[Assessment of aptitude for anatomic-clinic correlation in pediatric pathology]. / Evaluación de la aptitud para la correlación anatomo-clínica en patología pediátrica.

Introduction: In the 18th Century, Giovanni Battista Morgagni demonstrated that localized injuries to different organs caused a great variety of clinical symptoms and signs. Since then, medical practice has evolved considerably and maintains the correlation of pathological changes with the signs and symptoms of the disease as part of the academic activity known as "anatomic-clinical session". The evaluation of the aptitude for the anatomic-clinical correlation has not been empirically estimated in pediatric pathology. Objective: Construct and validate an evaluation instrument to quantitatively estimate the aptitude for the anatomical-clinical correlation in pediatric pathology (AA-CCPP). Method: Analytical cross-sectional study. An evaluation instrument was constructed with 90 true, false and I don't know type statements, grouped based on three indicators: I, diagnostic integration; II, identification of pathogenic mechanisms and III, identification of clinical and paraclinical data. The instrument was applied to three groups of residents. The Kruskal-Wallis test was used to compare the results between the groups. Results: The AA-CCPP grade was very low in most residents. When comparing the global scores between the different groups, the pediatric pathology group was the highest. The indicator that obtained the best results was that of Diagnostic Integration. Conclusions: The level of development of the AA-CCPP observed allows us to deduce that the learning strategy known as clinical-pathological conference should be strengthened.

Introducción: En el siglo xviii, Giovanni Battista Morgagni demostró que las lesiones localizadas en diferentes órganos condicionaban gran variedad de síntomas y signos clínicos. Desde entonces, la práctica médica evolucionó considerablemente y conserva la correlación de los cambios anatomopatológicos con los signos y síntomas de la enfermedad como parte de la actividad académica conocida como «sesión anatomoclínica¼. La evaluación de la aptitud para la correlación anatomo-clínica no ha sido estimada empíricamente en patología pediátrica. Objetivo: Construir y validar un instrumento de evaluación para estimar de manera cuatitativa la aptitud para la correlación anatomo-clínica en patología pediátrica (ACA-CPP). Método: Estudio tranversal analítico. Se construyó un instrumento de evaluación con 90 enunciados tipo verdadero, falso y no sé, agrupados en tres indicadores: I) integración diagnóstica; II) identificación de mecanismos patogénicos; y III) identificación de datos clínicos y paraclínicos. Se aplicó el instrumento a tres grupos de residentes. Para comparar los resultados entre los grupos se utilizó la prueba de Kruskal-Wallis. Resultados: El grado de ACA-CPP fue muy bajo en la mayoría de los residentes. Al comparar las puntuaciones globables entre los diferentes grupos, el de patología pediátrica fue el más alto. El indicador que obtuvo mejores resultados fue el de integración diagnóstica. Conclusiones: El nivel de desarrollo de la ACA-CPP observado permite deducir que la estrategia de aprendizaje conocida como sesión anatomo-clínica debe fortalecerse.

Highlights and Perspectives From a Collaborative Global Health Pathology Experience in Trinidad and Tobago.

OBJECTIVES: Global health education is important during residency training in exposing doctors to conditions that are not common in the United States and developing their awareness of global health care disparities. Most medical decisions are based on results from anatomic or clinical pathology laboratories, which are essential services for appropriate medical care in international settings. Nevertheless, US pathology residency trainees have limited global health exposure and thus are rarely exposed to diagnostic services in these settings. Moreover, literature documenting what is needed to create a global health elective in pathology is limited. METHODS: We designed an international pathology elective in Trinidad and Tobago involving one main public hospital site and several off-site laboratories. Objectives and goals were established before the rotation. Apart from daily mentor-led education sessions, the trainee participated in teaching, quality improvement projects, and cultural experiences. Engagement with medical officers, personnel staff, and people in the community was encouraged.Results: Challenges encountered included funding, transportation, limited laboratory resources, medical registration, and malpractice insurance. These were mitigated through carefully planned steps, including communicating with registration bodies and liaising with pathology organizations for funding. CONCLUSIONS: Overall, the global health rotation was successful. We provide a detailed roadmap for other pathology training programs interested in establishing similar global health electives.

