Arch Pathol Lab Med. 2017 Jun 22. doi: 10.5858/arpa.2017-0114-SA. [Epub ahead of print]

Rapid On-Site Evaluation of Endobronchial Ultrasound-Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society.

Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Chowdhuri SR, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M.

Abstract

CONTEXT:

- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.

OBJECTIVE:

- To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.

DATA SOURCES:

- An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.

CONCLUSIONS:

- Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that while ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications, it is helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.

"It can start from the age of 40 onwards, and the process speeds up dramatically after the age of 60..."

How to combat age-related muscle loss

Why it happens and what you can do

"Sarcopenia is the medical term for muscle loss, from the Greek meaning 'vanishing flesh,' and is a natural part of ageing. When we lose muscle mass, it affects our strength and functional fitness, and can eventually make it hard to perform everyday tasks, such as carrying shopping and climbing the stairs.

It can start from the age of 40 onwards, and the process speeds up dramatically after the age of 60, doubling from 0.5% per year to 1%, then 2% at age 70, and 4% at the age of 80.

The problem is widespread, in part due to many people having a sedentary lifestyle. It's estimated that a third of people in care homes may have sarcopenia, increasingly the risk of frailty and falls. It's also an issue that's getting worse. Experts predict that 63 per cent more pensioners could suffer from sarcopenia by 2045 – with women more affected than men."

"'So what’s sacred at a university?' he asks. 'Victims are sacred,' he answers."

Can Jonathan Haidt Calm the Culture Wars?

By Evan R. Goldstein

"When I went to Yale, in 1981, it said above the main gate ‘Lux et Veritas’: Light and Truth. We are here to find truth," Haidt says as he paces the stage at the Students for Liberty conference in Washington. "This is our heritage all the way back to Aristotle, Plato, Socrates." But the pursuit of truth is being supplanted by a new mission, he warns, the pursuit of social justice. He paraphrases Marx: "The point is not to understand the world; the point is to change it."

It’s human nature to make things sacred — people, places, books, ideas, Haidt says. "So what’s sacred at a university?" he asks. "Victims are sacred," he answers. And a victimhood culture offers only two ways to get prestige: Be a victim, or, if you can’t manage that, stand up for victims. How? "By punishing the hell out of anyone who in any way, shape, or form, even inadvertently, marginalizes a member of a victim class."

AMA J Ethics. 2017 Jun 1;19(6):578-584. doi: 10.1001/journalofethics.2017.19.6.nlit1-1706.

Who Is Experiencing What Kind of Moral Distress? Distinctions for Moving from a Narrow to a Broad Definition of Moral Distress.

Fourie C1.

Author information

1

Benjamin Rabinowitz Assistant Professor in Medical Ethics in the Department of Philosophy's Program on Values in Society at the University of Washington in Seattle, and an adjunct assistant professor in the Department of Bioethics and Humanities.

Abstract

Moral distress, according to Andrew Jameton's highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress-e.g., constraint and uncertainty-and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.

More playtime with dad linked to lower obesity risk for young kids

More playtime with dad linked to lower obesity risk for young kids

"Children were 30 percent less likely to be obese at age 4 if their fathers had increased their parenting time in the preceding two years than were those whose dads did not."

"Academic pathologists have a special obligation to, if not become directly involved in advocacy, at least have a broad and current understanding of those issues..."

Arch Pathol Lab Med. 2017 Apr 18. doi: 10.5858/arpa.2017-0105-SA. [Epub ahead of print]

Twenty-First Century Pathologists' Advocacy.

Allen TC.

Abstract

Pathologists' advocacy plays a central role in the establishment of continuously improving patient care quality and patient safety, and in the maintenance and progress of pathology as a profession. Pathology advocacy's primary goal is the betterment of patient safety and quality medical care; however, payment is a necessary and appropriate component to both, and has a central role in advocacy. Now is the time to become involved in pathology advocacy; the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) and the Protecting Access to Medicare Act of 2014 (PAMA) are two of the most consequential pieces of legislation impacting the pathology and laboratory industry in the last 20 years. Another current issue of far-reaching impact for pathologists is balance billing, and yet many pathologists have little or no understanding of balance billing. Pathologists at all stages of their careers, and in every professional setting, need to participate. Academic pathologists have a special obligation to, if not become directly involved in advocacy, at least have a broad and current understanding of those issues, as well as the need and responsibility of pathologists to actively engage in advocacy efforts to address them, in order to teach residents the place of advocacy, and its value, as an inseparable and indispensable component of their professional responsibilities.

