Interesting story at FierceMobileHealthcare on use of Kindle for accessing medical literature.
Category Archives: Pathology
Telestroke has another success
Mayo Clinic is expanding both its telemedicine and its robot presence in Florida by rolling out a new stroke telemedicine project. Mayo's first partner in the project is Parrish Medical Center in Titusville, Fla. On April 30, an In Touch Health Multipresence Robot joined the staff in Parrish to allow
Mayo Clinic physicians to consult from afar by robot-assisted teleconference on stroke patients.
It's just like "being at the foot of a patient's bed," Kevin Barrett, M.D., a vascular neurologist at Mayo Clinic's Florida campus, told the Jacksonville Business Journal. "You can examine their mental status, language function, facial movements, strength in the arms and legs by asking them to perform certain maneuvers, and the bedside nurse can assist with some components of the exam."
The telemedicine project is aimed at connecting stroke specialists with local physicians to allow patients to be treated more quickly and closer to home. And time is critical with these patients. When a stroke patient arrives at the emergency department, that triggers a call to the Mayo neurologist. And "with the assistance of a nurse at the patient's bedside, the doctor can remotely examine the patient," after the patient is moved to a hospital room.
What patients and medical staff at the hospital see during the consult is a "live image of the Mayo Clinic physician" on the monitor screen atop the robot. The fact that the image is where the robot's head would be adds to the effect, since the robot is "shaped like a human,"
Francisco Garcia, medical director of the emergency department for Parrish Medical Center, told the journal.
The Florida telemedicine project, along with a stroke telemedicine project in Arizona, received a CoDE Innovation Fund award from the Mayo Clinic Center for Innovation in 2009 and 2010, helping to
make the roll out possible.
Case of the Week 51
The following were seen in a concentrated wet preparation of stool. No history is available. Identification?
40X objective
100X objective
100X objective
100X objective
100X objective
Dr. Alexander R. Judkins Named Department Head of Pathology Laboratory Medicine at Childrens Hospital Los Angeles
Had an opportunity to meet and hear Alex speak a few months ago on the progress he was making at CHOP with digital pathology and bioinformatics. He is clearly a thought leader in this area and forward thinking beyond his other professional and academic achievements. Alex has accepted the chair position at Childrens Hospital of Los Angeles. Look forward to more accomplishments in your new role Alex!
(Abbreviated press release below)
Alexander R. Judkins, M.D., has been named the new Department Head of Pathology and Laboratory Medicine at Childrens Hospital Los Angeles, according to an announcement last week by Richard D. Cordova, FACHE, president and CEO of Childrens Hospital Los Angeles. Dr. Judkins begins his duties on July 1, 2010.
Since 2007, Dr. Judkins has served as the chief of the Division of Neuropathology, Department of Pathology and Laboratory Medicine at Children's Hospital of Philadelphia (CHOP). He also is director of the Pathology Core Laboratory at CHOP and assistant professor of Pathology and Laboratory Medicine at the University of Pennsylvania School of Medicine.
Dr. Judkins will replace Timothy Triche, M.D., Ph.D., who is stepping down after 21 years to create a new Center for Personalized Medicine at Childrens Hospital Los Angeles.
"We are pleased we were able to convince Dr. Judkins to join our team," said Mr. Cordova. "He will serve as the liaison between the Pathology Department here at Childrens Hospital Los Angeles and the appropriate laboratories and the Department of Pathology with our partners at the Keck School of Medicine of the University of Southern California."
Dr. Judkins will be responsible for the overall performance and quality of the pathology and laboratory services program at Childrens Hospital. His administrative and clinical oversight duties will include integration of pediatric pathology programs, academics, research, patient care, fiscal planning and monitoring.
In addition, he will oversee teaching and education as it relates to the Department of Pathology at Childrens Hospital and will serve as the Vice Chair of the Department of Pathology and Laboratory Medicine at USC Keck School of Medicine.
Dr. Judkins is recognized for his diagnostic expertise and research in pediatric brain tumors, particularly embryonal CNS neoplasm including atypical teratoid/rhabdoid tumors (AT/RT). He is a contributor to the 2007 World Health Organization Classification of Tumors. Pathology & Genetics: Tumors of the Nervous System and a reviewer for Children's Oncology Group.