Use of whole slide imaging (WSI) for distance teaching.

BACKGROUND: Time, travel and financial constraints have meant that traditional visiting teaching engagements are more difficult to accomplish. This has been exacerbated with the advent of the COVID-19 pandemic. The use of digital pathology and whole slide imaging (WSI) as an educational tool for distance teaching is underutilised and not fully exploited. This paper highlights the utility and feedback on the use of WSI for distance education/teaching. MATERIALS AND METHODS: Building on an existing relationship with the University of the West Indies (UWI), pathologists at University Health Network, Toronto, provided distance education using WSI, a digitised slide image hosting repository and videoconferencing facilities to provide case-based teaching to 15 UWI pathology trainees. Feedback was obtained from residents via a questionnaire and from teachers via a discussion. RESULTS: There was uniform support from teachers who felt that teaching was not hampered by the 'virtual' engagement. Comfort levels grew with each engagement and technical issues with sound diminished with the use of a portable speaker. The residents were very supportive and enthusiastic in embracing this mode of teaching. While technical glitches marred initial sessions, the process evened out especially when the slide hosting facility, teleconferencing and sound issues were changed. CONCLUSIONS: There was unanimous endorsement that use of WSI was the future, especially for distance teaching. However, it was not meant to supplant the use of glass slides in their current routine, daily practice.

Panorama atual do ensino da Patologia Clínica/Medicina Laboratorial nas escolas médicas do Brasil / Current overview of the teaching of Clinical Pathology/Laboratory Medicine in medical schools in Brazil

Introdução: Os testes laboratoriais exercem papel fundamental no atendimento médico de uma maneira geral há muitos anos. Além disso, o gasto com exames laboratoriais representa menos de 3% do custo total em saúde, tornando a relação custo-benefício altamente favorável ao uso dessa ferramenta. A despeito dessa enorme importância, a educação médica em relação a testes laboratoriais no Brasil ainda é incerta não existindo dados concretos sobre o ensino da Patologia Clínca/Medicina Laboratorial até a data do estudo (2019). Objetivo: Pretende-se traçar um panorama atual do ensino da Patologia Clínica/Medicina Laboratorial na graduação das escolas médicas do Brasil, comparando com o ensino da Patologia Geral. Materiais e métodos: Foi realizada uma pesquisa de levantamento ou um inquérito de dados das matrizes curriculares das escolas médicas do Brasil, por meio do acesso ao seu portal eletrônico. A relação de todas as instituições de ensino médico foi obtida junto ao site do Ministério da Educação no ano de 2019. Resultados: No Brasil há um predomínio de escolas privadas sobre públicas, sendo método de ensino tradicional (59%) mais comum em relação ao Problem-Based Learning (39%). Somente 23% das escolas médicas do Brasil possuem a disciplina de Patologia Clínica/Medicina Laboratorial em suas matrizes curriculares. Em contrapartida, a Patologia Geral está presente em 57% das escolas. A região Centro-Oeste possui a menor prevalência (14,24%) quanto ao ensino de Patologia Clínica/Medicina Laboratorial, enquanto que a região Sudeste mostrou a maior prevalência (28,57%). Conclusão: Apenas 23% das escolas médicas no Brasil possuem o ensino da Patologia Clínica/Medicina Laboratorial em suas grades curriculares. (AU)

Introduction: Laboratory tests play, in general, a fundamental role in medical care for many years. In addition, the cost of laboratory tests represents less than 3% of the total spent on the health system, making the cost-benefit ratio highly favorable to its use. Despite this enormous importance, medical education regarding those tests in Brazil is still uncertain, with no concrete data about the teaching of Clinical Pathology/Laboratory Medicine found until the date of the study (2019). Objective: To draw a current overview of the teaching of Clinical Pathology/Laboratory Medicine in undergraduate medical schools in the country, comparing with the teaching of General Pathology. Materials and methods: A survey was conducted by a data collection from curricular matrices of medical schools in Brazil, by the access to their websites. The list of the medical education institutions was obtained by the website of the Ministério da Educação in 2019. Results: In Brazil there is a predominance of private over public schools, the traditional teaching method (59%) is more common in relation to Problem-Based Learning (39%). Only 23% of medical schools in Brazil have the subject of Clinical Pathology/Laboratory Medicine in their curriculum matrix. In contrast, General Pathology subject is present in 57% of the schools. The Midwest region has the lowest prevalence (14,24%) regarding the teaching of Clinical Pathology/Laboratory Medicine, while the Southeast region showed the highest prevalence (28,57%) .Conclusion: Only 23% of medical schools in Brazil have the teaching of Clinical Pathology/Laboratory Medicine in their curriculum.