AMA J Ethics. 2017 Jun 1;19(6):608-616. doi: 10.1001/journalofethics.2017.19.6.msoc1-1706.

Culture and Moral Distress: What's the Connection and Why Does It Matter?

Berlinger N1, Berlinger A2.

Author information

1

Research scholar at the Hastings Center in Garrison, New York, and the first author of the second edition of the Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (Oxford University Press, 2013) and the author of Are Workarounds Ethical?: Managing Moral Problems in Health Care Systems (Oxford University Press, 2016), and After Harm: Medical Error and the Ethics of Forgiveness (Johns Hopkins University Press, 2005).

2

Nurse working in chronic disease care in Madison, Wisconsin.

Abstract

Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to "culture" may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias. We offer sets of practical recommendations to encourage learning, critical thinking, and professional reflection among students, clinicians, and clinical educators.

N Engl J Med. 2017 May 11;376(19):1806-1808. doi: 10.1056/NEJMp1701174. Epub 2017 Mar 29.

Medical Liability - Prospects for Federal Reform.

Mello MM1, Kachalia A1, Studdert DM1.

Author information

From Stanford Law School (M.M.M., D.M.S.) and the Departments of Medicine (D.M.S.) and Health Research and Policy (M.M.M.), Stanford University School of Medicine, Stanford, CA; and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston (A.K.).

"Medical malpractice reform appears to be back on the federal policy agenda, and some GOP-proposed reforms, such as safe harbors and administrative compensation, are sensible. But design and implementation details matter: patients’ needs should be front and center."

Otolaryngol Head Neck Surg. 2017 May 1:194599817707943. doi: 10.1177/0194599817707943. [Epub ahead of print]

Medical Malpractice Implications of Clinical Practice Guidelines.

Ruhl DS1, Siegal G2,3.

Author information

1

1 Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA.

2

2 School of Law, University of Virginia, Charlottesville, Virginia, USA.

3

3 Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.

Abstract

Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

Max Gunther believes we need to re-examine our eating habits

"Take fast food, for example: so many people regularly choose not to cook their own meals, which often taste a lot better and are significantly healthier than fast food.

However, the issue is in the name itself – people choose fast food because of how quickly it is prepared."

Arch Pathol Lab Med. 2017 Jun 22. doi: 10.5858/arpa.2017-0114-SA. [Epub ahead of print]

Rapid On-Site Evaluation of Endobronchial Ultrasound-Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society.

Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Chowdhuri SR, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M.

Abstract

CONTEXT:

- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.

OBJECTIVE:

- To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.

DATA SOURCES:

- An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.

CONCLUSIONS:

- Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that while ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications, it is helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.

Understanding the myth behind weight loss

The statistics are scary; health experts predict that by 2030 half of the Americans will be obese!

"How did this happen? Obesity is a very complex situation. Obesity is defined as 120% more of ideal body weight. It is a problem, which is much too complex to be solved by fad diets, reality television programs or will power! Figuring out, how much to eat, what to eat, when to eat, how our bodies control weight and how to change people and orient them towards healthy diet habits is not easy."

Diagnosing obesity by mathematically estimating abdominal fat

"Recent studies have shown that abdominal obesity is linked with diseases such as congestive heart failure and metabolic syndrome," said author Jin Keun Seo. "Static electrical impedance tomography, or EIT, could be employed as a non-invasive surrogate of disease progression in these conditions."

In addition to being noninvasive, EIT, an imaging technique, provides real-time data without using ionizing radiation, which makes it preferable to computed tomography (CT) since it's less harmful to patients. Another imaging technique commonly used for this purpose, magnetic resonance imaging (MRI) has poorer spatial resolution than EIT.

Read more at: https://phys.org/news/2017-06-obesity-mathematically-abdominal-fat.html#jCp

The Effects of School-Based Condom Availability Programs (CAPs) on Condom Acquisition, Use and Sexual Behavior

AIDS Behav. 2017 Jun 17. doi: 10.1007/s10461-017-1787-5. [Epub ahead of print]

The Effects of School-Based Condom Availability Programs (CAPs) on Condom Acquisition, Use and Sexual Behavior: A Systematic Review.

