MedWorm: Pathologists

The Quick Chip

ADVANCE Discourse: Lab — Wed, 19 Jun 2013 14:58:00 +0100

Treatment for a bacterial infection can all come down to a question of time. According to a recent story from Medical News Today , researchers from the University of Toronto (UT) in Canada have developed a chip to identify the problem and the best course...(read more) (Source: ADVANCE Discourse: Lab)

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Neonatal Diagnosis by Whole Genome Sequencing in Only Two Days

Lab Soft News — Wed, 19 Jun 2013 12:00:00 +0100

For me, the two most important current uses of whole-genome sequencing in clinical care relate to patients with malignant neoplasms and critically ill newborn infants (see: Neonatal Diagnosis by Whole-Genome Sequencing in 2 Days). This latter process was detailed in a recent article an excerpt of which is provided below: In a pilot clinical study in the U.S. researchers have applied whole-genome sequencing (WGS) to diagnose genetic diseases in critically ill newborns in under two days, rather than the 4-6 weeks turnaround time needed for genetic analysis using current methods. The approach, called STAT-Seq by its developers at Children’s Mercy Hospital in Kansas City, combines WGS sequencing of blood DNA, with a newly developed bioinformatics platform that marries the clinical symp...

Using Altered Metabolic Pathways to Diagnose Alzheimers Disease

Lab Soft News — Tue, 18 Jun 2013 12:00:00 +0100

In previous notes, I have touched lightly on metabolomics but have not discussed the relevance of this science for clinical applications (see: Metabolomics, Metabolomic Profiling, and Systems Biology). A recent article made me more aware of some of the diagnostic opportunities made possible by this approach (see: Blood test could diagnose Alzheimer’s in earliest stage). Below is an excerpt from the article: Blood offers promise as a way to detect Alzheimer’s disease at its earliest onset, Mayo Clinic researchers say. They envision a test that would detect distinct metabolic signatures in blood plasma that are synonymous with the disease — years before patients begin showing cognitive decline. Their study was recently published online in the journal PLOS ONE.Researchers analyzed cereb...

Mutations in COQ2 in Familial and Sporadic Multiple System Atrophy

neuropathology blog — Sat, 15 Jun 2013 20:15:00 +0100

Researchers from the Multiple System Atrophy (MSA) Research Collaborative in Japan just published online in the New England Journal of Medicine findings providing evidence that functionally impaired variants of the COQ2 gene (involved in the biosynthetic pathway for coenzyme Q10) are associated with an increased risk of developing MSA. This group previously identified multiplex families with MSA, indicating a genetic component in a disease that had previously been considered a non-genetic disorder. (Source: neuropathology blog)

Case of the Week 262

Creepy Dreadful Wonderful Parasites — Sat, 15 Jun 2013 20:03:00 +0100

The following were seen in fresh BAL fluid. The individual objects measured approximately 15 microns in diameter:If you're using an iPhone and can't see the videos, you can access them directly through YouTube at:http://www.youtube.com/watch?v=MPgv8GFyNsAhttp://www.youtube.com/watch?v=QQgFOda2b8Ehttp://www.youtube.com/watch?v=7JznHCkQeE4http://www.youtube.com/watch?v=SwOa5iydFhkIdentification?Thank you to Anna and Madi that kindly donated these cases! (Source: Creepy Dreadful Wonderful Parasites)

Supreme Court rules that native DNA is NOT patentable!

Pathology Informatics from the Trenches — Thu, 13 Jun 2013 14:57:00 +0100

See full decision here. This is a great day for genomic medicine. No more requirement to send your specimen to a black box to get tested. (Source: Pathology Informatics from the Trenches)

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Best Post of November 2012: Photos reveal unique features of Einstein's cerebral cortex

neuropathology blog — Thu, 13 Jun 2013 13:47:00 +0100

The next in our "Best of the Month" series is from November 21, 2012: Photographs taken shortly after his death, but never before analyzed in detail, have now revealed that Einstein’s brain had several unusual features, providing clues about the neural basis of his extraordinary mental abilities.Nature.com reports that, while doing Einstein's autopsy, the pathologist Thomas Harvey removed the physicist's brain and preserved it in formalin. He then took dozens of black and white photographs of it before it was cut up into 240 blocks. Now, anthropologist Dean Falk of Florida State University in Tallahassee and her colleagues have obtained 12 of Harvey’s original photographs from the National Museum of Health and Medicine in Silver Spring, Maryland, analyzed them, and compared the pattern...

FDA Launches New Patient Network Website; Useful Resource for Clinical Trials

Lab Soft News — Thu, 13 Jun 2013 12:00:00 +0100

Here is some very big news. The FDA has just launched a patient network website (see: The FDA Patient Network Website - Pretty Darn Patient-Centered). Here are the details: The twin goals for this website are promoting the educational mission of the FDA, and promoting opportunities for patient advocacy within the FDA — and earlier in the policymaking process than has been the case historically....[A spokesperson described it in the following way:]“The idea is to engage the patient community, to have the patient voice heard at the FDA....The FDA Safety & Innovation Act (enacted in mid-2012) mandates the involvement of patient representatives in roles beyond those of the advisory committees. Draft procedures for patient involvement are due to be made public in September ...

Groundbreaking Trial at the Mayo Clinic

ADVANCE Discourse: Lab — Wed, 12 Jun 2013 17:56:00 +0100

In a ground-breaking trial for researchers and physicians at the Mayo Clinic, stem cells will be put to use in their first clinical trial on patients with a rare early-childhood heart disease. Hypoplastic left heart syndrome (HLHS) is a defect characterized...(read more) (Source: ADVANCE Discourse: Lab)

Medicare Officials Post Hospital Prices; A Step in the Right Direction

Lab Soft News — Tue, 11 Jun 2013 12:00:00 +0100

I am a supporter of greater transparency in hospital pricing. Unfortunately, the way hospitals price their services is so out of kilter that this will be a difficult goal to achieve (see: Why Medical Bills Are Killing Us). Nevertheless, we need to be encouraged by some small steps in the right direction. A recent article reported that Medicare officials have now posted prices for 3,000 hospitals on the web to raise consumer awareness (see: Medicare Officials Post Prices of 3,000 Hospitals in Effort to Raise Consumer Awareness of Arbitrary Hospital Pricing). Below is an excerpt from the article: For the first time ever, a federal agency has posted on the Internet the prices hospitals charge for healthcare services specifically to help consumers price shop when they select a hospital s...

Case of the Week 261

Creepy Dreadful Wonderful Parasites — Mon, 10 Jun 2013 14:20:00 +0100

The following movie was generously donated by Dr. Sheldon Campbell and set to music by my husband (who was also responsible for naming the file the "creep of the week"):Also on YouTube: http://www.youtube.com/watch?v=wJXQHwLIP3gIdentification? (Source: Creepy Dreadful Wonderful Parasites)

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Answer to Case 261

Creepy Dreadful Wonderful Parasites — Sun, 09 Jun 2013 19:32:00 +0100

Answer: Pediculus humanus, either P. h. humanus or P. h. capitus, the body and head lice respectively. This little arthropod can be readily identified by its elongated body (which is dorso-ventrally flattened, like someone stepped on it), lack of wings, and 'raptorial' legs adapted for grasping hair shafts.Interestingly, you can't reliably tell head lice and body lice apart morphologically, and you might be tempted to think that they are the same organism. However, in nature they occupy very distinct geographical niches (body and clothing vs. head respectively) and they will only breed with each other under laboratory conditions.In this case, Vanessa pointed out that "You could make a tentative argument for it being a head louse rather than a body louse as it's still...

People Sometimes Lie about Their Health Behaviors; Health Halo Bias

Lab Soft News — Fri, 07 Jun 2013 13:43:54 +0100

It should not come as a surprise to any reader of this blog that patients sometimes provide less accurate information (i.e., lie) when completing health questionnaires in topics relating to smoking behavior, drinking habits, and daily exercise. It's just human nature to do so and perhaps avoid a lecture from the physician during the visit. Such patient lies were discussed in a recent article (see: People lie about their health behaviors: Dartmouth study). Below is an excerpt from it: People lie about their health related behaviors. It’s a problem that has long bedeviled health research on issues ranging from diet to exercise to smoking. And it’s not just that we have faulty memories. Many of us stretch the truth to make ourselves seem more virtuous in the eyes of the person i...

Condensed Principles of Big Data

Specified Life — Thu, 06 Jun 2013 18:21:00 +0100

Last night I re-read yesterday's post (Toward Big Data Immuntability), and I realized that there really is no effective way to use this blog to teach anyone the mechanics of Big Data construction and analysis. My guess is that many readers were confused by the blog, because a single post cannot provide the back-story to the concepts included in the post.So, basically, I give up. If you want to learn the fundamentals of Big Data, you'll need to do some reading I would recommend my own book, Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information. Depending on your background and agenda, you might prefer one of the hundreds of other books written for this vibrant field (I won't be offended).The best I can do is to summarize, with a few princ...

Tips from Physician-Attorneys about How to Avoid Malpractice Suits

Lab Soft News — Wed, 05 Jun 2013 20:23:49 +0100

Discussion about Integration of Surgical Pathology with Molecular Diagnostics). It goes without saying that pathologists need to ensure that their hospital clinical guidelines allow them to order such additional tests when and if necessary. (Source: Lab Soft News)

The Data Pool

ADVANCE Discourse: Lab — Wed, 05 Jun 2013 19:15:00 +0100

As genetic sequencing continues to become less expensive, more people are considering taking a closer look at their genes. The prospect of a deepening data pool has left researchers looking for different, more universal methods of information sharing....(read more) (Source: ADVANCE Discourse: Lab)

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Toward Big Data Immutability

Specified Life — Wed, 05 Jun 2013 12:04:00 +0100

Today's blog continues yesterday's discussion of Big Data Immutability.Big Data managers must do what seems to be impossible; they must learn how to modify data without altering the original content. The trick is accomplished with identifiers and time-stamps attached to event data (and yes, it's all discussed at greater length in my book, Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information).In today's blog, let's just focus on the concept of a time-stamp. Temporal events must be given a time-stamp indicating the time that the event occurred, using a standard measurement for time. The time-stamp must be accurate, persistent, and immutable. Time-stamps are not tamper-proof. In many instances, changing a recorded time residing in a file or data set requires not...

Case of the Week 260

Creepy Dreadful Wonderful Parasites — Tue, 04 Jun 2013 14:49:00 +0100

The following were found in a cod fillet from a grocery that prides itself on "fresh, never frozen" fish. When these were brought to the attention of the grocery store staff, they were not surprised, and instead saw this as an indication of how fresh their fish were! Remember folks - Cook your fish until the flesh is white and flaky (for white fish) or freeze it thoroughly before serving it raw or rare!Many thanks to Henry Bishop and Blaine Mathison who were kind enough to share these videos with me. (Source: Creepy Dreadful Wonderful Parasites)

Consequences Of Data Mutability

Specified Life — Tue, 04 Jun 2013 11:47:00 +0100

Today's blog, like yesterday's blog, is based on a discussion in Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information. The book's table of contents is shown in an earlier blog. Here is an example of a immutability problem: You are a pathologist working in a university hospital that has just installed a new, $600 million information system. On Tuesday, you released a report on a surgical biopsy, indicating that it contained cancer. On Friday morning, you showed the same biopsy to your colleagues, who all agreed that the biopsy was not malignant, and contained a benign condition that simulated malignancy (looked a little like a cancer, but was not). Your original diagnosis was wrong, and now you must rectify the error. You return to the computer, an...