Dr. Judkins is also recognized for his work in non-neoplastic pediatric neuropathology, where his focus has been on developmental malformations and the neuropathology of seizure disorders. He is a co-author of the recently published Non-neoplastic Disease of the Central Nervous System, First Non-Neoplastic Disease Fascicle Series, Armed Forces Institute of Pathology.
Dr. Judkins has developed unique expertise in digital pathology and is working to build tools to integrate bioinformatics and pathology image data analysis. He also has made significant contributions to both the Children's Hospital of Philadelphia Research Institute and the Department of Pathology and Laboratory Medicine. He developed the Pathology Core Laboratory to offer services and support to researchers at the CHOP, as well as the broader University of Pennsylvania research community.
Dr. Judkins received a bachelor's degree (1991) from State University of New York Geneseo, graduating Summa Cum laude. He received his medical degree (1996) from the University of Rochester School of Medicine in New York.
Dr. Judkins trained at the Hospital of the University of Pennsylvania, where he completed residency training in anatomic pathology (1996-97), and served as chief resident (1998-99). He completed fellowships in neuropathology (1999-2001, the Hospital of the University of Pennsylvania) and forensic pathology (2001-02, Office of the Medical Examiner in Philadelphia and MCP Hahneman University).
Dr. Judkins is board certified in anatomic pathology, neuropathology and forensic pathology. He joined the faculty of the University of Pennsylvania School of Medicine as an Assistant Professor in the Department of Pathology and Laboratory Medicine and the staff of CHOP as a neuropathologist in 2002.
He currently serves in editorial positions at a variety of journals and publications, including Brain Pathology, the Journal of Neuropathology and Experimental Neurology and Acta Neuropathologica.
Hospital’s Emergency Room Use of Telemedicine through Webcam
Axillary Node Dissection, Sentinel Lymph Node Biopsy May Pose More Harm Than Good In Patients With Pure DCIS
Medscape (5/3, Ellis; registration required) reported that "two commonly used procedures -- axillary node dissection and sentinel lymph node biopsy -- might pose more harm than good to patients with pure ductal carcinoma in situ (DCIS)," according to a study presented at the American Society of Breast Surgeons 11th Annual Meeting. One of the study's authors said that "her findings indicate that not only do these procedures and their subsequent findings not affect survival 'in any way,' the procedure itself carries some morbidity -- albeit low."
Will Pathology PACS eliminate injuries or cause different ones?
I wonder who is more susceptible to work-related injuries. Pathologists or radiologists? Is anyone aware of any data as that below for radiology for pathology? Will pathology PACS eliminate stress and strain from microscope use or simply create other injuries?
Radiologists may be prone to work-related injuries
By Erik L. Ridley
AuntMinnie staff writer
Thanks to a lack of attention paid to developing comfortable and ergonomic work spaces, radiologists appear susceptible to work-related musculoskeletal symptoms, according to research presented Monday at the American Roentgen Ray Society (ARRS) meeting in San Diego.
Researchers from Massachusetts General Hospital (MGH) in Boston found that only 7.2% of surveyed radiologists did not have any work-related musculoskeletal symptoms. Investments in training and education seem required to address this health risk to radiologists, according to the study team.
"It's an important problem that affects every radiologist, regardless of your level of training, what specialty you're in, your location, and [whether you're in] academic or private practice," said Dr. Anand Prabhakar, a clinical fellow in abdominal imaging. "We need to do something about it before it becomes very debilitating to people."
Following anecdotal reports that many radiologists suffer from work-related musculoskeletal symptoms, the MGH research team sought to determine the prevalence of these symptoms in radiologists at a large tertiary-care hospital. They also wanted to investigate the effects of several workstation ergonomic factors and work habits on these symptoms, according to Prabhakar.
They administered a written questionnaire to 28 randomly selected radiologists (17 male, 11 female; age range = 36-50 years) from various divisions of a single radiology department. All of these radiologists primarily utilized PACS and speech recognition for interpretation, but also occasionally viewed hard-copy images, according to the researchers.