Wang T1, Lurie M2, Govindasamy D3,4, Mathews C5,6.

Author information

1

Health Policy Research Department, The Fenway Institute, Fenway Health, Boston, MA, USA.

2

Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.

3

Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, PO BOX 19070, Tygerberg, Western Cape, South Africa. darshini.govindasamy@mrc.ac.za.

4

Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, Western Cape, South Africa. darshini.govindasamy@mrc.ac.za.

5

Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, PO BOX 19070, Tygerberg, Western Cape, South Africa.

6

Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, Western Cape, South Africa.

Abstract

We conducted a systematic review to assess the impact of school-based condom availability programs (CAPs) on condom acquisition, use and sexual behavior. We searched PubMed to identify English-language studies evaluating school-based CAPs that reported process (i.e. number of condoms distributed or used) and sexual behavior measures. We identified nine studies that met our inclusion criteria, with the majority conducted in the United States of America. We judged most studies to have medium risk of bias. Most studies showed that school-based CAPs increased the odds of students obtaining condoms (odds ratios (ORs) for individual studies ranged between 1.81 and 20.28), and reporting condom use (OR 1.36-3.2). Three studies showed that school-based CAPs positively influenced sexual behavior, while no studies reported increase in sexual activity. Findings suggest that school-based CAPs may be an effective strategy for improving condom coverage and promoting positive sexual behaviors.

Obesity report is no surprise, yet still alarming

Posted: Jun. 19, 2017 11:45 am

"Among the most troubling statistics uncovered by researchers who reported on 195 countries was that obesity rates doubled in 73 countries between 1980 and 2015. Moreover, it has tripled in children and young adults in countries such as China, Brazil and Indonesia."

Vera Luiza Capelozzi, Timothy Craig Allen, Mary Beth Beasley, Philip T. Cagle, Don Guinee, Lida P. Hariri, Aliya N. Husain, Deepali Jain, Sylvie Lantuejoul, Brandon T. Larsen, Ross Miller, Mari Mino-Kenudson, Mehrad Mitra, Kirtee Raparia, Anja Roden, Frank Schneider, Lynette M. Sholl, and Maxwell Lawrence Smith (2017) Molecular and Immune Biomarkers in Acute Respiratory Distress Syndrome: A Perspective From Members of the Pulmonary Pathology Society. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Molecular and Immune Biomarkers in Acute Respiratory Distress Syndrome: A Perspective From Members of the Pulmonary Pathology Society

Vera Luiza Capelozzi, MD, PhD; Timothy Craig Allen, MD, JD; Mary Beth Beasley, MD; Philip T. Cagle, MD; Don Guinee, MD; Lida P. Hariri, MD, PhD; Aliya N. Husain, MD; Deepali Jain, MD, DNB, FIAC; Sylvie Lantuejoul, MD, PhD; Brandon T. Larsen, MD, PhD; Ross Miller, MD; Mari Mino-Kenudson, MD; Mehrad Mitra, MD; Kirtee Raparia, MD; Anja Roden, MD; Frank Schneider, MD; Lynette M. Sholl, MD; Maxwell Lawrence Smith, MD

From the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of Pathology, the University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Cagle and Miller); the Department of Pathology, Virginia Mason Medical Center, Seattle, Washington (Dr Guinee); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, University of Chicago, Chicago, Illinois (Dr Husain); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, INSERM Unit, Centre Léon Bérard, Lyon, France (Dr Lantuejoul) and the Université Joseph Fourier INSERM Unit, Grenoble, France (Dr Lantuejoul); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Larsen and Smith); the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mitra); Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota (Dr Roden); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Schneider); and the Department of Pathology, Brigham and Women's Hospital, Boston (Dr Sholl).

Reprints: Timothy Craig Allen, MD, JD, University of Texas Medical Branch, Department of Pathology, 301 University Blvd, Galveston, TX (email: tcallen@utmb.edu).