Study Shows that Hospitals Can Sometimes Profit from Hospital-Acquired Infections

Lab Soft News — Tue, 04 Jun 2013 00:09:34 +0100

I have long been under the impression that hospitals make the most profit from short-stay inpatients that require numerous lab tests and radiology procedures. Such tests and procedures have high profit margins as opposed to direct patient care which is labor intensive and not as remunerative. It turns out that this may not be entirely correct. A recent study suggests that patients who develop septicemias in ICUs, and thus have prolonged stays, may yield high profits for hospitals, at least when private insurance companies are involved (see: Dirty little secret: Hospitals PROFIT when patients develop bloodstream infections). Below is an excerpt from the article: Johns Hopkins researchers report that hospitals may be reaping enormous income for patients whose hospital stays are complicated b...

Answer to Case 260

Creepy Dreadful Wonderful Parasites — Mon, 03 Jun 2013 14:24:00 +0100

Answer: Agent of anisakiasis; either Anisakis sp. or Pseudoterranova decipiensThese movies, along with many other movies, live specimens, slides, and fixed specimens are included in the labs of the UMN Global Health Course. This CDC co-sponsored course is given every year and includes 3 parasitology labs taught by me and Blaine Mathison. Check it out their web site for more information! www.globalhealth.umn.edu/education (Source: Creepy Dreadful Wonderful Parasites)

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Big Data Is Immutable

Specified Life — Mon, 03 Jun 2013 12:10:00 +0100

Today's blog, like yesterday's blog, is based on a discussion in Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information. The book's table of contents is shown in an earlier blog.excerpt from book: "Everyone is familiar with the iconic image, from Orwell's 1984, of a totalitarian government that watches its citizens from telescreens. The ominous phrase, "Big Brother is watching you," evokes an important thesis of Orwell's masterpiece; that a totalitarian government can use an expansive surveillance system to crush its critics. Lest anyone forget, Orwell's book had a second thesis, that was, in my opinion, more insidious and more disturbing than the threat of governmental surveillance. Orwell was concerned that governments could change the past a...

Big Data Versus Massive Data

Specified Life — Sun, 02 Jun 2013 14:28:00 +0100

This post is based on a topic covered in Big Data: Preparing, Sharing, and Analyzing Complex Information, by Jules J Berman.In yesterday's blog, we discussed the differences between Big Data and small data. Today, I wanted to briefly discuss the differences between Big Data and massive data.Big Data is defined by the three v's: 1. Volume - large amounts of data;.2. Variety - the data comes in different forms, including traditional databases, images, documents, complex records;.3. Velocity - the content of the data is constantly changing, through the absorption of complementary data collections, through the introduction of previously archived data or legacy collections, and from streamed data arriving from multiple sources. It is important to distinguish Big Data from...

Differences between Big Data and Small Data

Specified Life — Sat, 01 Jun 2013 18:05:00 +0100

Excerpt Principles of Big Data: Preparing, Sharing, and Analyzing Complex Information,by Jules J Berman (see yesterday's blog).Big Data is very different from small data. Here are some of the important features that distinguish one from the other.1. Goalssmall data-Usually designed to answer a specific question or serve a particular goal. Big Data-Usually designed with a goal in mind, but the goal is flexible and the questions posed are protean. 2. Locationsmall data-Typically, small data is contained within one institution, often on one computer, sometimes in one file. Big Data-Typically spread throughout electronic space, typically parceled onto multiple Internet servers, located anywhere on earth. 3. Data structure and contentsmall data-Ordinarily co...

Best Post of October 2012: IDH1 Mutations in Oligodendrogliomas: PNA-clamping PCR is best analytic method

neuropathology blog — Fri, 31 May 2013 17:38:00 +0100

Time for the next in our "Best of the Month" series.. At the time of it's original publication, Dr. Craig Horbinski had this to say about a study which had recently been published in Brain Pathology: "Only catch is whether the method is TOO sensitive. After all, if all oligos are positive for IDH1, why do the "inferior" IDH tests effectively stratify prognosis? I'll be keen to see if anyone else can replicate this work."Here's the original post from October 22, 2012: Although direct sequencing of mutations in isocitrate dehydrogenase 1 (IDH1) has been considered to be the gold standard method to detect this mutation, the sensitivity of this technique has been questioned especially because specimens from glial tumors may contain large numbers of non-tumor cells. The group screened 141 cases...

Big Data Book Explained

Specified Life — Fri, 31 May 2013 16:48:00 +0100

My Big Data book In yesterday's blog, I announced the publication of my new book, Principles of Big Data, 1st Edition: Preparing, Sharing, and Analyzing Complex Information. Here is a short essay describing some of the features that distinguish this Big Data book from all of the others.The book describes:How do deal with complex data objects (unstructured text, categorical data, quantitative data, images, etc.), and how to extract small data sets (the kind you're probably familiar with), from Big Data resources.How to create Big Data resources in a legal, ethical and scientifically sensible manner.How to inspect and analyze Big Data. How to verify and validate the data and the conclusions drawn from the data..The book expands upon several subjects that are om...

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Medicine Goes Mobile

ADVANCE Discourse: Lab — Fri, 31 May 2013 16:20:00 +0100

Smartphones are amazing pieces of technology. Not only can we organize our calendars, surf the internet, listen to music, play scrabble and communicate with our friends and family using any number of social networking platforms -- let alone the actual...(read more) (Source: ADVANCE Discourse: Lab)

An HIE Saga from Massachusetts; The Challenges of Interoperability

Lab Soft News — Fri, 31 May 2013 14:31:41 +0100

Discussion of Findings). There are many reasons why physicians would leave private practice or not enter one at the conclusion of training. However, John't note suggested to me one more reason for this shift. Both physicians and hospitals are being pressured to install EHRs. It may be the case, as with the urologist described above, that physicians in private practice have come to the conclusion that their efficiency is irretrievably harmed by these systems. Therefore, they logically make a decision to take salaried hospital positions where their compensation is less directly linked to their personal productivity and efficiency. (Source: Lab Soft News)

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Specified Life — Thu, 30 May 2013 15:28:00 +0100

Conclusions Are Asserted 164 Step 9. Conclusions Are Examined and Subjected to Validation 16412. Failure Background 167 Failure Is Common 168 Failed Standards 169 Complexity 172 When Does Complexity Help? 173 When Redundancy Fails 174 Save Money; Don’t Protect Harmless Information 176 After Failure 177 Use Case: Cancer Biomedical Informatics Grid, a Bridge Too Far 17813. Legalities Background 183 Responsibility for the Accuracy and Legitimacy of Contained Data 184 Rights to Create, Use, and Share the Resource 185 Copyright and Patent Infringements Incurred by Using Standards 187 Protections for Individuals 188 Consent 190 Unconsented Data 194 Good Policies Are a Good Policy 197 Use Case: The Havasupai Story 19814. Societal Issues Background 201 How Big Data Is Perceived 201 The Necessity...

Big Data Book Contents

Specified Life — Thu, 30 May 2013 15:28:00 +0100

Strides in Stem Cell Survival

ADVANCE Discourse: Lab — Wed, 29 May 2013 15:12:00 +0100

Recent research conducted in the treatment of blood diseases and cancers showed a marked improvement in survival rates for patients after receiving stem cell transplants. A Newswise article chronicled the study from the Center for international Blood...(read more) (Source: ADVANCE Discourse: Lab)

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Department of Biomedical Informatics at Pitt Has Open Post-Doc Position

Lab Soft News — Wed, 29 May 2013 14:59:30 +0100

Dr. Mike Becich has passed on to me the following information about a funded post-doc position in the Department of Biomedical Informatics at the University of Pittsburgh Medical School. Here's more information about DBMI. --BAF The Biomedical Informatics Training Program at the University of Pittsburgh is in the process of recruiting a post-doctoral research scholar in biomedical informatics (NLM funded). Research areas represented by the Pitt faculty include: Bioinformatics Intelligent medical training systems and user modeling Knowledge representation and interoperability Machine learning and data mining Clinical translational bioinformatics and biostatisticsNatural language processing Medical imaging development and evaluation Outbreak and disease surveillance Human-...

Mayo Telestroke Program Deemed Highly Successful

Lab Soft News — Tue, 28 May 2013 14:31:27 +0100

Some very useful telemedicine applications are emerging and being evaluated, particularly those utilizing smart phone apps. The Mayo telstroke program in Arizona was used as a testbed to assess one such app, as discussed in a recent article (see: Mayo telestroke study affirms accuracy of ResolutionMD smartphone app). Below is an excerpt from it: The evidence is building that smartphones are suitable for remote viewing of medical images by consulting specialists. The latest comes from the Mayo Clinic Telestroke Network in Arizona, which found that the ResolutionMD Mobile smartphone app [a diagnostic medical image viewer]...was adequate for evaluating remotely located stroke patients.“CT head interpretations of telestroke network patients by vascular neurologists using Re...

Case of the Week 259

Creepy Dreadful Wonderful Parasites — Mon, 27 May 2013 22:49:00 +0100

The following were obtained by the Minnesota State Health Department from standing ditch water during routine environmental surveillance. (CLICK ON IMAGES TO ENLARGE)Identification?Which stage of the organism is shown here? (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 259

Creepy Dreadful Wonderful Parasites — Sun, 26 May 2013 14:36:00 +0100

Answer: Culicine mosquito larvaeYou can place these mosquito larvae in the Culicinae subfamily due to the presence of respiratory siphons that allow them to hang below the water at an angle and breathe the oxygen above:This is in contrast to anopheline mosquitoes (Anophelinae subfamily) who do not have a respiratory siphon and instead rest parallel to the surface of the water, breathing through their tail. The Culicinae subfamily includes the genera Aedes, Culex, and Culiseta. Different species in these genera transmit a number of viruses and parasites, including yellow fever, dengue, West Nile virus, Eastern equine encephalomyelitis, Japanese encephalitis, and agents of lymphatic filariasis. Fortunately, most of these are not found in Minnesota where thes...

The TERT Gene

ADVANCE Discourse: Lab — Fri, 24 May 2013 16:59:00 +0100

We’ve discussed dark matter before . Understanding the unobserved and unknown areas of the human genome could ultimately lead to a better understanding of cancer and, subsequently, better treatment options. A Dark Daily news briefing reported recent studies...(read more) (Source: ADVANCE Discourse: Lab)

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Informed Consent as it Relates to Reporting Genomic Results to Patients

Lab Soft News — Wed, 22 May 2013 23:54:47 +0100

The question of how and when to report genomic results to patients and informed consent relating to such results is becoming much more complicated and controversial (see: Patients Should Always Receive Their Genomic Information According to Recent Report). This previous note made reference to a statement by the American College of Medical Genetics and Genomics (ACMG) suggesting that patients should always have access to their genomic information. However, the consenting of genetic testing and the return of these results is much more complicated than normal lab testing. This point was emphasized in a recent article (see: Returning Genetic Incidental Findings Without Patient Consent Violates Basic Rights, Experts Say). An excerpt of it is presented below: Genetic testing has long...