The questionnaire gathered information such as demographics, work-related musculoskeletal symptoms, work habits, and workstation design. Of the respondents, 50% had worked on the same system for longer than five years. In addition, 96% had two to three monitors at their workstation.
Only 7.2% were symptom-free, and 70% had seen a physician for work-related musculoskeletal symptoms. The researchers also found that 75% had changed their work schedule in response to symptoms.
Prevalence of musculoskeletal symptoms included:
- Neck pain in 42.8%
- Lower back pain in 39.2%
- Headache in 32.1%
- Shoulder pain in 32.1%
- Wrist pain in 7.4%
The MGH researchers also discovered that three radiologists (17%) never adjusted their chairs; all had three or more symptoms of musculoskeletal pain. Only 32.3% of respondents always adjust their chairs, while 42.8% said they sometimes did.
As for adjusting their monitors, 60.7% never did. Elbow rests were never used by 53.5% of respondents, of which 46% had shoulder pain. Only 50% had a regular exercise program.
However, the researchers did not find any relationship between those who had more adaptive responses overall and those who had fewer symptoms.
Prabhakar attributed the prevalence of musculoskeletal problems to a combination of factors, including the piecemeal approach of putting together radiology work spaces in the PACS era.
"For example, the PACS station is not purchased at the same time [from] the same vendor; it's not integrated with, say, the desk, telephone, mouse, keyboard, and dictation system," he told AuntMinnie.com. "There really has not been any interest in somebody putting it all together and really taking into account radiologist comfort."
Cost also can be a factor, Prabhakar said. Training and education are often not provided on how to set up work spaces to be more comfortable and ergonomic.
In another notable survey finding, radiologists expressed strong preferences for having more tools for combating repetitive stress injury, some of which are very low cost, he said. For example, approximately 70% of respondents thought a wireless mouse would be helpful and approximately 60% said a wireless keyboard would be helpful. And although it would be more expensive than a wireless keyboard or wireless mouse, more than 80% of respondents wanted a desk with an adjustable height.
"If we can somehow test whether those small things could help people, then I think it's a small investment in the long-term health of radiologists," he said. "I suspect, and I haven't proven it, that if radiologists are more comfortable, then they're going to work more efficiently. And that will increase productivity, which I think is the measure that administrators will look at before they invest in it."
As for specific steps radiologists can take to improve their work-space environment, Prabhakar suggests examining recommendations produced by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA). Those guidelines, which are available online as an e-tool, provide a range of tips for creating safe and comfortable workstations.
"Ultimately, I hope that this project inspires other people to take control of their own workspace, maybe inspire industry or academic institutions to address the problem, and hopefully future research will prove that this may improve our productivity," he said.
Future research efforts will evaluate the impact of training and education on the symptoms of work-related musculoskeletal symptoms, Prabhakar said.
Announcement for Upcoming Aperio Digital Pathology Seminars in Chicago and Cleveland
Join Us for the Chicago and Cleveland Digital Pathology Seminars
CHICAGO
May 13, 2010
Hyatt Regency
on the Riverwalk
CLEVELAND
May 14, 2010
Hyatt Regency Cleveland
Aperio is pleased to announce the first-annual Chicago and Cleveland Digital Pathology Seminars. The seminar is complimentary and meals will be provided.
Meet and network with fellow clinicians, pathologists, histologists, biostatisticians, researchers, informaticians, and biologists to share ideas about implementing digital pathology in drug development, academic, and research environments.
SAMPLE SEMINAR TOPICS:
Marc Friedman, PhD, Aperio
Hands-On Breakfast Workshop: Slide Scanning 101
Scott Spear, Aperio
Spectrum Plus and Data Management
Peter Gann, MD, ScD, University of Illinois at Chicago
Aging, the Architecture of Normal Breast Tissue, and Breast Cancer Risk
Christopher Tully, Aperio
Image Analysis 101: Tools for Analyzing Histology
Gerard Gagne, Abbott Laboratories
Bringing the Divide - Using Digital Pathology to Guide Ultrastructural Pathology Evaluations
Bill Standwill, HistoRx
AQUA® Technology for Precise Biomarker Expression Measurement in Tissue
Frank Voelker, DVM, DACVP, Flagship Biosciences
Measuring Fat and Vacuolar Space Using
Digital Pathology
Jared Schwartz, MD, PhD, Aperio
Overcoming Psychological Barriers to Adoption of Digital Pathology and Other Novel Technologies
Ossama (Sam) Tawfik, MD, PhD, Kansas University Medical Center
Interactive Multi-Disciplinary Web Conferencing for Radiology/Pathology Correlation of Breast Biopsies: How Integrated Breast Cancer Diagnostics are Improving Patient Care
Bruce Dunn, MD, Milwaukee VA Medical Center
Primary Diagnostic Telepathology
RSVP TODAY TO RESERVE YOUR SEAT!