Acute respiratory distress syndrome (ARDS) is a multifactorial syndrome with high morbidity and mortality rates, characterized by deficiency in gas exchange and lung mechanics that lead to hypoxemia, dyspnea, and respiratory failure. Histologically, ARDS is characterized by an acute, exudative phase, combining diffuse alveolar damage and noncardiogenic edema, followed by a later fibroproliferative phase. Despite an enhanced understanding of ARDS pathogenesis, the capacity to predict the development of ARDS and to risk-stratify patients with the disease remains limited. Biomarkers may help to identify patients at the greatest risk of developing ARDS, to evaluate response to therapy, to predict outcome, and to improve clinical trials. The ARDS pathogenesis is presented in this article, as well as concepts and information on biomarkers that are currently used clinically or are available for laboratory use by academic and practicing pathologists and the developing and validating of new assays, focusing on the assays' major biologic roles in lung injury and/or repair and to ultimately suggest innovative, therapeutic approaches.

Ross Miller, Timothy Craig Allen, Roberto J. Barrios, Mary Beth Beasley, Louise Burke, Philip T. Cagle, Vera Luiza Capelozzi, Yimin Ge, Lida P. Hariri, Keith M. Kerr, Andras Khoor, Brandon T. Larsen, Eugene J. Mark, Osamu Matsubara, Mitra Mehrad, Mari Mino-Kenudson, Kirtee Raparia, Anja Christiane Roden, Prudence Russell, Frank Schneider, Lynette M. Sholl, and Maxwell Lawrence Smith (2017) Hypersensitivity Pneumonitis: A Perspective From Members of the Pulmonary Pathology Society. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Hypersensitivity Pneumonitis: A Perspective From Members of the Pulmonary Pathology Society

Ross Miller, MD; Timothy Craig Allen, MD, JD; Roberto J. Barrios, MD; Mary Beth Beasley, MD; Louise Burke, MD; Philip T. Cagle, MD; Vera Luiza Capelozzi, MD, PhD; Yimin Ge, MD; Lida P. Hariri, MD, PhD; Keith M. Kerr, BSc, MBChB, FRCPath, FRCPE; Andras Khoor, MD; Brandon T. Larsen, MD, PhD; Eugene J. Mark, MD; Osamu Matsubara, MD, PhD; Mitra Mehrad, MD; Mari Mino-Kenudson, MD; Kirtee Raparia, MD; Anja Christiane Roden, MD; Prudence Russell, MBBS (Hons), FRCPA; Frank Schneider, MD; Lynette M. Sholl, MD; Maxwell Lawrence Smith, MD

From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Hariri, Mark, and Mino-Kenudson); the Department of Pathology, Aberdeen University School of Medicine, Aberdeen, United Kingdom (Dr Kerr); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Dr Khoor); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Larsen and Smith); the Department of Pathology, National Defense Medical College, Tokorozawa, Japan (Dr Matsubara); the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mehrad); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Dr Roden); the Department of Pathology, St Vincent's Pathology, Fitzroy, Australia (Dr Russell); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Schneider); and the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl).

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: tcallen@utmb.edu).

Context.— Hypersensitivity pneumonitis (HP) is a lung disease that develops in susceptible individuals after inhalational exposure to an organic antigen or chemical compound. Pathogenesis is attributed to a combination of type III (immune complex–mediated) and type IV (delayed) hypersensitivity reactions to the inciting agent.

Objective.— To provide an overview of the current status of the medical literature regarding hypersensitivity pneumonitis.

Data Sources.— A literature search was performed using PubMed and Google search engines. The terms “hypersensitivity pneumonitis” and “extrinsic allergic alveolitis” were used, with the search starting on January 9, 2017, and concluding March 8, 2017.

Conclusions.— As a pathologist, it is important to consider hypersensitivity pneumonitis when examining lung specimens because it is often clinically and pathologically overlooked. Recognizing the often subtle findings and correlating them with the patient's history or suggesting a thorough clinical investigation of potential exposures can be of help in identifying the underlying condition so that the patient can be appropriately managed.

Safe travels to all to the 2017 Pulmonary Pathology Society Biennial Meeting!

2017 Pulmonary Pathology Society Biennial Meeting

"Skepticism about truth is really more self-rationalization than good philosophy."

Teaching Humility in an Age of Arrogance

"Skepticism about truth is really more self-rationalization than good philosophy. It protects our biases and discourages us from trying to see ourselves as who we really are. More than that, a rejection of objective truth invites despotism simply because it collapses truth into whatever those in power allow to pass for truth in your bubble. And once that is accepted, then the very idea of speaking truth to power becomes moot. You can’t speak truth to power when power speaks truth by definition."