Harmonization of Training, Training Requirements, Board Certification, and Practice of Hematopathology.

OBJECTIVES: Hematopathology (HP) is a rapidly changing field with insufficient data to provide guidance to program directors (PDs), the Accreditation Council for Graduate Medical Education, or the American Board of Pathology. METHODS: Two surveys were performed-one for HP PDs and one, given twice, for HP diplomates doing Maintenance of Certification/Continuing Certification reporting in 2017 to 2018. RESULTS: Bone marrow (BM), lymph node (LN), and flow cytometry interpretations and peripheral blood/fluid reviews are performed by more than 80% of hematopathologists and are the areas with the greatest amount of training. A smaller proportion of hematopathologists is involved in other HP-related activities. Most PDs believed fellows should perform BM procedures. Interpretation of 400 or more LNs and 500 BMs was PDs' median expectations for fellows. PDs and HP diplomates considered coagulation and benign RBC disorders overemphasized on the certification examination. CONCLUSIONS: These results highlight how varied the practice of HP is and can provide guidance to HP PDs, those responsible for assessing HP programs, and the American Board of Pathology.

Improving Anatomic Pathology in Sub-Saharan Africa to Support Cancer Care.

OBJECTIVES: Cancer care requires both accurate pathologic diagnosis as well as pathologic cancer staging. We evaluated three approaches to training pathologists in sub-Saharan Africa to perform pathologic cancer staging of breast, cervix, prostate, and colorectal cancers. METHODS: One of three training methods was used at each workshop: didactic, case-based testing (CBT), or a blended approach. The project involved 52 participants from 16 pathology departments in 11 countries in East, Central, and Southern Africa. Evaluation of each method included pre- and postworkshop knowledge assessments, online pre- and postworkshop surveys of practice changes at the individual and institutional levels, and selected site visits. RESULTS: While CBT resulted in the highest overall average postassessment individual scores, both CBT and blended approaches resulted in 19% increases in average scores from pre- to postworkshop assessments. Institutions that participated in the blended workshop had increased changes in practice as indicated by the institutional survey. CONCLUSIONS: Both CBT and a blended approach are effective methods for training pathologists in pathologic cancer staging. Both are superior to traditional lectures alone.

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory.

PURPOSE: To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. METHODS: The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. RESULTS: Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. CONCLUSION: An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory / Avaliação de indicadores de controle de qualidade interno de exames de citopatologia cervical realizados em laboratórios monitorados pelo Laboratório Externo de Controle de Qualidade

PURPOSE: To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. METHODS: The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. RESULTS: Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. CONCLUSION: An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills ...