To RSVP for this seminar, contact Nicole Siska, Aperio Events Team, at 760.539.1193 or nsiska@aperio.com.
ASCP 2010 Annual Meeting Digital Pathology Course Offerings
The upcoming ASCP Annual Meeting will feature several sesssions discussing Pathology 2.0, digital pathology, including telepathology and image analysis and personalized healthcare.
Looks like an excellent faculty for these sessions. The meeting will take place in San Francisco between October 27-31, 2010.
A257 Harnessing Web 2.0 to Improve Consultation and Communication
Thursday, October 28 9:30 am - 11:30 am
Get an overview of the power of Web 2.0 to link laboratory practitioners across the globe. Discussions will include a big-picture view of how the internet is changing communication among professionals, how digital pathology can facilitate consultations, and much more. Interactive lectures will offer you an opportunity to connect with select web sites and participate in a Q&A session. You will leave with the ability to:
Establish communication networks with colleagues around the world.Understand how digital image capture/sharing will transform practice in the next decade.Access web sites that offer specialized content in pathology and laboratory medicine.
Moderator:
William E. Schreiber, MD, FASCP, University of British Columbia
Faculty:
Dean Giustini, MLS, MEd, University of British Columbia
Michael Feldman, MD, FASCP, University of Pennsylvania
Credits: 2.0 CME
SP88 Hauling Pathology and Pathologist into the 21st Century – Telepathology and Image Analysis
Thursday, October 28 9:30 am - 11:30 am
Review telepathology for patient care, including new systems, software, government regulations, and a real-world two-year experience with a successful telepathology deployment. You will also benefit from a multifaceted view of image analysis, including a brief overview, current commonly used applications, potential research applications, and possible future developments in image analysis. You will leave with the ability to:
Recognize the challenges for so-called low- and high-end telepathology systems.Appreciate the utility of image analysis for patient care and how these solutions can generate revenue for pathology departments.Appreciate how images analysis can be applied to daily practice and research.
Moderator:
N. Volkan Adsay, MD, FASCP, Emory University
Faculty:
Alexis B. Carter, MD, FASCP, Emory University
Alton B. "Brad" Farris, III, MD, FASCP, Emory University
Credits: 2.0 CME
SP89 Expanding the Pathologists’ Toolbox in the Era of Personalized Healthcare – Next-Generation Pathology Technology
Thursday, October 28 3:00 pm - 5:00 pm
Hear about new information regarding several technologies – including virtual slide imaging/image analysis, circulating tumor cells, and quantum dot multiplexing – with the potential to form the basis of future high-value medical diagnostics performed and interpreted by pathologists. The faculty will discuss the need for research-grade discovery technologies to be adapted rapidly into diagnostic products that are not only analytically accurate, but also fit into routine clinical practice. You will leave with the ability to:
Recognize the relevance of the Personalized Healthcare (PHC) model for pathologists.Understand the basic principles underlying key technologies that may play an important role in the future of pathology.
Moderator:
Jared Schwartz, MD, FASCP, Aperio Technologies, Inc.
Gary Pestano, PhD, Ventana Medical Systems
Mara Aspinall, MBA, On-Q-ity
Credits: 3.0 CME
ATA 2010 Meeting Announcement
To zero in on the latest telemedicine, telehealth, ehealth, mobile applications, and advanced remote medical technology, sign up now for the 15th American Telemedicine Association Annual International Meeting and Exposition to take place at the Henry B. Gonzalez Convention Center in San Antonio, Texas, on May 16-18 2010.