Suzanne M. Dintzis, Emily K. Clennon, Carolyn D. Prouty, Lisa M. Reich, Joann G. Elmore, and Thomas H. Gallagher (2017) Pathologists' Perspectives on Disclosing Harmful Pathology Error. Archives of Pathology & Laboratory Medicine: June 2017, Vol. 141, No. 6, pp. 841-845.

ORIGINAL ARTICLES

Pathologists' Perspectives on Disclosing Harmful Pathology Error

Suzanne M. Dintzis, MD, PhD; Emily K. Clennon, BA; Carolyn D. Prouty, DVM; Lisa M. Reich, PhD; Joann G. Elmore, MD, MPH; Thomas H. Gallagher, MD

From the Departments of Pathology (Dr Dintzis), Medicine (Ms Clennon and Drs Prouty, Reich, Elmore, and Gallagher), and Epidemiology (Dr Elmore), University of Washington, Seattle.

Reprints: Suzanne M. Dintzis, MD, PhD, Department of Pathology, University of Washington Medical Center, 325 Ninth Ave, Box 359791, Seattle, WA 98104 (email: dintzis@u.washington.edu).

The authors have no relevant financial interest in the products or companies described in this article.

Context.— Medical errors are unfortunately common. The US Institute of Medicine proposed guidelines for mitigating and disclosing errors. Implementing these recommendations in pathology will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists' experiences with and attitudes toward disclosure of medical error.

Objective.— To understand pathologists' attitudes toward disclosing pathology error to treating clinicians and patients.

Design.— We conducted 5 structured focus groups in Washington State and Missouri with 45 pathologists in academic and community practice. Participants were questioned about pathology errors, how clinicians respond to pathology errors, and what roles pathologists should play in error disclosure to patients.

Results.— These pathologists believe that neither treating physicians nor patients understand the subtleties and limitations of pathologic diagnoses, which complicates discussions about pathology errors. Pathologists' lack of confidence in communication skills and fear of being misrepresented or misunderstood are major barriers to their participation in disclosure discussions. Pathologists see potential for their future involvement in disclosing error to patients, but at present advocate reliance on treating clinicians to disclose pathology errors to patients. Most group members believed that going forward pathologists should offer to participate more actively in error disclosure to patients.

Conclusions.— Pathologists lack confidence in error disclosure communication skills with both treating physicians and patients. Improved communication between pathologists and treating physicians could enhance transparency and promote disclosure of pathology errors. Consensus guidelines for best practices in pathology error disclosure may be useful.

Obesity reaching 'epidemic levels' in Asia

Health care threat costing $1.66 billion annually: ADBI report

"More worryingly, childhood obesity in Asia and the Pacific has started to take on 'unseen dimensions.' In 2014, 23% of children in China were overweight or obese, and the figure stood at 22.5% in Malaysia."

Paula S. Ginter and Timothy M. D'Alfonso (2017) Current Concepts in Diagnosis, Molecular Features, and Management of Lobular Carcinoma In Situ of the Breast With a Discussion of Morphologic Variants. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Current Concepts in Diagnosis, Molecular Features, and Management of Lobular Carcinoma In Situ of the Breast With a Discussion of Morphologic Variants

Paula S. Ginter, MD; Timothy M. D'Alfonso, MD

From the Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York.

Reprints: Timothy M. D'Alfonso, MD, Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 E 68th St, Starr 1039, New York, NY 10065 (email: tid9007@med.cornell.edu).

Context.— Lobular carcinoma in situ (LCIS) refers to a neoplastic proliferation of cells that characteristically shows loss of E-cadherin expression and has long been regarded as a risk factor for invasive breast cancer. Long-term outcome studies and molecular data have also implicated LCIS as a nonobligate precursor to invasive carcinoma. In the past few decades, pleomorphic and florid LCIS have been recognized as morphologic variants of LCIS with more-aggressive histopathologic features, less-favorable biomarker profiles, and more-complex molecular features compared with classic LCIS. There is still a lack of consensus regarding certain aspects of managing patients with LCIS.

Objectives.— To review recently published literature on LCIS and to provide an overview of the current morphologic classification of LCIS, recent molecular advances, and trends in patient management.