Internal War Zone

ADVANCE Discourse: Lab — Wed, 22 May 2013 19:59:00 +0100

The more we learn about our own bodies, the more it seems like there’s just an endless war going on in there. Scientists have long since known about helpful bacteria inside of our bodies that help prevent infections, but an article from Medical News Today...(read more) (Source: ADVANCE Discourse: Lab)

AACC Urges Action

ADVANCE Discourse: Lab — Tue, 21 May 2013 15:47:00 +0100

The AACC is urging laboratory professionals to contact their members of Congress and request that they support H.R.1248, the Newborn Screening Saves Lives Reauthorization Act, which would preserve recent advances in state newborn screening programs. Earlier...(read more) (Source: ADVANCE Discourse: Lab)

Case of the week 258

Creepy Dreadful Wonderful Parasites — Mon, 20 May 2013 23:58:00 +0100

The following case was donated by Drs. Stephanie Slemp, Nicole Hubbard, Morgan McCoy, Ryan Relich, and Bryan Schmitt. The following liver mass was resected from a 20 year old man. The man had recently immigrated to the U.S. from South America. Below is a cross-section of the lesion. While awaiting the histopathology, what is your differential diagnosis from the gross exam? (Source: Creepy Dreadful Wonderful Parasites)

Why Having A Pet Tends to Improve Your Heart Health

Lab Soft News — Mon, 20 May 2013 18:35:30 +0100

There is a correlation between having a pet such as a dog or cat and an improved health status. Exactly how this works was the subject of a recent article (See: American Heart Association: Pets, especially dogs, are good for the heart). Below is an excerpt from it: An animal companion may not just warm your heart, but also help you maintain a healthy heart....Pet ownership, particularly dog ownership, is probably associated with a decreased risk of heart disease," [said the] director of the cardiac care unit at Baylor College of Medicine....[T]here are 78.2 million owned dogs and 86.4 million owned cats in the United States. Thirty-nine percent of U.S. households have at least one dog, while 33 percent have at least one a cat. The AHA's committee reviewed previous rese...

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Answer to Case 258

Creepy Dreadful Wonderful Parasites — Sun, 19 May 2013 21:05:00 +0100

Answer: echinococcal cystNote that you can make out the walls of several daughter cysts, which likely collapsed in vivo or during sectioning.As some of you mentioned, other less likely options based on this gross appearance would be a non-infectious cystic lesion and an amebic liver abscess. The latter is unlikely given that the concents would be red-brown necrotic material classically referred to as "anchovy paste." The definitive diagnosis is secured by microscopic examination of fluid obtained from the cyst or tissue sections of the cyst walls. In this case, tissue sections revealed thick laminated layers, consistent with E. granulosus:40x magnification100x magnificationRare refractile hooklets were also seen within the degenerated granular cyst contents (1...

Neuropathologist Roger Brumback found murdered in his home

neuropathology blog — Sat, 18 May 2013 16:56:00 +0100

Neuropathologist Roger Brumback, 65, and his wife were found murdered in their Nebraska home on Tuesday. Dr. Brumback, an active member of the neuropathology community, was the former chair of pathology at Creighton University in Omaha.Roger Brumback, MDThe bodies of Dr. Brumback and his wife, Mary, were discovered by a piano mover who had arrived at their home to find the front door ajar. In addition to his work as a neuropathologist, Dr. Brumback was a clinical pediatric neurologist and was the founding Editor-in-Chief of the Journal of Child Neurology. At a memorial held at Creighton in his honor, medical students described Brumback as a kind and caring man who was devoted to teaching.Police are looking at any link between this killing and that of the son of another Creighton patho...

A Medicinal Redbox

ADVANCE Discourse: Lab — Fri, 17 May 2013 18:14:00 +0100

QuiqMeds, a Pennsylvania-based company located outside of Philadelphia, deals in a very different type of vending machine. With 6 machines located in local physician’s offices in the area and plans to increase that number in the region before expanding...(read more) (Source: ADVANCE Discourse: Lab)

Epic Founder Faulkner Gives Hospital Executives Exactly What They Want

Lab Soft News — Fri, 17 May 2013 18:02:18 +0100

Judith Faulkner, founder and CEO of Epic, is warming up to the media according to an interview in Forbes by Zina Moukheiber (see: An Interview With The Most Powerful Woman In Health Care). Here's the reason that she offers in the interview: I’m recognizing that when we were small, we could stay under the radar, but now it’s harder. I get so many requests for interviews. If I talk to everyone, we can’t do our job with our customers and work on our software. It would be hard to stay focused. Here's one of the many reactions to the piece by David Shaywitz, also of Forbes (see: Two Quick Reactions To Epic Faulkner Interview: SV Should Show Judy More Love; We Should Shouldn't Let Hospitals Off Hook) Interoperability issues associated with Epic may reflect tacit pre...

Should Hospitals Develop Lab Formularies Like Those in the Pharmacy?

Lab Soft News — Fri, 17 May 2013 00:14:13 +0100

I recently learned about the concept of a lab formulary, an analogue of the pharmacy formulary. The latter is a list of the stock drugs carried by the pharmacy in a hospital. Prescriptions for hospital patients can only be written by physicicans for the drugs listed in the formulary. The comparable notion on the lab side is that only tests contained in the lab formulary can be ordered by physicians. Here is an article that describes the concept in greater detail (see: Constructing A Lab Formulary). Below is an excerpt from it: Given healthcare's increasing emphasis on cost control and quality measurement, laboratorians need to reconsider their roles within healthcare organizations. A lab that provides what appears to be a commodity service may be at risk of being marginalized at best o...

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The Institutionalization of Healthcare; Consequences of Big Medicine?

Lab Soft News — Wed, 15 May 2013 23:13:10 +0100

I posted a note five days ago about how the cost of healthcare seems to be gradually declining (see: Decrease in Healthcare Costs May Persist as Economy Revives). A reader, Ajit Alles, responded with a comment that decreasing expenditures of health my result in a lower quality of care, which I responded to in another note (see: The Correlation between the Cost of Care and the Health of a Population). He has responded to this second note with the following comment: As follow-up, I agree that we spend way too much on end of life care, but that won't be reduced without a cultural shift. People expect miracles from medicine based on what they hear on the news and see in TV dramas. We could spend less and get better results, but people have to first start accepting that modern healthcare ha...

Dark Matter

ADVANCE Discourse: Lab — Wed, 15 May 2013 21:07:00 +0100

“Dark matter” sounds like something George Lucas would tell us is at the heart of the empire. In reality, it’s the parts of the human genome that science has yet to identify -- which still sounds like it belongs in a sci-fi movie, but the discovery could...(read more) (Source: ADVANCE Discourse: Lab)

Case of the Week 257

Creepy Dreadful Wonderful Parasites — Tue, 14 May 2013 21:38:00 +0100

The following case was generously donated by Blaine Mathison. It is a photograph from a slide stained with a fluorescent antibody to a particular parasite. The green fluorescing objects measure approximately 4-6 micrometers in diameter. Diagnosis? (Source: Creepy Dreadful Wonderful Parasites)

Dr. Mark Cohen's "Wicked Clown" Mitochondrion

neuropathology blog — Tue, 14 May 2013 14:39:00 +0100

Inspired by the last post regarding unusual mitochondrial inclusions, the insurmountable Dr. Mark Cohen of Case Western sent in his favorite picture of an aberrant mitochondrion, which he likens to a "wicked clown": (Source: neuropathology blog)

Is Any Hospital Using the "Hybrid" Digital Pathology Business and Workflow Model?

Lab Soft News — Tue, 14 May 2013 14:26:32 +0100

In a previous note, I discussed the hybrid teleradiology business model (see: Hybrid Model of On-Site and Remote Radiology for Enhanced Patient Workflow). In a nutshell, it works in the following way: A radiology department at a 370-bed acute-care hospital in Carmichael, California, utilizes both its on-site radiologists and remote radiology ("nighthawk") consultants to improve the quality of care and workflow. Cases are turfed to the outside consultants when the local radiology expertise is unavailable (e.g., neuroradiology), when the local number of radiologists is insufficient to handle the current case load, and during the night and weekends when the local radiology department is not fully staffed. It occurred to me that this model would be ideal for smaller hospitals...

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Answer to case 257

Creepy Dreadful Wonderful Parasites — Mon, 13 May 2013 23:58:00 +0100

Answer: Cryptosporidium species. Lee suggested that this is the newly recognized species, Cryptosporidium enterprisium.Florida Fan rightly points out that, although considered the gold standard test for Cryptosporidium, the DFA may not detect all species that infect humans. Therefore, another test that can be used to confirm the identification of spherical, 4-6 micron diameter objects on wet prep, would be an Acid Fast stain. As the new molecular multiplex panels become commercially available, they also may be used as an initial or confirmatory test. (Source: Creepy Dreadful Wonderful Parasites)

The Correlation between the Cost of Care and the Health of a Population

Lab Soft News — Mon, 13 May 2013 23:43:41 +0100

In a recent note, I reported that the cost of healthcare in the U.S. was beginning to decline, perhaps due, in part, to reasons other than the drop in the economy (see: Decrease in Healthcare Costs May Persist as Economy Revives). A reader of Lab Soft News submitted the following comment in response to the post: Costs are down, but has health taken a beating? If people are seeing less of their physicians are they then showing up sicker? Does this give us a healthier population? I have come to believe that spending more on healthcare does not necessarily result in greater health for a population. The U.S. ranks 40th in life expectancy when compared to other countries according to a 2012 WHO study (see: List of countries by life expectancy). We also spend far more per capita and as a percent...

ETS2 mediates tumor suppressor function and MET inhibition in lung adenocarcinoma

The Daily Sign-Out — Mon, 13 May 2013 17:16:09 +0100

There was a very intriguing paper published online by Clinical Cancer Research on May 9 last week that should be of interest for those involved in lung cancer research. The authors are Mohamed Kabbout, Melinda Garcia, Junya Fujimoto, et al.... (Source: The Daily Sign-Out)

Decrease in Healthcare Costs May Persist as Economy Revives

Lab Soft News — Fri, 10 May 2013 17:52:16 +0100

One of the biggest challenges facing our economy is the cost of healthcare which has been rising for years as a percentage of GDP. Recently, however, health spending has been decreasing. There has been much speculation as to whether this slowdown is transient or lasting. A recent article addressed this topic (see: Slowdown in Health Costs’ Rise May Last as Economy Revives). Below is an excerpt from it: One of the economic mysteries of the last few years has been the bigger-than-expected slowdown in health spending, a trend that promises to bolster wages and help close the wide federal deficit over the long term — but only if it persists. Major new studies...have concurred that at least some of the slowdown is unrelated to the recession, and might persist as the economy recovers. David ...

A Trip Down Memory Lane

ADVANCE Discourse: Lab — Fri, 10 May 2013 16:15:00 +0100

There’s a scene in the 60s-era AMC series “Mad Men” that involves a pregnant woman smoking and drinking while her friend’s child runs around with a dry cleaning bag over her head. All of this happens in the space of about a minute, and there are so many...(read more) (Source: ADVANCE Discourse: Lab)

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Does Genomic Health Have Another Winner with Oncotype DX Prostate Cancer Test?

