RESUMO
OBJECTIVES: To suggest a basic new approach for pathology training programs to consider when a resident requires remediation, probation, or dismissal. METHODS: Remediation, probation, or dismissal of the poorly performing pathology resident is one of the most difficult and challenging aspects of any pathology training program. The poorly performing resident requires extra time and resources from the faculty and the program and can be disruptive for the entire program. Effective remediation requires faculty development, a well-constructed remediation or probation plan, and documentation. RESULTS: Despite best efforts, not all remediation plans are successful and dismissal of the resident will need to be seriously considered. CONCLUSIONS: Approaches to dealing with resident performance issues can be variable and need to be tailored to the issue being addressed.
Assuntos
Competência Clínica/normas , Internato e Residência/normas , Patologia/educação , Ensino de Recuperação/métodos , Educação de Pós-Graduação em Medicina , Avaliação Educacional , Humanos , Patologia/normasRESUMO
PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
Assuntos
Neoplasias da Mama/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias da Mama/epidemiologia , Estudos Transversais , Feminino , Humanos , Variações Dependentes do Observador , Patologia/educação , Patologia/normas , Patologia/estatística & dados numéricos , Lesões Pré-Cancerosas/epidemiologiaRESUMO
Hoy en día, entre los pacientes que asisten a la consulta dental un porcentaje elevado presenta alguna patología cardiaca, por lo que resulta necesario tomar ciertas precauciones antes y durante un procedimiento estomatológico, para evitar situaciones de emergencia. El objetivo del mismo es describir en primer lugar las normas de comportamiento de pacientes de riesgo porque constituyen la base de toda atención médico-odontológica, incluye, así: la historia clínica, la monitorización del paciente, farmacoterapia, control de la ansiedad, la relación con el médico especialista, la prevención, control de urgencias y la clasificación de pacientes cardíaco como: la posición del sillón dental, la posible medicación ansiolítica, las técnicas de sedación que se puede utilizar, las indicaciones y contraindicaciones del uso de los anestésicos locales con vasoconstrictores. Posteriormente las normas específicas de cada caso en particular, por ejemplo: se debe considerar que existen pacientes con terapia anticoagulantes y sus normas de interrupción isquémica o un cuadro hipertensivo ante determinadas patologías como la endocarditis bacteriana o cardiopatía valvular, o la necesidad de disponer pastillas de nitroglicerina, vasodilatadores, para su uso en casos de alguna cardiopatía isquémica. Por último, se mencionan las pautas a seguir en casos de urgencia como la interrupción del tratamiento dental, la posición del sillón, la administración de ciertos medicamentos y el traslado a un centro asistencial
Assuntos
Humanos , Cirurgia Bucal , Hipertensão/complicações , Odontologia , Isquemia Miocárdica/complicações , Patologia/normasRESUMO
Given interest from the professionals concerned, an external quality assurance scheme for cervical cytology can successfully be introduced in developing countries. This is a very important precondition if screening programs are to be expanded and decreases in mortality from cervical cancer are to occur in developing countries. Nicaragua and Peru have been experimenting with an external quality assurance system adapted from the Scottish and Northern Ireland scheme. It has been received with enthusiasm and acceptance and has helped cytology laboratories in these countries focusing on quality issues. Nevertheless, a successful quality control scheme that is to result in improvements in the quality of professionals' diagnostic skills needs to be accompanied by a remedial program for subperformers.
Assuntos
Patologia/normas , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/normas , Erros de Diagnóstico/estatística & dados numéricos , Erros de Diagnóstico/tendências , Educação/normas , Educação/estatística & dados numéricos , Educação/tendências , Feminino , Humanos , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Nicarágua , Patologia/educação , Patologia/estatística & dados numéricos , Serviço Hospitalar de Patologia/normas , Serviço Hospitalar de Patologia/estatística & dados numéricos , Serviço Hospitalar de Patologia/tendências , Peru , Controle de Qualidade , Reprodutibilidade dos Testes , Reino Unido , Neoplasias do Colo do Útero/mortalidade , Esfregaço Vaginal/estatística & dados numéricos , Esfregaço Vaginal/tendênciasRESUMO
AIM: To determine the agreement rates between clinical and autopsy diagnoses in a neonatal intensive care unit (NICU), distinguishing between the main diagnosis and cause of death. METHODS: Clinical and autopsy records of 75 infants who died in two consecutive years in the NICU (autopsy rate 42.6%) of a pediatric hospital in Mexico City were reviewed. RESULTS: Ninety-two percent of main clinical diagnoses were confirmed by autopsy. Four conditions (congenital cardiopathy, prematurity, specific congenital syndromes and hyaline membrane disease) accounted for more than two-thirds of diagnoses. However, for cause of death, the global agreement was only 50%. The most common conditions considered by clinicians (77%) and pathologists (56%) to be the causes of death were cardiogenic, septic or mixed shocks. Additionally, clinicians omitted 34 relevant conditions in 30 (40.0%) patients, and 21 of these conditions possibly played a role in the deaths of 17 (22.7%) patients. The most frequently omitted diagnosis was pneumonia, in 9 (26.5%) patients. Omissions were not related to gestational age, age at death, days as an inpatient, or gender. CONCLUSION: Despite a high agreement rate in the main diagnoses, notable imprecisions were present regarding cause of death and antemortem overlooking of potentially fatal conditions, confirming the useful role of autopsy to verify clinical diagnoses and suggesting that differentiation between the main diagnosis and cause of death should be carried out in future studies.