scholarly journals The Challenges of Implementing a “Patient-Oriented” Telepathology Network; the Eastern Québec Telepathology Project Experience

2012 ◽  
Vol 35 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Bernard Têtu ◽  
Jean-Paul Fortin ◽  
Marie-Pierre Gagnon ◽  
Said Louahlia
Keyword(s):  
Population Density ◽  
Case Management ◽  
Change Management ◽  
Frozen Section ◽  
Geographic Region ◽  
Entire Region ◽  
Pathology Laboratory ◽  
Innovative Solutions ◽  
Slide Scanner ◽  
Macroscopy Station

Background: The aim of the Eastern Québec telepathology project is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region in order to avoid unnecessary patient transfer.Methods: The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, two videoconferencing devices and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory. Of the remaining 15 sites, two have no pathologists, 6 have one and 7 have two or more.Results: The project has been successful and most appreciated by pathologists and surgeons. We report a number of challenges related to change management that we had to take into account in the course of implementation of this network. The challenges underscore the need for regular visits and active support to participating centers by the project team.Conclusion: The Eastern Québec telepathology network is successful and improves medical care in this region. In the course of implementation, we encountered a number of challenges which required innovative solutions.

Intraoperative Assessment of the Breast: Guidelines and Potential Pitfalls

2005 ◽  
Vol 129 (12) ◽  
pp. 1565-1574 ◽  
Author(s):  
Rodolfo Laucirica
Keyword(s):  
Frozen Section ◽  
Imaging Techniques ◽  
Error Rates ◽  
Disease Assessment ◽  
Surgical Approaches ◽  
Pathology Laboratory ◽  
Simplified Approach ◽  
Intraoperative Management ◽  
The Many ◽  
Careful Assessment

Abstract Context.—Intraoperative evaluation of breast tissue has changed as newer imaging techniques and surgical approaches to the treatment of breast cancer have placed the pathologist in a pivotal role in the management of this disease. Assessment of the index lesion and surgical margins are but two of the many tasks we face when the specimen arrives in the surgical pathology laboratory. We are also called on to correlate changes in the mammogram with the gross pathology, particularly in those cases in which the lesion is nonpalpable. More recently, pathologists have been asked to analyze 1 or more sentinel lymph nodes at the time of frozen section to look for metastatic disease. This review discusses many of these issues and also provides a simplified approach to the differential diagnosis of a variety of breast lesions one may encounter intraoperatively. Objective.—To provide guidelines for and address potential pitfalls in the intraoperative management of the breast. Data Sources.—Author's experience and pertinent literature. Conclusions.—Careful assessment of the gross specimen coupled with prudent utilization of frozen sections is pivotal to reducing intraoperative error rates and preventing needless anxiety for the patient.

Ecological applications of pheromone trapping of Malacosoma disstria and Choristoneura conflictana

2008 ◽  
Vol 140 (5) ◽  
pp. 573-581 ◽  
Author(s):  
Brad C. Jones ◽  
Maya L. Evenden
Keyword(s):  
Population Density ◽  
Populus Tremuloides ◽  
Geographic Region ◽  
Malacosoma Disstria ◽  
Flight Period ◽  
Wing Area ◽  
Pheromone Trapping ◽  
Microsporidian Infection ◽  
Collection Date ◽  
Choristoneura Conflictana

AbstractThe forest tent caterpillar, Malacosoma disstria Hübner (Lepidoptera: Lasiocampidae), and large aspen tortrix, Choristoneura conflictana (Walker) (Lepidoptera: Tortricidae), are important pests of trembling aspen, Populus tremuloides Michx. (Salicaceae), in western Canada. Populations of both species can be monitored with sex pheromone-baited traps as part of an integrated pest management program. Moths captured in pheromone traps can also be used for ecological studies. Captured males of each species were examined to test the effect of population density, geographic region, and collection date on moth quality. Moth quality was assessed on the basis of wing area and level of infection with microsporidian parasites. The level of microsporidian infection of M. disstria was strongly dependent on geographic region but not on population density. Male M. disstria from high-density populations had smaller wings than males from endemic populations. Wing area of male M. disstria decreased throughout the flight period. Neither collection date nor microsporidian infection level affected wing area of male C. conflictana. Collection date also did not affect the level of microsporidian infection of C. conflictana. These data support pheromone trapping as a tool to detect microsporidian infections and examine their temporal and density-dependent effects on wing size in M. disstria and C. conflictana populations.