In recent months, the industry has seen huge changes in both national and state telehealth policies, National Health Reform, billions spent on broadband and health IT, new FCC broadband activities, and states mandating telemedicine coverage. The next year will be equally critical for the industry.
To address the many changes and issues involved, Aneesh Chopra, Federal Chief Technology Officer of the U.S. and John P. Howe, III, MD, President and CEO, Project Hope will be the featured speakers at the opening plenary session on Tuesday May 18th.
If you use telecommunications solutions for healthcare, the ATA Annual Meeting is the single most important event of the year to keep you up-to-date on the latest developments in your field. ATA 2010 will provide insightful keynote speakers, peer-reviewed presentations, executive roundtables, professional networking events, daily breakout sessions, and pre-meeting certificate courses.
Educational concurrent sessions will feature 72 peer-reviewed sessions and discussions on clinical services, telemental health, pediatric telehealth, remote monitoring, consumer and mobile health, emergency and disaster response, operations, business and finance, regulatory issues, and reimbursement issues.
For a preliminary program and further details, go to http://www.americantelemed.org.
World’s Smallest, Lightest Telemedicine Microscope
via MedGadget
Researchers at The California NanoSystems Institute at UCLA (CNSI) have developed a tiny telemedicine microscope for imaging blood samples or other fluids, testing water quality or other public health need in resource-limited settings.
From the press release:
Slightly wider than a US quarter and weighing just 46 grams, the lensless microscope is a self-contained imaging device. Using LUCAS (Lensless Ultra-wide-field Cell Monitoring Array) technology, it generates holographic images of microparticles or cells by employing a light-emitting diode to (LED) illuminate the objects and a digital sensor array to capture their images.
Samples are loaded using a small chip that can be filled with saliva or a blood smear for health monitoring. With blood smears, the lensless microscope is capable of accurately identifying cells and particles, including red blood cells, white blood cells and platelets. The technology has the potential to help monitor diseases like malaria, HIV and tuberculosis.
The microscope is fairly robust with few moving parts and a large aperture. Images can be uploaded via a direct USB connection to a smart phone or other device, and sent to a hospital.
More information: UCLA engineer invents world's smallest, lightest telemedicine microscope
New Digital Pathology Blog – Digital Pathology Insights from Definiens
Peter Duncan and colleagues over at Definiens have started a new insightful blog appropriately called Digital Pathology Insights. (Link in sidebar provided).
There are a number of interesting posts already since this weekend including linked content about Definiens products such as in the video below.
As I have written about before, the use of image analysis algorithms is one of the major added value drivers for digital pathology and digital pathology adoption.
Definiens as part of their marketing strategy has also been active with other Web 2.0 modalities including You Tube and Twitter to showcase and educate users about their software programs.
Welcome Digital Pathology Insights to the blogosphere!
Blood Test Meant To Analyze Genetic Activity Could Replace Biopsies After Heart Transplantation
The New York Times (4/23, B5, Pollack) reports that "a blood test that analyzes genetic activity could let heart transplant patients avoid many of the invasive and uncomfortable biopsies now used to monitor whether their immune systems are rejecting their new organs," according to a study scheduled to be presented at the International Society for Heart and Lung Transplantation meeting and published online by the New England Journal of Medicine. The research "involved 602 patients at 13 American transplant centers who had received a transplant from six months to five years earlier." Half of the participants "were given periodic biopsies and the others the blood test," called AlloMap, "at the same frequency."
The Wall Street Journal (4/23, Winslow) reports that just under 15% of patients who were given the test died or experienced complications during the follow-up period, compared to just over 15% of patients who were given biopsies.
The Los Angeles Times (4/22, Maugh) "Booster Shots" blog reported that "the primary limitations of the study were that it did not include patients in the first months immediately after their surgery and that it probably did not include patients who were at high risk of rejection, the authors said."
The Time (4/22, O'Callaghan) "Wellness" blog reported that AlloMap "was approved by the US Food and Drug Administration in September 2008 and assesses rejection risk by examining gene expression in patients' white blood cells."
Reuters (4/23, Steenhuysen) quotes one of the researchers as saying, "This represents a major step forward in the way we manage a patient after heart transplants because we can now safely reduce the numbers of heart biopsies."