Lab Soft News — Thu, 09 May 2013 00:46:16 +0100

Oncotype DX definitely produced a winner with its Breast Cancer Assay. Here are the results of the test according to the company web site: 33% [of tested patients] switched from chemotherapy + hormone therapy to hormone therapy alone based on a low Recurrence Score result 4% [of tested patients] switched from hormonal therapy only to chemotherapy + hormonal therapy based on a high Recurrence Score result The company is now introducing a new assay for assessing the risk of biopsied prostate cancer (see: New Test Improves Assessment of Prostate Cancer Risk, Study Says). Here's an excerpt from a recent article discussing this new test: A new test can help distinguish aggressive prostate cancer from less threatening ones, potentially saving many men from unneeded ...

NKX2-1/TTF-1 drives pulmonary-specific differentiation in lung adenocarcinoma

The Daily Sign-Out — Wed, 08 May 2013 20:08:47 +0100

Snyder et al. recently published an intriguing report in Molecular Cell (21 March 2013) (featured free article) in which they convincingly demonstrate how tumors in which Nkx2-1 was deleted show striking different morphology from those in which Nkx2-1 is expressed.... (Source: The Daily Sign-Out)

Knowing

ADVANCE Discourse: Lab — Wed, 08 May 2013 15:49:00 +0100

ADVANCE Discourse: Lab Knowing Let’s forget about money for a second. I know that can be difficult – what, with all of those pesky adult responsibilities and everything, but bare with me. If money wasn’t an object, and your physician wanted to order a...(read more) (Source: ADVANCE Discourse: Lab)

PAML Invests in CellNetix, a Provider of Esoteric AP Services

Lab Soft News — Wed, 08 May 2013 01:09:01 +0100

PAML has invested in CellNetix, an esoteric anatomic pathology esoteric lab (see: Esoteric Anatomic Pathology Testing Is Goal of New Pact between PAML and CellNetix). Here are more details from this note in the Dark Daily: [The] agreement calls for both parties to collaborate in offering esoteric and reference anatomic pathology services nationally. It is an effort to align their clinical laboratory and anatomic pathology services to the evolving needs of hospitals, physicians and other providers....The two companies ...stated that they entered into an agreement to work together to form a “jointly owned national Esoteric Anatomic Pathology reference laboratory offering." For anatomic pathologists across the nation, this new agreement is notable. Independent pathology laboratory comp...

Angulated intramitochondrial inclusions in the left leg of a man with a left-sided limp

neuropathology blog — Mon, 06 May 2013 16:21:00 +0100

A 59-year-old male with a one-year history of limping as well as pain, weakness, and paresthesia of the left lower extremity who underwent lumbar microdiscectomy with cord decompression. Although the patient's pain subsided post-operatively, his other symptoms persisted. Since his CPK levels were chronically elevated (around the 500's), biopsies were later performed on the quadriceps bilaterally. Light microscopic examination was underwhelming except for some denervation effect on the left. However, subsarcolemmal clumping was evident with NADH histochemisty on both the right and left. This clumping prompted me to perform an ultrastructural examination, which revealed the following angulated intramitochondrial inclusions IN THE WEAK LEG ONLY:These inclusions were present in about 5% of mit...

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Case of the Week 256

Creepy Dreadful Wonderful Parasites — Mon, 06 May 2013 02:03:00 +0100

Multiple hairs were submitted to the laboratory for microscopic examination. Under the dissecting microscope, the following were seen:Identification?Thanks to H.A. for taking these photographs! (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 256

Creepy Dreadful Wonderful Parasites — Sat, 04 May 2013 19:55:00 +0100

Answer: Phthirus pubis, a.k.a. crab lice (3 to be exact).Note their classic 'crab-shaped' claws - used for grasping on to the coarse hairs of the genital region and eyebrows/eyelashes. Also shown here is a classic nit of P. pubis, with the raised operculum that allows it to be differentiated from the flatter operculum of the body/head louse, Pediculus humanus. Here are the 2 nits shown side by side for comparison:And now, a lovely poem from Blaine:On a trip to Vegas one man thought he mightHire company for the duration of the nightBut he got more than he paid forFrom his mistress d’amourFor now Phthirus pubis is the young man’s plight. (Source: Creepy Dreadful Wonderful Parasites)

UPenn Medical School Establishes Biomedical Informatics Institute

Lab Soft News — Fri, 03 May 2013 15:50:19 +0100

Medical schools are getting much more interested in developing more expertise in the field of bioinformatics. Here's an excerpt from an article about the development of a new bioinformatics center at the UPenn School of Medicine (see: Big data gets a home at University of Pennsylvania’s medical school): University of Pennsylvania’s Perelman School of Medicine in Philadelphia has established a dedicated center for biomedical informatics, underscoring the expansion of big data from drug development to population health. The Institute for Biomedical Informatics will focus on improving patient care and the research that goes into personalized medicine, according to a statement from Penn Medicine....The institute will work in partnership with Children’s Hospital of Philadelphia ...

Full Circle

ADVANCE Discourse: Lab — Fri, 03 May 2013 15:05:00 +0100

The rise of personalized treatment has healthcare professionals completely rethinking the way they treat cancer. At the molecular level, each is different and should be treated accordingly, but similarities shouldn’t be ignored either. A study from the...(read more) (Source: ADVANCE Discourse: Lab)

Lab-on-a-Chip, Round 2

ADVANCE Discourse: Lab — Thu, 02 May 2013 16:12:00 +0100

Imagine a healthcare facility where a small sample of blood is taken as you walk in the door, just .25 attomoles -- you’d barely notice. They drop your sample into a small, handheld device and, by the time your physician has come to see you, they are...(read more) (Source: ADVANCE Discourse: Lab)

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CAP releases guidelines for validating whole slide imaging

The Daily Sign-Out — Thu, 02 May 2013 04:03:28 +0100

The College of American Pathologists has released guidelines for validating whole slide imaging. While stating the lack of FDA approval for using WSI for primary diagnosis, the College is acknowledging the very likely adoption of WSI for primary diagnosis in... (Source: The Daily Sign-Out)

Research that Transfusion of "Older" Blood May Be Harmful to Patients

Lab Soft News — Wed, 01 May 2013 13:00:00 +0100

There was a time when I, in a previous incarnation as a blood banker, spent a lot of time thinking about the shelf life of blood and how to increase the utilization of blood in blood bank inventory. Hence, a recent article about this topic caught my eye, partly out of a sense of nostalgia (see: The Shelf Life of Donor Blood). Here is an excerpt from it: For decades, the Food and Drug Administration has limited storage of refrigerated red blood cells to 42 days. But it has been clear for some time that stored blood degrades in various ways long before that six-week limit, and some research suggests that the changes may be harmful to patients who receive older blood. Now a study published in the journal Anesthesia & Analgesia has found that after even 21 days, the membranes o...

Informed Patients as Micro-Experts; Web and Patient Education

Lab Soft News — Mon, 29 Apr 2013 13:36:05 +0100

I have always been supportive of the opportunity that the web provides for patients to learning about their diseases, compare their experiences with other patients, and learn about new therapies. This has been called participatory medicine in the past (see: "Participatory Medicine" and Its Relationship to Clinical Lab Testing; Recruiting Office Patients into a Participatory Model of Healthcare Delivery; The Future of Healthcare and the Four P's: Preventive, Predictive, Personalized, Participatory). Below is an excerpt of an article discussing how new web patient resources are popping up that enable education and greater participation in care (see: A Former Google Exec Aims To Power A Patient Revolution): Well-educated patients can have a valuable voice in drug dev...

Case of the Week 255

Creepy Dreadful Wonderful Parasites — Mon, 29 Apr 2013 13:24:00 +0100

A Sudanese refugee was seen for progressive confusion, daytime somnolence and personality disturbances. Despite treatment, he died and an autopsy was performed. Sections of brain revealed the following:Perivascular lymphoplasmacytic inflammation, H&E 400xLymphoplasmacytic inflammation, H&E 1000xLymphoplasmacytic inflammation, H&E 1000xA peripheral blood smear obtained prior to death showed the following:Diagnosis? What is the object seen in image 3 (also present in image 2)? (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 255

Creepy Dreadful Wonderful Parasites — Sun, 28 Apr 2013 16:16:00 +0100

Answer: African trypanosomiasis due to Trypanosoma brucei. It is not possible to tell the 2 subspecies of Trypanosoms brucei apart microscopically, but the origin of the patient (Sudan) would be consistent with East African trypanosomiasis due to T. b. rhodesiense. The flagellated form of T. brucei (called trypomastigotes) are typically seen in peripheral blood, and in late stage disease, in CSF. They can be differentiated from the similar-appearing T. cruzi trypomastigotes by the small size of their kinetoplast (arrows, below). Occasionally, trypomastigotes of other zoonotic organisms such as T. rangeli can be transiently present in the blood of humans, although they are not usually associated with disease. These trypomastigotes can be differentiated ...

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Bespoke (i.e, Customized) Cancer Treatment; Cancer "Cures" and the Media

Lab Soft News — Sun, 28 Apr 2013 15:25:35 +0100

Patients with cancer need to seek the most sophisticated care that they can obtain these days, which is usually found in cancer centers and academic hospitals (see: Patients with a Cancer Should Seek Treatment in Cancer Hospitals). Not only is treatment in such centers usually state-of-the-art but they also provide ready access to the best diagnostic tests including genomic analysis of both the patient and the tumor. They also provide ready access to controlled clinical trials where new drugs are being evaluated. Here's an excerpt from a recent article about how cancer centers are racing to map patients' genes with a interesting comments included about cancer and the media (see: Cancer Centers Racing to Map Patients’ Genes): ...Kieran P. Holohan [is], a 45-year-old lawyer w...

Annual AANP meeting is two months away

neuropathology blog — Fri, 26 Apr 2013 23:36:00 +0100

The Charleston Place Hotel in Charleston, South CarolinaNeuropathologists across the country are starting to make plans to attend the 89th Annual Meeting of the American Association of Neuropathologists, which will be held June 20-23, 2013 in Charleston, SC at the Charleston Place Hotel. The meeting with commence on Thursday the 20th with two half-day courses. There will be a morning course directed by Dr. Charles L. White entitled Practical Issues and Challenging Diagnoses in Forensic Neuropathology. The afternoon course is called Update in Frontotemporal Lobar Degenerations and is directed by Dr. Elizabeth J. Cochran. Other highlights later in the weekend include the return of Dr. Stanley Prusiner, Nobel laureate, who will talk about prion disease. (Dr. Prusiner last spoke to the AAN...

