I do not know what to make of all the recent news and stories about the Swine/North American/Newly mutated flu virus and how virulent it actually is.
Nonetheless, The 1x Objective has some nice videos and other links on the proposed pathogenesis for the mutated strain.
This is an article I had an opportunity to write for ADVANCE for Administrators of the Laboratory in conjunction with a recent article entitled "Integrating Digital Pathology" in this month's issue. My thanks to the publisher and Kelly Graham, assistant editor.
I will also present this topic at the upcoming CAP Futurescape meeting this June.
The term "Web 2.0" refers to a perceived second generation of Web development and design that aims to facilitate communication, secure information sharing, offer ability and collaboration on the Internet. Web 2.0 concepts have led to the development and evolution of Web-based communities, hosted services and applications, such as social-networking sites, video-sharing sites, wikis and blogs.
The term was first used by Dale Dougherty and Craig Cline and became notable after the O'Reilly Media Web suggested a new version of the World Wide Web. It does not refer to an update to any technical specifications, but rather to changes in the way software developers and users utilize the Web.
According to time to Tim O'Reilly, "Web 2.0 is the business revolution in the computer industry caused by the move to the Internet as a platform, and in an attempt to understand the worlds for success on that new platform." Tim Berners-Lee, inventor of the Web, has questioned whether one can use the term in any meaningful way, since many of the technological components of Web 2.0 have existed since the early days of the Web.
Regardless of whether you view Web 2.0 as new or simply a modification of existing Internet technologies, Web 2.0 technologies allow users to do more than just retrieve information. The Web 2.0 tool/technologies allow content by users for users that is interactive and dynamic rather than static information being retrieved without input.
Changing Nature of Pathology
Because of the image-intense nature of anatomic pathology and traditional educational and clinical business practices (i.e., atlases, case sharing and consultation among colleagues), there is opportunity for incredible synergy between anatomic pathology and Web 2.0 technology vis-à-vis, Pathology 2.0.
The user-participatory nature of Web 2.0 allows for openness, freedom and collective intelligence. This expanded user experience, dynamic content and harnessing of collective intelligence in a simple fashion provide for the easy exchanged, sharing and delivery of all sorts of information with comment and discussion. Several examples of this currently exist, from image sharing sites on Flickr to Aperio's Second Slide consultation (www.secondslide.com) hosting service to BioImagene's PathXchange (www.pathxchange.org). Other examples that facilitate pathology image sharing include Med Pix (rad.usuhs.mil/medpix/) and Medting (www.medting.com). Sites such as MyPACS.net (www.mypacs.net) also allow for the creation of pathology teaching files in ways to data share and collaborate.
New Wave
Other technologies such as social media sites (Facebook and Youtube) also allow users to post and share collective intelligence for research, educational and clinical practice. Again, the ability for content by users for users in a simple and accessible format allow glass slides (more accurately, images derived from glass slides) to be shared and viewed in a way that extends beyond institutional walls takes advantage of Web 2.0.
My Digital Pathology Blog at www.tissuepathology.com serves to educate pathologists and the pathology community on the deliverables of digital pathology, current news and events and applications in education, research and clinical practice. This is a form of "academic blogging" that may be timely or relevant to interested audience participants. It also allows for collaboration between industry and practitioners to expand the community, enhance the discussion, promote the technology and offer opinion from my perspective while also allowing others to comment, criticize and share in an open and dynamic dialog. Blogging allows users to share content and ideas, gives others a sense of your own work and interests and in my case, as an academic pathologist, allows a platform for non-peer reviewed writing that is original and unedited content (for better or worse). This extends into other networking opportunities.
Certainly these are disruptive technologies that some may not be comfortable with or feel have a place in medicine or pathology. There is a level of transparency to which we all must grow accustomed that extends far beyond our own microscope and slide storage rooms. The real value is in the collective intelligence that can now be harnessed.
Web 2.0 is about the next generation of applications on the Internet, featuring user-generated content, collaboration and community and offers technology to expand our horizons and to showcase our specialty of anatomic pathology like never before.
pathtalk.org has undergone a recent revision in concept and design from its inception in 2007.
Posts from this blog as well as other content from myself and 11 others currently will contribute to the blog. The administrator for the shared blog platform is Kenneth Youens.
If you are a pathologist or other laboratory professional interested in blogging about pathology and laboratory medicine, please contact us to find out about joining pathtalk.org as an author.
Two more blogging pathologists - welcome to the blogosphere!
Both have been linked on the blog roll on the right.
Karl Robstad, MD is a PGY-2 pathology resident at Albany Medical Center in Albany, NY. He claims the "blog was created to serve as medicine/pathology/informatics news blog as seen through the editorial eyes of a resident physician. Sometimes serious, but often intended for a laugh, this blog is an opportunity to share my take on and ideas about medicine and pathology today."
- Met Karl at the recent USCAP meeting and he shares the vision of informatics and new technologies in pathology. Some great posts so far on the subject. Will be interesting to read his thoughts from a resident's view of pathology informatics.
Pathology Informatics from the Trenches
Alexis Carter, MD, director of pathology informatics and Assistant Professor of Pathology and Laboratory Medicine at Emory University School of Medicine has started blogging at Pathology Informatics from the Trenches.
- A leader in pathology informatics on multiple levels. Look forward to her posts on her day to day experiences "in the trenches".
Another blogging pathologist -- welcome to Dr. Prashnant A. Jani from Thunder Bay, Ontario at Oncopathology.
According to Dr. Jani, the purpose of the blog is to "post recent updates in Oncopathology as well as to evaluate the importance of Pathologist in management of cancer".
First entries on the blog appear to be meeting the purpose and looks like one worth following. His website is also worth a look as well.