OBJETIVOS: Verificar o impacto da educação continuada realizada pelo Laboratório de Monitoramento Externo da Qualidade nos indicadores de monitoramento interno da qualidade dos exames citopatológicos. MÉTODOS: O estudo avaliou os indicadores de monitoramento interno da qualidade dos exames citopatológicos de 12 laboratórios monitorados pelo Laboratório de Monitoramento Externo da Qualidade, totalizando 185.194 exames, sendo 98.133 referentes ao período antes da educação continuada e 87.061 após a educação continuada. Os dados para avaliar os indicadores foram obtidos por meio do Sistema de Informações do Câncer do Colo do Útero disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. RESULTADOS: Verificou-se que, após a educação continuada, quatro laboratórios mantiveram o índice de positividade (IP) dentro do recomendado, quatro que estavam abaixo passaram a ter o IP dentro do recomendado, um permaneceu baixo, dois permaneceram muito baixo e um passou de muito baixo para baixo. Em relação ao indicador percentual de exames compatíveis com lesão intraepitelial escamosa de alto grau, cinco laboratórios mantiveram o índice dentro do recomendado, três que estavam abaixo do recomendado passaram a ter esse índice acima de 0,4 e quatro permaneceram abaixo do recomendado. Os indicadores atipias de significado indeterminado/alterados e razão atipias de significado indeterminado/lesões intraepiteliais mantiveram-se dentro do recomendado em todos os laboratórios. CONCLUSÃO: Observou-se melhora nos indicadores de positividade e percentual de exames compatíveis com lesão intraepitelial de alto grau, mostrando que o papel desempenhado pelo Laboratório de Monitoramento Externo da Qualidade contribui para o aprimoramento ...

[Virtual microscopy systems: analysis and perspectives]. / Sistemas de microscopía virtual: análisis y perspectivas.

Microscopy has been constantly evolving since the end of the Twentieth Century, with the introduction of new resources which have improved its practice. For example, the use of the virtual microscope has reached a high level of maturity; it is a synergy among disciplines such as pathology, histology, medical informatics and image analysis. This technology has moved forward many paradigms in research, diagnosis, education and medical training. The virtual microscopy systems require the digitalization of a physical slide, using motorized microscopes, pre and post image processing, compression, transmission and visualization. This article provides an extensive analysis of each of these processes. The main characteristics of virtual microscopy are presented as well as the impact of these systems in image interpretation and in diagnostic activities.

La ludopatía y lo empleados en la universidad de san buenaventura, seccional de Medellín, Colombia-2010 / Ludopathy and the employees at saint bonaventure university, Medellin branch, Colombia, 2010

El presente estudio consiste en una descripción del uso de los juegos de azar y vídeo juegos en los estudiantes, docentes y empleados de la Universidad de San Buenaventura, seccional de Medellín, y su relación con las dimensiones médica y psicológica con variables como son: dificultades de concentración, cambio del estado de ánimo, las molestias físicas, preferir el juego a las prácticas deportivas y la distensión que produce el juego; en este tercer momento se presentan los resultados con empleados. Para esto, se aplicó en un cuestionario a una muestra de 158 empleados, de una población de 250 de ellos, para el año 2010; se aplicó en el primer semestre de 2010, para un 95 de validez y un margen de error del 5.

This current article consists of a description of the use of game of chance and videogames, by the students, instructors, and employees at saint Bonaventure University, Medellin Branch and its relationship with both medical and psychological dimensions, which include variables like the following: concentration difficulties, change of mood, physical discomfort, preference of games to sports, and relaxed atmosphere as it is produced by games. In this second stage, the results with employees are shown. For such a purpose, a questionnaire, to a sample of 135 employees out of a population of 250 individuals, was given, corresponding to the year 2010. It was given during the first quarter of the same year, yielding a result of 95 validity and an error margin of 5.

[Clinical-pathology correlation aptitude of pneumopathology in undergraduate medical students]. / Aptitud para la correlación anatomoclínica de neumopatología en alumnos de pregrado.

OBJECTIVE: 1) To develop and validate an instrument to evaluate the clinical pathology correlation aptitude in pneumopathology (CPCAP). 2) Compare two groups of students: those who had already taken the respiratory pathology course and students that hadn't. METHODS: An instrument with real anatomopathology respiratory cases was developed. The measurement instrument was validated through expert rounds. It included 116 items of the "true", "false", or "don't know" type, with an agreement of 80 % or more in the answerers between the judges. The internal consistency was determined with Spearman Brown proficiency, reaching a value of 0.78. The sample studied was all the groups of each hospital of an organic pathology undergraduate universitary course. Two sampled were taken, students who had already been through respiratory pathology (Group A), and students who hadn't (Group B). RESULTS: The sample studied was of 485 applicants, from 64 different universitary groups. These were divided in two groups, with 245 (A) and 240 (B) students each. Its global medians were 51 and 36 for groups A and B respectively (p < 0.001). In the 55 % of the subgroups when compared individually taking into account each one of the hospital where they study the test results were significantly better in group A. DISCUSSION: In a general way, students in group A show a major development into CPCAP than students in B. However, development is not enough to reach the expected by the educative program. The results suggest that the teachers put greater effort in the correlation between anatomopathological changes and the clinical and paraclinical manifestations of the patients.