The Reanimator

ADVANCE Discourse: Lab — Fri, 26 Apr 2013 15:33:00 +0100

With genetic research has come the realization that cancers are unique -- not just in terms of where they are in the body, but in their molecular make up. Although the industry is focusing on personalized medicine as a treatment option recently, some...(read more) (Source: ADVANCE Discourse: Lab)

BRAF mutations in colorectal cancer: mini-review

The Daily Sign-Out — Fri, 26 Apr 2013 11:58:00 +0100

There has been a recent flurry of papers and reports from ASCO-GI 2013 pushing more molecular testing in colorectal cancer (CRC) and its clinical significance with regard to prognostic and predictive factors, especially with MMR/MSI. One area that caught my... (Source: The Daily Sign-Out)

An Explanation about How ACOs May Save Money

Lab Soft News — Thu, 25 Apr 2013 16:28:26 +0100

I have never quite understood how accountable care organizations (ACOs) are supposed to reduce the cost of healthcare although many hospitals have been creating them, often with the help of consultants (see: Hospital Executives Search for the Formula for an Accountable Care Organization). I recently came across a clear explanation about how ACOs are designed to work (see: ACOs Won't Work According to Clayton Christensen in the WSJ). Below is an excerpt from the article (see: A Health Provider Finds Success in Keeping Hospital Beds Empty): [T]he Affordable Care Act, President Obama’s health care law, has helped encourage a shift to [Advocate Health Care's] payment model. Such agreements were merely a theory four years ago. But an estimated 428 accountable-care organizations ...

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Feelings and Brain Scans

ADVANCE Discourse: Lab — Wed, 24 Apr 2013 16:41:00 +0100

During a hospital visit, a doctor will often ask about pain, but how can it be better calculated beyond just words? A story from NPR followed researchers led by Tor Wager, PhD, associate professor of psychology and neuroscience from the University of...(read more) (Source: ADVANCE Discourse: Lab)

Cancer Tissue Acquisition and Genomic Testing in Integrated Diagnostic Centers

Lab Soft News — Wed, 24 Apr 2013 00:52:46 +0100

In a recent article, Dr. Eric Topol discussed what he describes as the "cancer clinic of the future." However, much of his discussion was directed at tumor tissue specimen collection and genomic testing (see: Topol on the Cancer Clinic of the Future). Below is an excerpt from it: So what is the cancer clinic of the future going to look like, because it's just starting to get developed today? For example, when we have an individual presenting for a new diagnosis of cancer, we have to move away from fine-needle aspiration and minimal tissue; we need real tissue to be able to process it properly. Not only do we need the formalin-fixed paraffin-embedded (FFPE) specimen, but we also need another type of FF -- that is, flash-frozen specimens so that we can then whole-genome ...

Hospital EHRs Inadequate for Big Data; Need for Specialized -Omics Systems

Lab Soft News — Mon, 22 Apr 2013 21:10:59 +0100

The EHRs now being installed in hospitals, viewed as the key hospital information systems, are totally unable to mange the "big data" that is being generated as a byproduct of precision medicine. This was the conclusion in a viewpoint article in JAMA by Justin Starren and co-authors. (see: Electronic Health Records Upgrades Needed for Big Medical Data). Starren is chief of the Division of Health and Biomedical Informatics in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine. Here is an excerpt from an article describing their views: Even as physicians across the nation transition to electronic health records, commonly known as EHRs, these data systems are not sophisticated enough to handle or store the amount of e...

The Other Real Threat to Intel; Better Utilization of its Chips

Lab Soft News — Sat, 20 Apr 2013 15:52:40 +0100

I, like many other people with an IT interest, have been closely following the decline in PC sales (see: The Shift from PCs to Tablets; Most iPads Stay in the Living Room). On the face of it, this shift would seem not to bode well for chip manufacturers like Intel. However and simultaneously, the server business is booming with the proliferation of web users and more attention to cloud computing. Christopher Mims addressed this scenmario in a recent article (see: The (other) real threat to Intel’s business: You’re making better use of its products), Below is an excerpt from it: ...Well, the PC is dying, and that’s been devastating to [Intel's] revenue. But that misses an important point: Intel’s server business is doing well. It’s the only part of the company that’s b...

Generic OxyContin Not Approved By FDA

ADVANCE Discourse: Lab — Fri, 19 Apr 2013 18:41:00 +0100

The idea of making a potentially dangerous drug less prone to abuse is something that stands out in the effort to stop prescription drug misuse in the United States. Many companies have incorporated time release capsules to curb the possibility of abuse,...(read more) (Source: ADVANCE Discourse: Lab)

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Welcome to the World of Pseudo-Academia: Pathology-2013

Lab Soft News — Thu, 18 Apr 2013 18:23:17 +0100

A recent article detailed a conference and journal scam that is being foisted on gullible academics in search of publications and lecture appearances, probably to pad their CVs (see: Scientific Articles Accepted (Personal Checks, Too). Here is an excerpt from the article from the NYT. I am only quoting part of it so link to it for more details. [Some] scientists [have recently] stumbled into a parallel world of pseudo-academia, complete with prestigiously titled conferences and journals that sponsor them. Many of the journals and meetings have names that are nearly identical to those of established, well-known publications and events....The number of these journals and conferences has exploded in recent years as scientific publishing has shifted from a traditional business model for profes...

Stem Cells and ALS

ADVANCE Discourse: Lab — Wed, 17 Apr 2013 22:28:00 +0100

Most of us know amyotrophic lateral sclerosis (ALS) by its other name, Lou Gehrig’s disease. After a recent preliminary trial at Emory University yielded positive results, a phase II trial has been approved by the FDA. An article from Newswise described...(read more) (Source: ADVANCE Discourse: Lab)

A Rich Focus

neuropathology blog — Tue, 16 Apr 2013 20:09:00 +0100

The grey arrow is pointing to a Rich focusA Rich focus is a tuberculoma in the cerebral cortex that ruptures into the subarachnoid space, causing tuberculous meningitis. It is named for Johns Hopkins pathologist Dr. Arnold Rice Rich (1893-1968), who first described it. (Source: neuropathology blog)

Hospitals Need to Expand Cloud Services Starting with Radiology Images

Lab Soft News — Tue, 16 Apr 2013 01:54:46 +0100

I began raising exploring cloud computing in healthcare in early 2008 (see: Cloud Computing in Healthcare: Key Questions to Ask; Finally, A Clear Definition for Cloud Computing). It looks like we are finally seeing some movement toward this technology some five years later (see: Where Do You Keep All Those Images?). Here is an excerpt from an article in the WSJ on the subject: Health-care providers are starting to embrace the fast-growing area of technology known as cloud services, the model of shared computing in which data is stored on remote servers that hospitals can access via desktop, tablet or smartphone. Instead of big capital investments in their own storage, they are paying a relatively modest upfront charge and monthly usage fees for cloud services. About 15% of heal...

Case of the Week 254

Creepy Dreadful Wonderful Parasites — Mon, 15 Apr 2013 19:19:00 +0100

This week's case is just a fun identification. (Hint, these objects were obtained at the local hospital pharmacy...) Questions:1. What are they used for in the health care setting?2. Which bacteria is associated with them? (Source: Creepy Dreadful Wonderful Parasites)

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Answer to Case 254

Creepy Dreadful Wonderful Parasites — Sun, 14 Apr 2013 13:04:00 +0100

Answer: Hirudo medicinalis, the European medicinal leech. Today, leeches are not used for 'balancing humors' but instead to to reduce venous pooling of blood in delicate surgeries such as reconstructive and reattachment surgeries. Medicinal leeches secrete a number of anticoagulants in addition to hirudin which facilitate blood flow and therefore promote wound healing. Note that leeches are annelids and not trematodes, despite their superficial resemblence. You can appreciated their segmented nature in this photograph:Medicinal leeches carry Aeromonas hydrophila in their gut. Therefore, it is important to give the patient antimicrobial prophylaxis when prescribing medicinal leech therapy. (Source: Creepy Dreadful Wonderful Parasites)

Of Mice and Rats

ADVANCE Discourse: Lab — Fri, 12 Apr 2013 20:05:00 +0100

I’ve discussed the introduction of human genes into test mice before , but apparently rats are showing much more promise in Alzheimer’s research. A recent article from NPR discussed the need for a better model for humans in the study and, potentially,...(read more) (Source: ADVANCE Discourse: Lab)

Counting White Blood Cells with a Portable Flow Cytometry Device

Lab Soft News — Thu, 11 Apr 2013 21:30:20 +0100

I closely track the development of devices that will enable lab testing in a mini-lab or even a home setting previously that is now only available in hospitals or physician offices. I do this for two reasons: (1) I believe that patients and healthcare consumers should assume more responsibility for their own health; and (2) healthcare providers need to move the locus of much of their delivery to alternative care sites in order to provide cheaper, faster, and better care (see: The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals). Hence, a recent article about an experimental devices for counting white blood cells caught my eye (see: Counting white blood cells at home). Below is an excerpt from it: White blood cells, or leukocytes, are the immune system'...

Genomic Research and EMR

ADVANCE Discourse: Lab — Wed, 10 Apr 2013 21:39:00 +0100

With so many new technologies emerging in recent years, trying to combine multiple advances can be challenging, especially when those advances haven’t been standardized yet. In a recent article from Newswise, doctors and researchers from both the Mayo...(read more) (Source: ADVANCE Discourse: Lab)

NFL Physician Says Diagnosis of "Chronic Traumatic Encephalopathy" Lacks Validity

Lab Soft News — Wed, 10 Apr 2013 12:00:00 +0100

I have been closely following the topic of chronic traumatic encephalopathy (CTE) because of the evolving diagnostic aspects of the disease and also because of the large stakes involved with regard to the NFL and college football. I think that I already know how this story is going to turn out. Neurologists, pathologists, and radiologists are going to develop tests and imaging procedures that will provide earlier evidence of concussive injury for both amateur and professional football players. This will result in many players having to sit on the bench for longer periods of time after such injuries. This will cause some fans and league owners a lot of anxiety. Meanwhile, the NFL will do whatever it can to delay the development of faster and more accurate CTE diagnostic tools. One facet of ...

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Best Post of September 2012: DecisionDx-GBM: Should every glioblastoma patient be getting this test?

neuropathology blog — Tue, 09 Apr 2013 12:38:00 +0100

The next in our Best of the Month Series is from September 12, 2012. It's worth revisiting the question of whether or not genetic testing of brain tumors is appropriate in patients who are not on research studies: What does the neuropathology community think of DecisionDx-GBM? This is a product offered by Castle Biosciences, based in Phoenix, AZ. DecisionDx-GBM is a gene expression profile test developed at The University of Texas M. D. Anderson Cancer Center for the purpose of increasing the accuracy of the prognosis and predicted responsiveness of glioblastoma multiforme to first line radiation plus temozolomide. The test is able to distinguish GBM tumors with a proneural phenotype (tumor signature) from those with a mesenchymal / angiogenic phenotype. Patients with a proneural phenotype...

Case of the Week 253

Creepy Dreadful Wonderful Parasites — Tue, 09 Apr 2013 02:40:00 +0100

The following images are taken from slides submitted to our surgical pathology consult service for identification. The associated gross description describes a tan firm object measuring 0.3 cm x 0.3 cm x 0.1 cm. 40x magnification 100x magnification200x magnification200x magnification400x magnificationIdentification? (Source: Creepy Dreadful Wonderful Parasites)

Patients Should Always Receive Their Genomic Information According to Recent Report

Lab Soft News — Mon, 08 Apr 2013 12:00:00 +0100

I have always been enthusiastic about the need to provide patients and healthcare consumers with most, if not all, of their lab test results shortly after they become available. The only exceptions would be results relating to newly diagnosed serious diseases such as cancer where the information should be first communicated in person by a physician. In such cases, there should be a time delay baked into the release of the information to patients. Genomic testing has prompted a new debate about the availability of test results. The wide availability of patient portals/personal health records (PHRs) has also fueled these discussions (see: Publishing Test Results in Patient Portals: Holding a Tiger by the Tail; Next Step in Patient Portals: Secure Messaging and Administrat...