MedPage Today (4/22, Phend) reported, "Rather than suggesting that the assay should become the standard, the real implication is the evidence the study offers questioning whether any routine screening is needed over the longer term after transplantation, [John A. Jarcho, MD, of Brigham and Women's Hospital] said" in an accompanying editorial. HeartWire (4/22, Stiles) and MedWire (4/22, Price) also covered the story.
CALL FOR ABSTRACTS: Medicine 2.0’10: 3rd World Congress on Social Media and Web 2.0 in Health, Medicine, and Biomedical Research on November 29-30, 2010 in Maastricht, The Netherlands.
CALL FOR ABSTRACTS:
http://bit.ly/dCOIeT
DEADLINE: May 31st, 2010
As announced earlier this year, the Medicine 2.0® conference – in 2008 and 2009 hosted in Toronto – goes global and will in 2010 be organized in Europe. The University of Twente (UT), the Radboud University Nijmegen Medical Centre (UMNC) and the National Institute for Public Health and the
Environment (RIVM) will host Medicine 2.0 Congress (Medicine 2.0’10: 3rd World Congress on Social Media and Web 2.0 in Health, Medicine, and Biomedical Research) on November 29-30, 2010 in Maastricht, The Netherlands.
Medicine 2.0® 2010 will be supported by the core Medicine 2.0® team in cooperation with scientists from UT, UMNC and RIVM; the website will remain at http://www.medicine20congress.com, and the submission and dissemination process will remain centralized. Medicine 2.0'10 will serve as an umbrella for REshape (Fall edition, UMNC) and the ‘Supporting health by technology’ (IIIrd edition) symposium
series (University of Twente, RIVM).
Abstract submissions for the Medicine 2.0'10 congress in Masstricht are open.
Medicine 2.0'10 will contain a mix of traditional academic/research, practice and business presentations, keynote presentations, and panel discussions to discuss emerging issues. We strive for an interdisciplinary mix of presenters from different countries and disciplines (e.g. health
care, social sciences, computer sciences, engineering, business) and with a different angle (research, practice, and business).
Participants are invited to either submit a 500 word abstract to propose a 15 minute single-presenter talk, or can submit a a 500 word panel proposal to present or discuss a topic in a 45-60 min session with 3-4 colleagues from other organizations/institutions (panel proposals with all authors from
the same institution or organization are not permitted).
All submissions will be considered for one of the Medicine 2.0 Awards, if eligible. To nominate your work for one of the awards, read the award criteria and prepare the abstract as outlined below. Note that in order to be considered for the IMIA Medicine 2.0 Award, a checkbox must be checked on the submission form (consideration for all other awards is automatic).
Track what is being submitted in real time through RSS feed at http://feeds2.feedburner.com/med2submit.
Follow on Twitter (http://twitter.com/medicine20)
Only requirement issubmission of a short abstract, no full papers. However, the meeting is working towards (optional) publication of full papers in PubMed-indexed publications, either in form of a full paper submitted to a special issue of the Journal of Medical Internet Research, or publication of the presentation transcript including the audio/video podcast in a new, electronic forthcoming serial called "Medicine 2.0", indexed in PubMed.
If you are interested in either of these options, please check the respective checkboxes in the abstract submission form (subject to additional publication charges).
For general questions please contact the conference secretariat at congres@key-cs.nl
What is the real cost of healthcare?
While I don’t usually write about my personal health, I was recently asked about health care reform during a discussion at the American Pathology Foundation meeting recently in Las Vegas. While the discussion centered on the main issue – not a full reform of the current healthcare system but rather insurance reform, it prompted me to put to words a few personal experiences and ask the question “What is the real cost of healthcare?”
In May of last year I came down with what I thought was a community acquired pneumonia. This was about the time of the first reported cases of H1N1 and out of fear of quarantine at the time for what I was sure was not H1N1 I avoided doctors and hospitals. After trying a couple courses of antibiotics prescribed by a colleague, without relief, I found myself at an “express care” facility on a weekend morning desperate for relief from my symptoms of fever, cough and chest pain.