Pipeline Installation in a Confined Location Under the Bow River by Horizontal Directional Drilling

2002 ◽  
Author(s):  
Joe Zhou ◽  
Alan Glover ◽  
Paul Rudge
Keyword(s):  
Population Density ◽  
Project Team ◽  
Gas Pipeline ◽  
Environmental Concerns ◽  
Directional Drilling ◽  
Horizontal Directional Drilling ◽  
Unique Challenge ◽  
Right Of Way ◽  
Innovative Solutions ◽  
The Town

In the summer of 2000, TransCanada PipeLines Ltd. (TransCanada) upgraded portions of the Western Alberta System (WAS) NPS 36 gas pipeline through the town of Cochrane Alberta. The pipeline upgrade required the installation of new sections of pipe to meet the higher Class Location designation due to population density increase. Environmental concerns, expressed by federal and provincial regulators and the Cochrane community for the in-stream disturbance associated with a conventional “open cutting” installation, prompted TransCanada to design a directionally drilled crossing. A unique challenge to this project was the Bow River crossing within a congested and restricted right of way. The project team developed and implemented a series of innovative solutions which led to the successful conclusion of the project in September 2000. This paper summarizes the unique design and construction implemented in this project.

scholarly journals Analysis of frozen section in correlation with surgical pathology diagnosis

2019 ◽  
Vol 7 (6) ◽  
pp. 2312
Author(s):  
Ashwini Tangde ◽  
Vaidik Shrivastava ◽  
Anil Joshi
Keyword(s):  
Frozen Section ◽  
Final Diagnosis ◽  
Surgical Pathology ◽  
Histopathological Diagnosis ◽  
Pathology Laboratory ◽  
Medical College ◽  
Incorrect Diagnosis ◽  
Frozen Section Diagnosis ◽  
Sensitivity Specificity ◽  
Suspected Lesion

Background: Frozen section (FS) is a rapid diagnostic procedure performed on tissues obtained intraoperatively. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metastasis, and identifying small structures. But it bears many disadvantages and limitations, the most of which is the danger of incorrect diagnosis. Therefore, it is critical to determine efficiency of frozen section performance periodically.  This study was performed to determine accuracy of frozen section by correlating the intra-operative frozen section diagnosis with final diagnosis on permanent sections.Methods: In this retrospective study, authors compared the results of frozen section with their final permanent section diagnosis in Government Medical College and Hospital, Aurangabad, Maharashtra, India during January 2017 to December 2018.Results: Study comprises 83 patients, of which 73 were female and 10 were male. Out of 83 cases, the diagnosis of 76 cases was concordant with conventional histopathology diagnosis while seven were discordant. This gave overall accuracy rate of 91.57% and discordant rate of 8.43%. The overall sensitivity was 85.71% and specificity was 97.92%. The positive predictive and negative predictive value was 96.77% and 90.38% respectively.Conclusions: The accuracy, sensitivity, specificity of frozen section diagnosis in this study  are comparable with most international quality control statistics for frozen sections. The results suggest that the correlation of intra-operative frozen section diagnosis with the final histopathological diagnosis on permanent sections forms an integral part of quality assurance activities in the surgical pathology laboratory and specific measures should be taken to reduce the number of discrepancies.

scholarly journals Spatiotemporal Distribution of Varicella in South Korea

2020 ◽  
Author(s):  
Young Hwa Lee ◽  
Young June Choe ◽  
Seung-Sik Hwang ◽  
Sung-Il Cho
Keyword(s):  
Population Density ◽  
Spatial Autocorrelation ◽  
Vaccine Coverage ◽  
Demographic Data ◽  
Spatial Regression ◽  
National Level ◽  
Geographic Region ◽  
Incidence Rates ◽  
Surveillance Period ◽  
Varicella Zoster

Abstract Background Varicella is a highly contagious disease caused by the varicella-zoster virus (VZV). Given its tendency to cluster geographically, spatial analyses may provide better understanding of the pattern of varicella transmission. We investigated the spatial characteristics of varicella in Korea and the risk factors for varicella at a national level. Methods Using national surveillance and demographic data, we examined the spatial distribution of incidence rates and their spatial autocorrelation and calculated Moran’s index. Spatial regression analysis was used to identify sociodemographic predictors of varicella incidence at the district level. Results An increasing tendency in the annual incidence of varicella was observed over a 12-year period (2006–2017), with a surge in 2017. There was a clear positive spatial autocorrelation of the varicella incidence rate during the surveillance period. During 2006–2014, High-High (HH) clusters were mostly confined to the northeast region and neighboring districts. Population density and the number of hospitals per 1,000 persons had negative coefficients, and the former was significant. Childhood percentage, percentage of children under 12 years of age among total population, and vaccine coverage rate had positive coefficients, but only the former was significant. Conclusion There was a temporal uptrend in the incidence of varicella in Korea from 2006 to 2017 in the setting of positive spatial associations. The varicella incidence according to geographic region varied with population density, childhood percentage, suggesting the importance of the community-level surveillance and monitoring strategies.