Answer to Case 253

Creepy Dreadful Wonderful Parasites — Sun, 07 Apr 2013 19:05:00 +0100

Answer: Arthropod, most likely a hard tick given the presentation and gross descriptionThis case is somewhat reminiscent of Case 251 in which an object that could have been identified by macroscopic examination was submitted for histologic processing, therefore making the identification extremely difficult. However, there are still features present that allow this 'object' to be identified as an arthropod, as shown in the photo below (CLICK ON IMAGE TO ENLARGE):You'll note that the features in this case are very similar to a previous case of an embedded tick that was sectioned by histology (Case 83).Here is a poem by Blaine Mathison to go with all of these types of cases!Why pathologists are so quick to slice-and-dicewhen an ID on this bug would be much more preciseif they had j...

The New Equation in Health Insurance: Cooperate in Screening or Pay More

Lab Soft News — Sat, 06 Apr 2013 13:28:10 +0100

There is no question in my mind that mandatory health screening will be the norm for many of us, at least those who receive health insurance as a job benefit. Such screening has the dual effect of alerting an individual's healthcare providers about real or potential problems and also engaging the individual in the process of monitoring his or her own health. The covered individual can opt out of such screening but it's going to cost more money to do so. Details about the plan offered to CVS Caremark were discussed in a recent article (see: A Choice for Employees: Get a Health Screening or Pay an Extra $600). Below is an excerpt from it. Also see: If Workers Are Out of Shape, Should Companies Make Them Pay? (paywall). CVS Caremark employees with company health ins...

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Univercell Builder

ADVANCE Discourse: Lab — Fri, 05 Apr 2013 20:37:00 +0100

The introduction of new drugs that combat disease and infection at the genetic level has been a landmark breakthrough, both for laboratory science as well as for patient treatment plans. Cell-based therapeutics, on the other hand, stand to become influential...(read more) (Source: ADVANCE Discourse: Lab)

"Bedless Hospitals"

ADVANCE Discourse: Lab — Wed, 03 Apr 2013 17:08:00 +0100

The introduction of two new hospital facilities in the US marks the beginning of a shift in the healthcare industry. According to a recent news release from Dark Daily, a nationwide change from inpatient- to outpatient-based treatment approaches has resulted...(read more) (Source: ADVANCE Discourse: Lab)

GAO Issues Report about the Potential to Hack Embedded Medical Devices

Lab Soft News — Wed, 03 Apr 2013 17:00:19 +0100

The array of implantable medical devices that store and download data continues to grow. Examples include three types of cardiac devices: pacemakers , implantable cardioverter defibrillators (ICD), and biventricular pacemakers (see: UNC Electrophysiology Services). All of these devices contain chips that store data that can be downloaded for subsequent review and analysis. I posted a previous note discussing whether patients with such devices are legally entitled to access this data (see: Should Patients Have Access to Data from Their Implanted Medical Devices?). I recently came across an interesting article recently about a possible hacking threat of implanted medical devices (see: Hacking medical devices – movie plot or realistic threat?), Below is an excerpt fr...

The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals

Lab Soft News — Mon, 01 Apr 2013 16:45:52 +0100

More than anything else, healthcare providers now need to learn how to deliver less expensive healthcare. It's what I have been calling cheaper, faster, better care. This goal cannot be achieved successfully by requiring nurses and physicians to work harder and faster or squeezing hospital suppliers for better prices. This has generally been the strategy in the past when profit margins have slipped. No, a substantial part of the answer lies in the development and practice of new models of healthcare delivery. All of this was succinctly stated in a recent article quoting George Halvorson, chairman and CEO of Kaiser Permanente. The following paragraph was embedded in a longer article about the future of healthcare (see: The Face of Future Health Care): Yet even with all of its effo...

Case of the Week 252

Creepy Dreadful Wonderful Parasites — Mon, 01 Apr 2013 00:54:00 +0100

Here is a bit of an unusual case: this was noted in a tube of "sterile saline" in another area of the lab and sent to parasitology for identification. Thoughts? Comments? (Source: Creepy Dreadful Wonderful Parasites)

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Answer to Case 252

Creepy Dreadful Wonderful Parasites — Sat, 30 Mar 2013 22:28:00 +0100

Answer: Mosquito, not further identified I apologize for not providing a genus and species level identification - the mosquito started falling apart when I went to remove it from the tube and I'd like to keep it intact as a display. However, one of my viewers cleverly suggested that this was the previously undescribed Culex salinenis!To answer the question of how it got into the tube to begin with, I had to investigate how the saline tubes are made. First, empty glass tubes are received in bulk from the manufacturer in our media prep lab. They arrive shrink-wrapped in plastic, and are stored like this until needed. The tubes are then unwrapped in the media lab and immediately filled with sterile saline (also purchased in bulk) using an automated pipe...

Laboratory Leadership Training

ADVANCE Discourse: Lab — Fri, 29 Mar 2013 16:58:00 +0100

There’s that famous saying, “Some are born great, some achieve greatness, and some have greatness thrust upon them.” I think it can be applied to any quality, especially leadership. As a kid, I always thought it was something people were just born with...(read more) (Source: ADVANCE Discourse: Lab)

Job Prospects Dimming for Residents in Radiology; Defining the Underlying Problems

Lab Soft News — Fri, 29 Mar 2013 15:51:27 +0100

I closely track job prospects in radiology because of the similarity of the field to pathology. Two years ago, I posted a note about the declining job prospects in radiology (see: Radiology Jobs Trend Downward; Blame Technology and Reimbursement). A recent article provides more evidence about this decline (see: Job Prospects Are Dimming for Radiology Trainees). Below is an excerpt from it: For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work....Recent radiology graduates with huge medical school debts are having trouble find...

More Speculation about the Cerner Purchase of Labotix

Lab Soft News — Wed, 27 Mar 2013 23:08:33 +0100

In yesterday's note, I mused about the Cerner purchase of Labotix (see: Cerner Enters Lab Automation Market with Purchase of Labotix but Why?). The post elicited the following comment: I have never been a fan of Cerner for a host of reasons. Nevertheless, their acquisition of Labotix is dumb, at best. The lab industry is littered with similar disasters. Within a few years Labotix will quietly slide away as a "diversion" to Cerner's core business. The message is "stick to your knitting" and you won't get burned. Charging into a low margin hardware business will not save a software business. The wonks at Cerner will eventually figure that out. Here's the last two sentences of my note: Cerner may have purchased Labotix with its 22 associates and contractors...

In the Genes

ADVANCE Discourse: Lab — Wed, 27 Mar 2013 20:40:00 +0100

The ethical implications of genetic sequencing are really only just beginning to be fully realized, and these questions continue to contribute to the growing debate over information provided by the human genome. A recent story from NPR chronicled Henrietta...(read more) (Source: ADVANCE Discourse: Lab)

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Cerner Enters Lab Automation Market with Purchase of Labotix but Why?

Lab Soft News — Wed, 27 Mar 2013 01:46:09 +0100

My impression about Cerner over roughly the past decade has been that the company left the pathology and clinical lab market behind in its pursuit of the larger EHR market. Now comes the news that it has acquired Labotix and seems to be interested in integrating its AP-LIS with this open-source lab automation system (see: Cerner Corporation Enters the Clinical Laboratory Automation Market by Acquiring Labotix Automation). Below is an excerpt from the article about the purchase from the Dark Daily: Never before has a major LIS vendor boldly acquired a lab equipment manufacturer with an intent to integrate and sell both products as a bundle to medical laboratories. In an unexpected move, healthcare informatics giant Cerner Corporation... purchased a clinical laboratory automation compa...

Case of the Week 251

Creepy Dreadful Wonderful Parasites — Mon, 25 Mar 2013 18:25:00 +0100

This case was generously donated by MicrobeMan and Dr. Euna Choi:A 56-year old male who had just returned hom from a safari in Uganda presented with a red swollen nodule over the right iliac crest and a 1.5 cm x 0.5 cm white-tan object was removed and submitted to surgical pathology. The following are H&E stained sections of this object:20 times original magnification20 times original magnification40 times original magnification100 times original magnification100 times original magnification 100 times original magnificationIdentification? (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 251

Creepy Dreadful Wonderful Parasites — Mon, 25 Mar 2013 00:47:00 +0100

Answer: fly larva; clinical presentation is consistent with myiasisMany commented that identification becomes more challenging when arthropods are sectioned and stained since the external features are obscured or lost. However, there are still features that allow us to positively identify this as a fly larva such as the overall size and shape, mandibles, and yellow cuticular spines:Unfortunately, definitive identification to the genus or species level is not possible without macroscopic examination of the larva. Therefore, we instead must rely on the clinical history, which would suggest that this larva is likely Cordylobia anthropophaga, otherwise known as the mango fly, tumbu fly, or putzi fly. This myiasis causing fly is endemic to parts of east and central Africa...

Atomic force microscopy! EMT and idiopathic pulmonary fibrosis

The Daily Sign-Out — Sat, 23 Mar 2013 14:48:37 +0100

Here is a very intesting article I recently found with some very cool technology: Abstract: Epithelial-mesenchymal transition (EMT) is closely implicated in the pathogenesis of idiopathic pulmonary fibrosis. Associated with this phenotypic transition is the acquisition of an elongated cell... (Source: The Daily Sign-Out)

Hybrid Model of On-Site and Remote Radiology for Enhanced Patient Workflow

Lab Soft News — Sat, 23 Mar 2013 14:36:43 +0100

Because teleradiology is so well established and digital pathology (i.e., telepathology) still in its infancy, we need to look carefully at how teleradiology is evolving to order to plan our own future in pathology. I have always held the opinion that digital pathology will not replace pathologists in smaller hospitals but rather support and supplement their work. Currently, pathologists in smaller hospitals select their most challenging surgical pathology cases and send the glass slides, via expedited delivery, to their favorite consultants for an additional opinion. The time interval for the return of the consultant reports will be variable but will usually will be measured in days. Under a digital pathology model, the same hospital pathologists will instead send the whole slide i...

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Handheld Testing

ADVANCE Discourse: Lab — Fri, 22 Mar 2013 21:01:00 +0100

The handheld testing application has always been something I’ve only ever imagined as a bad plot device in science fiction. For researchers at Columbia University’s The Flu Foundation School of Engineering and Applied Science, it was apparently much,...(read more) (Source: ADVANCE Discourse: Lab)

Google Launches Renewed Effort in Cloud Computing; Reaction in Hospitals

Lab Soft News — Thu, 21 Mar 2013 18:12:50 +0100

The future of large-scale, complex computing will undoubtedly involve the cloud. This scenario should include healthcare but the industry will embrace cloud computing late and perhaps never (see later). Cloud computing is an area where Google has lagged in development but is now trying to catch up according to a recent article (see: Google Elbows Into the Cloud), Below is an excerpt from it: In a battle for dominance in cloud computing, Google is taking on Microsoft and Amazon in their own back. Google said... that it was doubling its office space near Seattle, just miles from the campuses of Amazon and Microsoft, and stepping up the hiring of engineers and others who work on cloud technology. It is part of Google’s dive into a business known as cloud services — renting to other ...

