vision FISH results in
gastroesophageal cancer but as far as I can tell that is all.  I have yet to see any clinical
evidence—certainly not in this paper—to support their suggestion that ASCO CAP
breast cancer scoring is acceptable or that FISH HER2 results are the
definitive answer for gastric cancers. 

I hope that this is not the
beginning of numerous laboratory correlation studies on HER2 testing on gastric
or other types of cancer that lack clinical outcome data but spawn speculative
conclusions about clinical utility.  One
suggestion I would make if it has not already been done is to retrospectively
score TOGA clinical trial gastroesophageal cancers by ASCO CAP breast cancer
criteria and see which system best predicted drug response. 

Short of that effort, someone
would have to essentially repeat the TOGA trial to truly answer the question
posed by these authors. 

To my knowledge and for now,
the modified TOGA scoring criteria for gastroesophageal cancer HER2 status
remain uniquely validated by a clinical trial. 

Biologically, it seems
imprudent to expect standards for HER2 testing in breast cancer to translate
simply and unchanged across primary and anatomic sites from breast to stomach
to lung or any other organ.  That is not
the case for anti-EGFR drug modality or laboratory testing algorithms in lung
and colon cancers which have benefited from quite different anti-EGFR drugs and
laboratory testing strategies.  In lung
cancer, use of anti- HER2 therapies is currently investigative but already
there is some published literature indicting that HER2 gene mutation status
(not protein over expression and not gene amplification) may identify the
subset of lung cancer patients who respond to Herceptin. 

The name of the game is predicting
drug response and that requires empirical clinical outcome data.

 

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Jerry and his Doctors

Every once in awhile I come across another physician blog that tells it like it is without ranting and raving about managed care/insurance issues, hospital administrators or patients with unmet expectations.

This one comes from an internal medicine resident recounting an experience with a terminally-ill patient and end-of-life decisions, a living will, the needs of patients and the decisions made by an attending physician and a resident physician.

Her experiences remined me of the 3 months I spent as an intern in critical care units.  The discussion, and perhaps, more importantly, enforcement/following of living wills and the battles that ensue with families, doctors, housestaff, attendings and medical technology in the war against human disease.

For a sobering account and one doctor's piece of mind on this check out:

The only thing I had to do was help Jerry and I failed


Doctors-band-aid-300x243

 

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