Utility of Frozen Section Study in Quality Control of Surgical Pathology Laboratory

2017 ◽  
Vol 6 (2 (Part-2)) ◽  
pp. 467-470
Author(s):  
Vikram Narang ◽  
◽  
Rahul C Goyal ◽  
Nishant Batta ◽  
Bhavna Garg ◽  
...  
Keyword(s):  
Quality Control ◽  
Frozen Section ◽  
Surgical Pathology ◽  
Pathology Laboratory ◽  
Section Study

Factors influencing accrual to ACOSOG Z0011, a randomized phase III trial of axillary dissection vs. observation for sentinel node positive breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 601-601 ◽  
Author(s):  
A. M. Leitch ◽  
L. McCall ◽  
P. Beitsch ◽  
P. Whitworth ◽  
D. Reintgen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Frozen Section ◽  
Geographic Region ◽  
Axillary Node ◽  
Phase Iii ◽  
The South ◽  
American College Of Surgeons ◽  
Type Of Institution ◽  
Clinical Bias

601 Background: The American College of Surgeons Oncology Group opened a phase III randomized trial to assess the value of axillary node dissection (ALND) after positive sentinel node biopsy (SNB). After 5.5 years, the trial closed due to poor accrual with only 891 patients of the planned 1900 accrued. The purpose of the current analysis is to assess factors impacting accrual to Z0011. Methods: Women having SNB for T1 or T2 breast cancer were eligible for participation in the Z0010 trial to assess the significance of micrometastases identified by immunohistochemistry. If the SN was positive for metastasis by H&E, the patient was eligible for randomization on Z0011 trial. Intraoperative (IOR) and postoperative randomization were allowed. Patients having SNB outside of the Z0010 trial were eligible. Results: 1003 patients from the Z0010 trial were eligible for randomization on Z0011. Of these, only 37% were entered in Z0011. Z0010 participants accounted for 42% of patients in Z0011. 16% of patients not randomized refused ALND. 69% of those not randomized had ALND. 67% of these had no additional positive nodes. Only 14% had ≥ 4 positive nodes. Enrollment of eligible Z0010 patients varied by type of institution: 25% at academic sites, 42% at teaching affiliated and 53% at community (p < 0.0001). By geographic region, sites in the South entered 42% of eligible patients compared with 24–36% in other geographic regions (p=0.0027). Only 32% of patients were consented for IOR based on frozen section of the SN. Sites in the South and West were less likely to use IOR (25% and 28%) compared to Northeast and Midwest (45% and 46%) (p < 0.0001). 110 sites participated in Z0011, yet 48% of patients were enrolled by 10% of sites. Conclusions: Failure of this important trial to accrue as planned is likely related to the clinical bias of physicians and patients to standard ALND. Yet, 2/3 of patients had no additional positive nodes and extensive nodal disease was infrequent. While it was thought that IOR might improve accrual to Z0011, the most successful sites were less likely to use this approach. Community surgeons were most successful in randomizing patients. [Table: see text]

National Survey of Volunteer Pharmacy Preceptors

2010 ◽  
Vol 23 (3) ◽  
pp. 265-272 ◽  
Author(s):  
Maryann Z. Skrabal ◽  
Rhonda M. Jones ◽  
Ryan W. Walters ◽  
Ruth E. Nemire ◽  
Denise A. Soltis ◽  
...  
Keyword(s):  
Population Density ◽  
Experiential Education ◽  
Rural Areas ◽  
Online Survey ◽  
Pharmacy Practice ◽  
The United States ◽  
Geographic Region ◽  
Education Environment ◽  
Rural Sites ◽  
Density Methods

Objectives: To survey volunteer pharmacy preceptors regarding experiential education and determine whether differences in responses relate to such factors as geographic region, practice setting, and population density. Methods: An online survey was sent to 4396 volunteer experiential preceptors. The survey consisted of 41 questions asking the preceptor to comment on the experiential education environment. Experiential education administrators from 9 schools of pharmacy administered the survey to their volunteer preceptors in all regions (Northeast, Midwest, South, and West) of the United States, in various pharmacy practice settings, and areas of differing population densities. Results: A total of 1163 (26.5%) preceptors responded. Regionally, preceptors in the West disagreed more than those in the Midwest and the South that they had enough time to spend with students to provide a quality experience and also required compensation less often than their counterparts in the Northeast and South. Concerning practice settings, hospital preceptors accepted students from more schools, had greater increases in requests, turned away more students, and spent less time with the students compared to preceptors in other settings. Population density differences reflected that preceptors at urban sites took and turned away more students than those at rural sites. Preceptors from rural areas spent more time with students and felt they were spending enough time with their students to provide quality experiences when compared to other preceptors. Conclusions: The results of this national volunteer preceptor survey may assist pharmacy school leaders in understanding how location, practice type, and population density affect experiential education, preceptor time-quality issues, and site compensation so they can take necessary actions to improve quality of student practice experiences.

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