How do you calculate a brain tumor's MIB-1 index?

neuropathology blog — Thu, 21 Mar 2013 15:22:00 +0100

Elizabeth J. Cochran, MDI was recently contacted by the affable Elizabeth Cochran, MD asking if I would post a query regarding MIB-1 counts on brain tumors. Does anyone know if there is a standardized approach to this? Please tell us your approach to MIB-1 quantification in the comment section. Dr. Cochran takes an approach based on an article she had read in Human Pathology some time ago, summarized as follows: 1. Examine control section stained with MIB-1 antibody to confirm that the stain worked.2. Survey the slide of the case to be counted to find the area(s) that have the most stained nuclei.3. Put reticule in right eyepiece of microscope.4. Place the area identified in #2 under the reticule at 40x power.5. Using the hand held counter, count all the immunoreactive nuclei w...

The Fine Print

ADVANCE Discourse: Lab — Wed, 20 Mar 2013 20:42:00 +0100

I remember when the Body Worlds Exhibit came to my local museum. I couldn’t believe it -- those were real people. My dad laughed when I told him about it and said, “That’s why you really have to read the fine print when you sign up to be an organ donor.”...(read more) (Source: ADVANCE Discourse: Lab)

Intestinal Ova Detected by iPhone Camera in Tanzania

Lab Soft News — Wed, 20 Mar 2013 15:12:46 +0100

The idea of using an iPhone to run health apps and for various types of physiologic monitoring with plug-in devices has been much in the news (see: Patients as Monitors of Their Own Health; Conflation of Health Monitoring by Mobile Devices with Access to EMR & PHR Data; Healthcare Consumers as Self-Trackers; Process Enabled by New Apps). A recent article raises the possibility of using the iPhone camera for the diagnosis of intestinal worm infections in rural Tanzania (see: Worms detected by converted iPhone microscope). Below is an excerpt from it: Scientists used an iPhone 4S to diagnose intestinal worm infections in schoolchildren in rural Tanzania. They attached an $8...ball lens to the handset camera lens, and used a cheap [flashlight] and double-sided tape to create a...

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Patients with a Cancer Should Seek Treatment in Cancer Hospitals

Lab Soft News — Mon, 18 Mar 2013 18:28:48 +0100

For cancer care, I strongly recommend that patients choose oncologists working in well-known cancer hospitals (see: Some Tips for Selecting a "Good" Doctor and a "Good" Hospital). The reasons for such a choice are the following: (1) these physicians generally have specialized practices with better patient outcomes; (2) they often engage in research and teaching and thus are on the forefront of science and technology; and (3) they are generally salaried so that their livelihoods are not dependent on the selection of higher-priced therapies which may not be optimal for patients. In multiple previous notes, I have commented on the oncology or chemotherapy concession (see: Academic Oncology and the "Chemotherapy Concession"; The Oncology Concession Under At...

Case 250

Creepy Dreadful Wonderful Parasites — Sun, 17 Mar 2013 17:36:00 +0100

Welcome to Case 250! Here is a challenging case (in a little more detail than normal) to commemorate this milestone post:A 90-year-old male from Missouri presented with a 3-day history of fever and dyspnea. His medical history included hypertension and splenectomy due to injury. He lived with his wife and reported no recent travel, pet or known tick exposure. On admission, he was febrile (temperature 40˚C) and hypotensive (105/58). Laboratory values of note were elevated leukocytes (13,100 cells/mL; 58% neutrophils), decreased hemoglobin (9.5 g/dL), low platelet count (106,000 cells/mL), increase liver function tests (total bilirubin 3.2; alkaline phosphatase 45 units per liter; aspartate transaminase 1935 units per liter; alanine transaminase 872 units per liter). Chest r...

Answer to Case 250

Creepy Dreadful Wonderful Parasites — Sat, 16 Mar 2013 16:57:00 +0100

Answer: Babesiosis, due to a species other than B. microtiThank you all for the comments! Most of you realized that there was something special about this case given the classic morphologic features of babesiosis (with many tetrads/maltese cross forms), supportive clinical history, and yet repeatedly negative PCR tests for B. microti. (The fact that I chose this as the 250th case probably also let you know that there was something unusual about it!) As some of you mentioned, the blood film results are diagnostic for babesiosis, regardless of the PCR results, and therefore further work-up is not necessarily required for patient care. However, we were very curious to know what the causative species of his infection was and felt that the negative PCR ha...

An oddball sellar region mass

neuropathology blog — Fri, 15 Mar 2013 20:26:00 +0100

In the last post, it was noted that Dr. Peter Burger presented a series of sellar region "oddball lesions" at the recent USCAP meeting. The esteemed Dr. Mark Cohen was good enough to provide photographs (above) of one particular lesion that was discussed at the meeting: an osteolipoma of the tuber cinereum. Thank you, Dr. Cohen! (Source: neuropathology blog)

Most Web Site Internal Search Engines Are Inadequate

Lab Soft News — Fri, 15 Mar 2013 18:18:58 +0100

I have been frustrated for years by the inadequacy of many web site internal search engines. I will use the search engine of the New York Times as one example of my point. After I have read a story in the print edition of the newspaper, I will then often try to access the same story on-line using the NYT internal search feature in preparation for writing a blog note. For search terms, I may use two or three of the exact words from the newspaper headline and then fail to retrieve the article most of the time. I often then include in the search the last name of the reporter. This usually works for me. By way of contrast, my Google searchs on almost any topic, even with what may be inadequate search terms, almost always satisfy me. Keep in mind that Google, of course, covers all of the inform...

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Dr. Thomasina Bailey reviews pituitary session at recent USCAP meeting

neuropathology blog — Thu, 14 Mar 2013 19:33:00 +0100

A guest post from Thomasina Bailey, MD: I spent Saturday night, March 9, up late in Baltimore at the AANP session at USCAP. The talks focused on sellar lesions. The panel consisted of Drs. Lopez, Kleinschmidt-DeMasters, and Burger. Dr. Lopez from UVA gave a really great overview of sellar lesions focusing in on pituitary adenomas. She discussed the things that are clinically significant in the work-up of pituitary adenomas along with the controversies over atypical adenomas and carcinomas of the pituitary. At the end of her talk, she listed her own WHO classification of pituitary adenomas giving a comparison to meningioma WHO grading.The next lecture was given by Dr. Kleinschmidt-DeMasters of University of Colorado on What’s New in Inflammat...

Unreported Drug Side Effects Discovered by Analysis of Google Big Data

Lab Soft News — Thu, 14 Mar 2013 18:34:10 +0100

Discussion about Big Data; Relevance for Healthcare). The key aspect of such Google research is understanding how to interpret search engine queries. Here's a graph of the search term gonorrhea from Google Trends with volume peaking in October, 2010. A correlation with relevant news headlines is also provided. (Source: Lab Soft News)

T-cells, Bee Cells

ADVANCE Discourse: Lab — Wed, 13 Mar 2013 20:16:00 +0100

It seems like bees have been all over the news lately. Even if a story isn’t directly about them, it somehow seems to find a way to relate. A recent story from Newswise cited the similarities between honey bees and human T-cells, which have apparently...(read more) (Source: ADVANCE Discourse: Lab)

CIOs and Central IT Departments Have Become Increasingly Less Useful

Lab Soft News — Wed, 13 Mar 2013 13:25:37 +0100

Here's an interesting article from outside of healthcare about the lack of utility of IT departments and CIOs (see: IT Departments Have Become Completely Useless), See if you agree with him. The use of the word "useless" in the title certainly overstates the case but most of the points in the article are sound. Below is an excerpt from it: The role of the CIO, the Chief Information Officer, has been debated about as long as the term in itself exists. Rarely before has there been such a misleading description, because in many companies the person assuming the position of CIO was rarely seen as the chief 'Information' Officer....I teach a course at London Business School for the Senior Executive Program. Top executives from all over the world spend three weeks in London...

ACOs Won't Work According to Clayton Christensen in the WSJ

Lab Soft News — Tue, 12 Mar 2013 13:18:38 +0100

Clayton Christensen and colleagues published a recent op-ed piece in the Wall Street Journal explaining why ACOs won't work (see: The Coming Failure of 'Accountable Care'). I have expressed similar sentiments about these organizations in the past. The concept was invented by the federal government and not by physicians and hospital executives who are responsible for creating and managing them (see: Hospital Executives Search for the Formula for an Accountable Care Organization; ; How to Define and Reduce Unnecessary Services). Most of these incumbents are not that interested in decreasing the cost of healthcare and generally like the status quo. Below is a truncated version of the WSJ article. I am only presenting the highlights so link to the original if you ...

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API and ASCP Forge Alliance

Lab Soft News — Mon, 11 Mar 2013 14:23:12 +0100

Discussion about Integration of Surgical Pathology with Molecular Diagnostics). I plan to return to this idea in upcoming notes. (Source: Lab Soft News)

Case of the Week 249

Creepy Dreadful Wonderful Parasites — Sun, 10 Mar 2013 20:39:00 +0100

Only 1 more week until we get to case 250! We're almost also at our 6-year anniversary. My first post was on March 25, 2007. Time flies... I'm still accepting suggestions if you have a special parasite that you would like to see for Case 250.Now on to this week's case - another donation by Florida Fan with a story to go with it:"While checking the air conditioner outside a rental property for a friend, we were swarmed with these (insert identification here). While they barely measured 2mm in length, they had no difficulty jumping up to our knees and at least an inch or two higher. The blood meal is still evident in the abdomen." (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 249

Creepy Dreadful Wonderful Parasites — Sat, 09 Mar 2013 17:37:00 +0100

Answer: As stated by Eagleville, "Jumpin' Jehosaphat! It's a flea. Sez me."This is indeed a flea, an insect of the order Siphonaptera. Adult fleas are characterized by their laterally flattened wingless bodies, long legs designed for jumping, and tube-like mouthparts for feeding on blood from their host. The presence of both genal and pronotal combs (shown below) with more than 5 "teeth" on the genal comb allow this flea to be identified as either Ctenocephalides felis or C. canis, the cat and dog flea respectively. Identification to the species level is based on more subtle characteristics of the hind tibiae and head.For some additional Flea Fun, check out this YouTube video that shows how fleas jump using their "feet" rather than their "knees."...