After completing a short medical history, I was seen by a nurse practioner with minimal waiting who was professional yet focused her questions and examination on the current problem. Within a few minutes I had prescriptions for another course of antibiotics and medication to relieve the cough and subsequent chest pain.
“Are you going to do a chest x-ray?” “No.
“Sputum culture?” “No, why?”
“Referral to infectious disease or pulmonary?” “Huh?”
By the next morning, my symptoms were gone. Of course, this likely would have resulted had I not seen this healthcare provider but for fifty bucks that my employer sponsored healthcare plan paid for I feel like it was time well spent and was able to sleep through the night for the first time in a couple of weeks.
Some time after this I asked a pulmonary colleague had I been seen by him or one of his colleagues what may have transpired. At the least he claimed a chest x-ray and consideration of bronchoscopy and possible PFT testing to exclude other underlying conditions. Seems like a stretch compared to what I needed and with the treatment being an inexpensive visit, antibiotic and cough supressant.
During my acute illness one of our fellows presented with acute flank pain to the ER on the same weekend. After sitting in pain for four hours in the ER it was determined he had a kidney stone and conservative managment was warranted. An ultrasound and CT later, twelve hundred bucks for the ER visit plus radiology costs. No pain relief. By the next week after conservative measures failed and he underwent additional urology consultations, lithotripsy and eventually surgical removal of the stone. Tack on another five grand. A post-op follow up, subsequent IVP and his bills were pushing $10K. This does not count time off from work and lost productivity. The insurance covered a minority of the expenses.
While I am not a pulmonologist or urologist and do not manage acute clinical conditions I wonder what may have happened if my colleague had gone to see the nurse practioner on the weekend as I did. Save the ER costs for same diagnosis, perhaps some more immediate relief of symptoms, quicker appropriate referral as this could not be managed in their setting and definitive care rendered with less delay and patient suffering.
Perhaps this model can be expanded. What is the real cost of healthcare by being overly investigative or delaying definitive care at the expense of conservative measures? It is obviously a difficult balance without the medicolegal implications either way.
I think that we should be looking at outcomes and a cost per outcome (or expected outcome) as function of dollars spent as a significant factor in terms of appropriately providing care while insuring the standards of care are met.
Would I have benefited from a more extensive work up? Would the outcome been different? Probably not. While it may not have been contraindicated and not harmful, or low risk, the costs beyond using emperical data may not justify a similar outcome.
Physicians are driven by data. But what is the data worth as a function of its cost?
CAP and ASCO Release New ER/PR Testing Guideline
The College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO) issued a joint guideline today aimed at improving the accuracy of immunohistochemistry (IHC) testing for the expression status of estrogen (ER) and progesterone receptors (PR) in treating breast cancer patients.
Because as many as two-thirds of breast cancers are ER and/or PR-positive, the new guideline has the potential to prolong and save the lives of the vast majority of breast cancer patients worldwide.
To improve the accuracy of ER and PR testing, the CAP and ASCO recommend the following:
- Testing ER and PR status on all newly diagnosed invasive breast cancers (primary site and/or metastatic site), and whenever appropriate, repeat testing in patients with a known breast cancer diagnosis who now present with a local or distant recurrence.
- Establishing uniform testing measures that focus on proven, reliable and reproducible assays and procedures.
- Having testing laboratories validate their assays against existing and clinically validated tests. Results should agree at least 90 percent of the time with those of the clinically validated assays for positive receptor status and at least 95 percent for negative receptor status.
- Transporting breast tissue specimens from the operating room to the pathology laboratory as soon as they are available for gross assessment. The time from tumor removal to initiation of fixation should be kept to one hour or less.
- Performing ER and PR testing in a CAP-accredited laboratory or in a laboratory that meets the accreditation requirements spelled out in the guideline. The CAP will require that every accredited lab performing testing participate in a mandatory proficiency testing program.
- Considering an ER and PR test, performed by IHC, positive if at least one percent of the tumor in the sample tests positive, which helps predict whether a patient is likely to benefit with endocrine treatment. The panel recognized that it is reasonable for oncologists to discuss the pros and cons of endocrine therapy with patients whose tumors contain low levels of ER by IHC (one percent to ten percent weakly positive cells) and to make an informed decision based on available information.