Aptitud para la correlación anatomoclínica de neumopatología en alumnos de pregrado / Clinical-pathologyc correlation aptitude of pneumopathology in undergraduate medical students

Objective. 1) To develop and validate an instrument to evaluate the clinical pathology correlation aptitude in pneumopathology (CPCAP). 2) Compare two groups of students: those who had already taken the respiratory pathology course and students that hadn 't. Methods. An instrument with real anatomopathology respiratory cases was developed. The measurement instrument was validated through expert rounds. It included 116 items of the "true", "false", or "don't know" type, with an agreement of 80 % or more in the answerers between the judges. The internal consistency was determined with Spearman Brown proficiency, reaching a value of 0.78. The sample studied was all the groups of each hospital of an organic pathology undergraduate universitary course. Two sampled were taken, students who had already been through respiratory pathology (Group A), and students who hadn't (Group B) Results.The sample studied was of 485 applicants, from 64 different universitary groups. These were divided in two groups, with 245 (A) and 240 (B) students each. Its global medians were 51 and 36 for groups A and B respectively (p < 0.001). In the 55 % of the subgroups when compared individually taking into account each one of the hospital where they study the test results were significantly better in group A. Discussion.In a general way, students in group A show a major development into CPCAP than students in B. However, development is not enough to reach the expected by the educative program. The results suggest that the teachers put greater effort in the correlation between anatomopathological changes and the clinical and paraclinical manifestations of the patients.

Objetivos. 1) Construir y validar un instrumento de medición de la aptitud para la correlación anatomoclínica en neumopatología (ACACN). 2) Comparar la ACACN de alumnos que ya tomaron el curso de patología y quiénes no. Métodos. Se elaboró un cuestionario con base en nueve casos anatomopatológicos con sus correspondientes estudios clínicos. Se estimó su validez conceptual por un grupo de expertos y la confiabilidad mediante correlación de mitades equivalentes. El instrumento quedó conformado por 116 ítems, que obtuvieron un porcentaje de acuerdo con 80 o mayor en las respuestas de los jueces y un coeficiente de .78 de confiabilidad (Spearman-Brown). Se aplicó un diseño ex post facto y las unidades de análisis fueron los grupos de cada hospital sede de un curso universitario de patología orgánica. Mediante un muestreo por cuota se seleccionaron dos muestras de alumnos de pregrado de la carrera de medicina para realizar las mediciones: quienes ya habían cursado la asignatura de patología (A) y quienes no (B). Resultados. Se incluyeron 485 alumnos, 245 de la muestra A y 240 de la muestra B, correspondientes a 64 grupos universitarios. Las medianas globales de ambas muestras fueron 51 y 36, respectivamente (p < 0.001). En la comparación entre muestras de una misma sede hubo diferencia significativa a favor de A en 39% de los grupos. Discusión. Los resultados muestran que la ACACN fue mayor en los alumnos que ya habían cursado la materia, en comparación con los que aún no lo habían hecho, sin embargo, el grado de desarrollo de la misma está lejos de las expectativas del programa educativo y refleja la necesidad de implementar modificaciones en la manera de cómo se imparte la materia.

La Cátedra de Patología y Clínica Infantiles la Universidad de La Habana (1899-1962) / The lecture-romm in chaild Pathology and Clincs of the Havana University

La asignatura Curso Especial de Enfermedades de la Infancia, que como cátedra independiente había sido creada por el plan de estudios de 1887, se impartía en el cuarto año del período de la licenciatura con extensión de un curso. Al ponerse en practica el Plan Lanuza (1899) se mantuvo como cátedra independiente pero cambió su nombre por el de Patología y Clínica Infantiles y se explicó en el quinto año del período de la licenciatura(AU)