Hot off the presses - ASCP and API Forge Alliance

Pathology Informatics from the Trenches — Fri, 08 Mar 2013 21:36:00 +0100

Special Ingredient

ADVANCE Discourse: Lab — Fri, 08 Mar 2013 21:04:00 +0100

Allow me to introduce you to the most famous cell you’ve never met. Traditionally, when we think of brain cells, we think of neurons -- up until today, I was blissfully unaware that there were even any other types of cells up there. Glial cells are similar...(read more) (Source: ADVANCE Discourse: Lab)

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Barefoot Blues

ADVANCE Discourse: Lab — Wed, 06 Mar 2013 22:04:00 +0100

Whether working at the bench or on the floor, clinical laboratorians tend to be on their feet a lot. Recently, there’s been a fad going around supporting minimalist sneakers -- you’ve probably seen a pair. They’re the ones that have places for your toes...(read more) (Source: ADVANCE Discourse: Lab)

Case of the Week 248

Creepy Dreadful Wonderful Parasites — Tue, 05 Mar 2013 01:45:00 +0100

Dear Readers,We are approaching the 250th Case! I think that #250 should be extra special and therefore I will be looking through all of my archives for something really fun. If any of you have any suggestions for a case you'd like to see, please let me know and I'll see what I can do.Now, on to this week's case, donated by Florida Fan:(a bit of a challenging case)The following were seen in a stool specimen from a 3 year old male. No other history was provided. Identification? The images were taken at 40x magnification, so each each mark on the scale bar represents 2.5 microns (eggs measure approximately 100 microns in length by 50 microns in width).Identification? (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 248

Creepy Dreadful Wonderful Parasites — Sun, 03 Mar 2013 19:47:00 +0100

Answer: Eggs of Macracanthorhynchus sp., one of the "thorny-headed" worms causing human acanthocephaliasis. The main Macracanthorhynchus species that infects humans is M. hirudinaceous, although a second species, M. ingens, can also rarely infect humans (there have been a few case reports), and the eggs of the two cannot be differentiated microscopically. Humans typically become infected following ingestion of larvae in the intermediate insect host - usually hydrophilid or scarabaeoid beetles for M. hirudinaceous and milipedes for M. ingens. I tend to agree with Anonymous that the child was more likely to eat a beetle than a miilipede, but you never know with kids! Humans are accidental hosts, while the definitive hosts in nature are pigs for M. hirudinace...

Steady Hands

ADVANCE Discourse: Lab — Fri, 01 Mar 2013 21:01:00 +0100

In what has to have been one of the most fun research studies in the history of academia, 21 surgical residents had to play video games on the Nintendo Wii “for an hour a day, five days a week, for four weeks” during their residency. In an article on...(read more) (Source: ADVANCE Discourse: Lab)

Results of CDC Study on Weight vs. Mortality Questioned by Experts

Lab Soft News — Fri, 01 Mar 2013 13:00:00 +0100

Everyone "knows" that overweight people have an increased mortality, right? When an article was published by a researcher from the CDC, the obesity researchers were aghast. It concluded that slightly overweight people have a lower all-cause mortality than normal weight and underweight people. These researchers convened a panel at Harvard to look at the meta-analysis methodology used in the controversial article. The result of all of this is described in an article on the web site of the Harvard Medical School (see: Weight and Mortality), Below is an excerpt from it. Read the whole article for more details. In January, when the Journal of the American Medical Association published a meta-analysis of 100 studies that probed the relationship between body mass index and mortali...

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Bionic Hand Can Feel

ADVANCE Discourse: Lab — Wed, 27 Feb 2013 21:33:00 +0100

Oh, yes. You read that correctly. It seems a Swiss researcher’s recent development in prosthetics has brought us just a little bit closer to a Star Wars level of innovation. According to an article from NBC News, the prosthetic limb is a usable appendage...(read more) (Source: ADVANCE Discourse: Lab)

eClinicalWorks Creates Healow; Integrates Multiple EHRs with Mobile App

Lab Soft News — Wed, 27 Feb 2013 17:14:00 +0100

eClinicalWorks has always been one of the most popular office EHRs (see, for example: More on eClinicalWorks: A Successful PMS for Office Practices; President of eClinicalWorks Discusses PHRs and Patient Portals). I consider the company to well managed, innovative, providing a product valued by its office-based physician customers. Their EHR seems to be reasonably priced and designed to meet its customer' needs. Interestingly, the company now comes to market with a product to integrate electronic records from multiple EHR vendors (see: Healow integrates patient medical records from multiple EHR systems), Here is an excerpt from a blog note about this news: eClinicalWorks has created a new business called Healow (Health and Online Wellness).The $25 million investment is aimed to b...

Review by Dr. Mark Cohen of "Neuropathology: A Volume in the High Yield Pathology Series", edited by Yachnis and Rivera-Zengotita

neuropathology blog — Tue, 26 Feb 2013 18:53:00 +0100

Mark L. Cohen, MDI am honored to present a guest post by the inimitable Dr. Mark Cohen of the illustrious Case Western Reserve University. Dr. Cohen not only reviews a great new neuropathology textbook, but illustrates yet again why he is widely known as the Maxwell Smart of Neuropathology. (Not really) Full disclosureSelf-annihilating conflicts of interest, as follows:Long-standing professional relationship with unbridled admiration for lead editor Tony Yachnis, both as a person and as a pathologist (he's not the Moderator of the world-famous Diagnostic Slides Session of the American Association of Neuropathologists, as well as their President-Elect, for nothing).I have contributed to several publications that compete within the same niche, and from which I have amassed a smal...

Case of the Week 247

Creepy Dreadful Wonderful Parasites — Tue, 26 Feb 2013 00:01:00 +0100

A businessman recently returned from India with recurring fevers and malaise. The following were seen on peripheral blood films. Identification? (CLICK ON IMAGES TO ENLARGE)Giemsa stain, 1000x original magnification (Source: Creepy Dreadful Wonderful Parasites)

Cancer Business Highly Remunerative for Sloan-Kettering Executives

Lab Soft News — Mon, 25 Feb 2013 15:10:58 +0100

I have posted a number of previous notes about the so-called oncology or chemotherapy concession that refers to the markups on the chemotherapeutic agents administered by oncologists to their patients (see: Academic Oncology and the "Chemotherapy Concession"; The Oncology Concession Under Attack by Health Insurance Companies). When the oncologists are salaried hospital employees, much of these profits are retained by the cancer hospitals that employ them. A recent article took a close look at Memorial Sloan-Kettering Cancer Hospital in New York and the salaries of their executive officers (see: The Profit Of Prestigious Cancer Care). Here is an excerpt from the article: In 2011, the hospital and research institution of Sloan-Kettering had an operating profit of $406 million...

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Answer to Case 247

Creepy Dreadful Wonderful Parasites — Mon, 25 Feb 2013 01:18:00 +0100

Answer: Infection with Plasmodium vivaxThere was a lot of great discussion on this case! The definitive features for identification as some readers pointed out were:1. Enlarged infected RBCs (compared to uninfected cells)2. Stippling seen in all forms (a.k.a. Schuffner's dots)3. "Ameboid" shaped of some trophozoites. The presence of stippling and enlarged size of the RBCs automatically puts this into the P. vivax/P. ovale category, and the next step is to differentiate between the 2 species. This can be done by considering the following features:P. vivax late stage trophozoites have an ameboid appearance (vs. P. ovale late stage trophs which are more compact). This can be seen in the following image:(Note that the infected RBCs are enlarged a...

A Breath of Fresh Air

ADVANCE Discourse: Lab — Fri, 22 Feb 2013 20:28:00 +0100

Writing an opening paragraph can be difficult. I like to take a deep breath before I start. It helps to clear things up, and I can think of a good way to introduce a subject without forcing it. I can’t imagine what it would be like if I couldn’t take...(read more) (Source: ADVANCE Discourse: Lab)

Google Strikes Deal with French Government Regarding Online Content

Lab Soft News — Fri, 22 Feb 2013 14:36:13 +0100

I have posted previous notes about the question of whether Google is a search engine and news consolidator or a publisher of content (see: When Does Sophisticated Web Search Result in the Creation of New Content?; Google as an Enabler and Protector of Global Information Exchange; Is Google a Publisher or a Search Engine? Can Google Have It Both Ways?; Google's Deal with Publishers; Broad Current Acceptance of E-Books). According to a recent article, this question has been sorted out, for the time being, in France (see: French Publishers Forge Deal With Google, Breaking Ranks With Europe). Below is an excerpt from the article: Publishers in France say they have struck an innovative agreement with Google on the use of their content online. Their counterparts elsew...

Dog-a-betes

ADVANCE Discourse: Lab — Wed, 20 Feb 2013 21:15:00 +0100

I can only imagine the spokespuppy for doggie diabetes is a bull dog named Woof-ford Brimley, who, instead of barking, speaks in a series of short-breathed and amiable growls. As it turns out, this may not have been too far off in Spain -- at least for...(read more) (Source: ADVANCE Discourse: Lab)

Not Much Progress in the Development of Physician Practice Web Sites

Lab Soft News — Wed, 20 Feb 2013 02:47:32 +0100

I have always thought that the development of practice web sites by physicians would be a wonderful way to reach out to patients and provide medical information as well as services such as the ability to book office appointments. In retrospect, such sites have not been evolved in the same way as other business segments (see: Physicians’ websites are more “electronic brochures” than online health resources). Here is an excerpt from the article: A new survey finds that doctors’ websites are woefully lacking when it comes to serving patients. No surprises there – after all, the most commonly used technology in a doctor’s office is still the fax machine. Here are the details of [a recent] survey [of] ...300 doctors with the highest patient satisfaction ratings in Boston, Denver and...

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Medicare Costs Rise as Knee Replacements Increase for Seniors

Lab Soft News — Mon, 18 Feb 2013 18:47:55 +0100

A portion of the financial challenge facing Medicare is the soaring cost of healthcare delivery in general. Another specific factor is the increasing cost of care for older patients who are covered by the program. One good example of this is knee arthroplasty for seniors on Medicare. This idea was detailed in a recent article (see: Medicare knee replacements surge 162% since 1991). Below is an excerpt from it: The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program....Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization....Th...

HIMSS13: Are You Prepared?

ADVANCE Discourse: Lab — Mon, 18 Feb 2013 17:44:00 +0100

The Annual Conference and Exhibition of the Health Information Management Systems Society is just around the corner, March 3-7, in New Orleans. ADVANCE editors will be on the scene networking with industry experts about important trends and cutting-edge...(read more) (Source: ADVANCE Discourse: Lab)

Case of the Week 246

Creepy Dreadful Wonderful Parasites — Mon, 18 Feb 2013 17:42:00 +0100

The following was sent to the parasitology laboratory for identification:The accompanying fluid was centrifuged and the pellet was examined microscopically, revealing the following object. If measures approximately 60 microns in greatest dimension.Identification? (Source: Creepy Dreadful Wonderful Parasites)

Answer to Case 246

Creepy Dreadful Wonderful Parasites — Sun, 17 Feb 2013 15:52:00 +0100

Answer: Proglottids of Diphyllobothrium sp. As leo-a-go-go said, "...no way of speciating it by microscopy alone, without a geographic history. Would be useful to know if offending fish was from salt or freshwater." Anonymous also noted that "If the patient is from South America, might be D. pacificum rather than D. latum." Worldwide, D. latum is the most frequently reported species in humans. However, the DPDx web site notes that "Several other Diphyllobothrium species have been reported to infect humans, but less frequently; they include D. pacificum, D. cordatum, D. ursi, D. dendriticum, D. lanceolatum, D. dalliae, and D. yonagoensis."Diphyllobothrium spp. proglottids are easily recognized by the fact that they are broader than they are long (hence th...