The CAP also developed a list of frequently asked questions to help members and laboratories understand what the new guideline will mean in their practice setting. In addition, a joint press release was posted today on the College's website and on ASCO's website, illustrating the collaboration between the two organizations on behalf of breast cancer patients.
Patients can find a resource guide on the College's patient website, http://www.MyBiopsy.org. In addition, the homepage of MyBiopsy.org features ER/PR breast cancer survivor Ruth Chermok and highlights the life-saving role of pathologists in diagnosing and assisting with the treatment of breast cancer patients.
This is the second time that the two organizations have collaborated on guidelines. In 2007, the CAP and ASCO issued clinical practice guideline recommendations to improve HER2 testing accuracy.
PathXL: Cloud Computing for Virtual Microscopy
i-Path has developed web-based software products together with an entirely hosted solution for virtual microscopy, removing the need to store any slides locally and for local installations of software, and providing reliable speedy access to images in a stable, managed environment. The product portfolio, PathXL™, represents cloud computing for virtual microscopy at its best, and offers a unique solution across a range of applications including education, training, competency testing, biomarker research, biobanking, and digital archiving of clinical samples.
Cloud computing is now a familiar cliché but has unique advantages when applied in digital pathology. It removes the need to purchase dedicated server hardware and employ dedicated staff to manage systems, reducing the cost by as much as 50% per annum. Storage and server capacity is all managed off-site in one of i-Path’s dedicated high performance server farms which guarantee up-time, regular backup and disaster recovery plans. Extensive storage facilities are available for clients to upload and manage their digital slide archives on-line. This is fully scalable allowing clients to grow their needs accordingly. i-Path’s cluster of high
performance image servers allows for high volumes of internet traffic without impacting on the speed of delivery. It is resilient where if one server goes down, traffic is routed to another server. By using satellite clusters, dispersed across continents, i-Path have reduced latency of image transmission over distance supporting the sharing of slides and easy collaboration across laboratories, hospitals and or universities. It is a highly secure facility, already being used by major Pharmaceutical organizations and Hospitals.
Clients can be given access to i-Path’s digital pathology software PathXL upon request – no need for on-site software installations and ongoing maintenance. Updates to software are made centrally and clients access all of the functionality via a standard web-browser. i-Path offer a range of digital pathology toolboxes aimed at supporting a range of applications. These include (i) an Educational Authoring Toolbox allowing clients to build and manage an e-learning web site including the ability to configure on-line tests on virtual slides for students, classrooms and residents (ii) External Quality Assurance Toolbox for managing virtual distribution of slides and polling diagnoses on-line (iii) Research Toolbox for management and
sharing of research slide sets and on-line scoring of biomarkers and (iv) TMA Toolbox for on-line archiving and scoring of TMA biomarkers.
PathXL, from i-Path, integrates novel web-based viewing technology and management software with a high performance hosting capacity to provide a cloudbased service to customers, across a range of disciplines.
Consult A Doctor, Inc. Names Retail Clinic Pioneer, Douglas Smith, M.D. as Chief Medical Officer
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Hospitals test iPad for patient education
You may have heard about the launch of Apple's iPad, and how the device seems to be drawing a lot of interest from healthcare circles. It's not only seen as something clinicians can use to chart patient encounters, but also as a tool for patient education.
The newly expanded Walt Disney Pavilion at Florida Hospital for Children in Orlando and St. Luke's Health System in Boise, Idaho, last week began testing a customized version of an app called Medical Video jLog from Eagle, Idaho-based Unity Medical, Health Data Management reports. Florida Hospital for Children will employ iPads as a way of explaining tests such as CT scans and MRIs to children with videos and interactive question-and-answer features. St. Luke's has loaded its iPads with with about 20 educational videos on topics such as heart and vascular procedures and physical therapy.
"This application will support our patient resource specialists in ensuring that children and their parents understand and feel comfortable with important medical procedures and mitigate any potential fears or concerns they may have," Marla Silliman, administrator of Florida Hospital for Children, says to the Orlando Business Journal.
For more information:
- see this Health Data Management news brief
- read this Orlando Business Journal article
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