Data Sources.— Sources included peer-reviewed, published journal articles in PubMed (US National Library of Medicine, Bethesda, Maryland) and published guidelines from the National Comprehensive Cancer Network (Fort Washington, Pennsylvania).

Conclusions.— Lobular carcinoma in situ represents a marker for increased risk of breast cancer, as well as a nonobligate precursor to invasive carcinoma. Morphologic variants of LCIS—florid and pleomorphic LCIS—are genetically more-complex lesions and are more likely to be associated with invasive carcinoma. Further investigation into which molecular alterations in LCIS are associated with progression to invasive carcinoma is needed to help guide medical and surgical management.

Ken Gatter (2017) FDA Oversight of Laboratory-Developed Tests: Where Are We Now?. Archives of Pathology & Laboratory Medicine: June 2017, Vol. 141, No. 6, pp. 746-748.

EDITORIALS

FDA Oversight of Laboratory-Developed Tests: Where Are We Now?

Ken Gatter, MD, JD

From the Department of Pathology, School of Medicine, Oregon Health Sciences University, Portland.

Reprints: Ken Gatter, MD, JD, Department of Pathology, School of Medicine, Oregon Health Sciences University, Mailcode L471, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098 (email: gatterk@ohsu.edu).

Waist-to-height ratio more accurate than BMI in identifying obesity, new study shows

Calculating a person's waist-to-height ratio is the most accurate and efficient way of identifying whether or not they are at risk of obesity in clinical practice, a new study by Leeds Beckett University shows.

"The research, published in the latest edition of PLOS ONE journal, aimed to improve the way that obesity is currently measured and classified by examining the whole-body fat percentage and visceral adipose tissue (VAT) mass (the fat stored around the abdominal region where most of internal organs lie) of a group of 81 adults (40 women and 41 men). It aimed to find the most accurate way of predicting this measurement in a clinical environment and set cut-points for obesity."

Yan Peng, Yasmeen M. Butt, Beiyun Chen, Xinmin Zhang, and Ping Tang (2017) Update on Immunohistochemical Analysis in Breast Lesions. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Update on Immunohistochemical Analysis in Breast Lesions

Yan Peng, MD, PhD; Yasmeen M. Butt, MD; Beiyun Chen, MD, PhD; Xinmin Zhang, MD; Ping Tang, MD, PhD

From the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Drs Peng and Butt); the Department of Pathology, Mayo Clinic and Foundation, Rochester, Minnesota (Dr Chen); the Department of Pathology, Cooper Medical School of Rowan University, Camden, New Jersey (Dr Zhang); and the Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York (Dr Tang).

Reprints: Yan Peng, MD, PhD, Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9073 (email: yan.peng@utsouthwestern.edu).

Context.— The utility of immunohistochemistry (IHC) in breast lesions needs to be updated with exceptions among these lesions. Biomarker studies with IHC in triple-negative breast carcinoma may help develop targeted therapies for this aggressive breast cancer. The distinction of metastatic lung adenocarcinoma to the breast and invasive breast carcinoma has significant prognostic and therapeutic implications. The determination can be challenging because both primary tumors can express estrogen receptor and/or HER2 by IHC, creating a diagnostic dilemma.

Objectives.— To provide a practical update on the use of IHC markers in differential diagnoses in breast lesions, including benign, atypical, precancerous, and malignant tumors; to highlight recently published research findings on novel IHC markers in triple-negative breast carcinoma cases; and to reinforce the importance of IHC use as an ancillary tool in distinguishing metastatic lung adenocarcinoma to the breast from primary breast carcinoma using real case examples.

Data Sources.— PubMed (US National Library of Medicine, Bethesda, Maryland) literature review and authors' research data and personal experiences were used in this review.

Conclusions.— Immunohistochemistry has an important role in making differential diagnoses in breast lesions in morphologically equivocal settings; recognizing IHC expression status in the exceptions among these lesions will aid in the correct diagnosis of challenging breast cases. Studies suggest that androgen receptor, p16, p53, GATA3, and PELP1 may have potential diagnostic, prognostic, and predictive value in triple-negative breast carcinoma cases; these findings may provide insight and a greater understanding of the tumor biology in triple-negative breast carcinomas. In distinguishing metastatic estrogen receptor–positive or HER2⁺ lung adenocarcinoma to the breast from primary breast carcinoma, napsin A, TTF-1, and GATA3 comprise a useful IHC panel.