Came across this post from NY Times Health blog this week. Couple of thoughts:
Biopsies required to fix for certain time should need for certain IHC (i.e. HER2) required. Formal guidelines coming on ER/PR as well just as we know have ASCO/CAP guidelines for HER2 testing. Despite the time requirement, processing can and often occurs in 1 day and can be signed out the following day. I would gather most laboratories will complete majority of sign-outs in one day. We do it routinely here otherwise get calls from clinicians by mid-day asking for results. Of course some require additional levels, review, consultation and/or IHC but the exception, not the rule. 2.5 day turn around time seems excessive. 5 days for 73 of 126 women not to have a result seems protracted. I would have hoped the patients' clinician explained reason for delay but this did not seem to occur either.
Nonetheless, in the laboratory industry the goals are to have high diagnostic accuracy, rapid turnaround time and cost control; said another way, you can have it right, fast or cheap, pick any two. If given a choice, I gather all of us would choose the right answer in a timely fashion at a reasonable cost. Nonetheless, it sometimes takes a little longer to ensure the right answer & may involve more tests increasing costs. Having been on both sides of this equation I would rather have the right answer even if it costs more and takes longer. I wonder what happens to cortisol levels with misdiagnoses and inappropriate, unnecessary or unindicated therapy...
Post and abstract from paper published below.
Waiting days for the results of a breast biopsy appears to affect stress hormone levels just as much as finding out you have cancer does, a new study shows.
Harvard researchers tracked 126 women who were undergoing breast biopsy, monitoring their levels of the stress hormone cortisol while they waited.
One of the most surprising findings, researchers said, was how long many women had to wait before receiving their results. While the average wait time was 2.5 days, many women had to wait five days or longer. By the fifth day, 37 women learned their biopsy was benign, 16 learned they had cancer and 73 still did not have a result, according to the report, which appeared in the medical journal Radiology. Most of the women who did not have a diagnosis had not received any information or explanation for the delay.
Women who were still uncertain about their diagnosis had abnormal cortisol levels that were “essentially indistinguishable’’ from the cortisol profiles of the women who were told they had cancer. And women without a diagnosis had significantly worse cortisol profiles compared to women who had received benign test results.
“If you talk to any woman who has had a biopsy who has had to wait for results, she will tell you it’s a horrible roller coaster,’’ said Dr. Elvira V. Lang, associate professor of radiology at Harvard Medical School and Beth Israel Deaconess Medical Center. “Even when patients hear they have a cancer, they can start doing something. But if you hang in there for five days and you still don’t know what direction it goes, it’s just very stressful.’’
The concern, Dr. Lang said, is that cortisol levels can influence wound healing and immune response, raising a woman’s potential health risks if she ultimately needs to be treated for cancer. And the stress and anxiety of waiting also affects the quality of life of a woman, her family and her ability to function well at work, she said.
Dr. Lang said the research should spur hospitals to focus not only on speeding up test results, but on improving communication and possibly offering psychological services to women who are waiting for a diagnosis. The study was funded by the Department of Defense breast cancer research program. Dr. Lang has a financial interest in a consulting firm that trains medical personnel how to improve communication with patients.
“We have to work much faster to get results to women,’’ Dr. Lang said. “You want to keep stressors as profound as this as short as possible.’’
Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis
Elvira V. Lang, MD, FSIR, FSCEH, Kevin S. Berbaum, PhD, and Susan K. Lutgendorf, PhD
From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115 (E.V.L.); and Departments of Radiology (K.S.B.) and Psychology (S.K.L.), University of Iowa, Iowa City, Iowa. Received June 19, 2008; revision requested July 22; revision received July 31; accepted August 27; final version accepted September 16. Supported by the U.S. Army Research and Materiel Command DAMD 17-01-01. E-mail: elang@bidmc.harvard.edu.
Purpose: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.
Materials and Methods: This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18–86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group).
Results: Women learned their diagnosis on days 1–6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (–0.092 ln [µg/dL]/hr; 95% confidence interval [CI]: –0.113 ln [µg/dL]/hr, –0.072 ln [µg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (–0.154 ln [µg/dL]/hr; 95% CI: –0.197 ln [µg/dL]/hr, –0.111 ln [µg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (–0.110 ln [µg/dL]/hr; 95% CI: –0.147 ln [µg/dL]/hr, –0.073 ln [µg/dL]/hr; P = .421).
Conclusion: Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.
© RSNA, 2009
Received an e-mail from Brian Moore today over at neuropathology blog about another pathologist blogger. The new blog is called The Daily Sign-Out started this month and inspired by Bruce Friedman's blog.
As a surgical pathologist, have enjoyed the posts to date and looks like a blog worth following.
Welcome to the blogosphere!
Many thanks to Joshua Guan over at Utopian Blue for sharing the below post with me and how he created the below image. The whole slide images you see in Silverlight object are acquired from a microscope camera.
"PhotoZoom makes it easy for anyone to create zooming albums from their uploaded photos. It is an experimental site, developed at Microsoft, that uses the Deep Zoom technology in Silverlight 2. The following image is a so-called digital pathology slide. The slide was mosaiced from 396 image tiles, with the full size of 26544 x 16412. I spent several weeks on the mosaic algorithm and finally worked it out using MATLAB 7. The result you see was generated by my ugly and brute MATLAB code. The deep zoom technology can be used in the online Digital Slide View.
Install Silverlight 2 to see the PhotoZoom image."
Here are a few more posts from Joshua's blog:
Check out Berci Mesko's comments from the Medicine Meets Virtual Reality 17 Conference which includes some interesting digital pathology applications showcased.
Stumble It!