Corruption: An Impediment to Delivering Pathology and Laboratory Services in Resource-Limited Settings.

OBJECTIVES: Corruption is a widely acknowledged problem in the health sector of low- and middle-income countries (LMICs). Yet, little is known about the types of corruption that affect the delivery of pathology and laboratory medicine (PALM) services. This review is a first step at examining corruption risks in PALM. METHODS: We performed a critical review of medical literature focused on health sector corruption in LMICs. To provide context, we categorized cases of laboratory-related fraud and abuse in the United States. RESULTS: Forms of corruption in LMICs that may affect the provision of PALM services include informal payments, absenteeism, theft and diversion, kickbacks, self-referral, and fraudulent billing. CONCLUSIONS: Corruption represents a functional reality in many LMICs and hinders the delivery of services and distribution of resources to which individuals and entities are legally entitled. Further study is needed to estimate the extent of corruption in PALM and develop appropriate anticorruption strategies.

Ethics of AI in Pathology: Current Paradigms and Emerging Issues.

Deep learning has rapidly advanced artificial intelligence (AI) and algorithmic decision-making (ADM) paradigms, affecting many traditional fields of medicine, including pathology, which is a heavily data-centric specialty of medicine. The structured nature of pathology data repositories makes it highly attractive to AI researchers to train deep learning models to improve health care delivery. Additionally, there are enormous financial incentives driving adoption of AI and ADM due to promise of increased efficiency of the health care delivery process. AI, if used unethically, may exacerbate existing inequities of health care, especially if not implemented correctly. There is an urgent need to harness the vast power of AI in an ethically and morally justifiable manner. This review explores the key issues involving AI ethics in pathology. Issues related to ethical design of pathology AI studies and the potential risks associated with implementation of AI and ADM within the pathology workflow are discussed. Three key foundational principles of ethical AI: transparency, accountability, and governance, are described in the context of pathology. The future practice of pathology must be guided by these principles. Pathologists should be aware of the potential of AI to deliver superlative health care and the ethical pitfalls associated with it. Finally, pathologists must have a seat at the table to drive future implementation of ethical AI in the practice of pathology.

Computational pathology definitions, best practices, and recommendations for regulatory guidance: a white paper from the Digital Pathology Association.

In this white paper, experts from the Digital Pathology Association (DPA) define terminology and concepts in the emerging field of computational pathology, with a focus on its application to histology images analyzed together with their associated patient data to extract information. This review offers a historical perspective and describes the potential clinical benefits from research and applications in this field, as well as significant obstacles to adoption. Best practices for implementing computational pathology workflows are presented. These include infrastructure considerations, acquisition of training data, quality assessments, as well as regulatory, ethical, and cyber-security concerns. Recommendations are provided for regulators, vendors, and computational pathology practitioners in order to facilitate progress in the field. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Ética médica en la práctica anatomopatológica / Medical ethics in anatomical-pathological practice

El objetivo del presente estudio está dirigido a exponer particularidades éticas del trabajo anatomopatológico a la luz de la realidad histórico social. Se emplean métodos teóricos y empíricos y a partir del análisis documental se opera con referentes en los enfoques contemporáneos. El estudio de aspectos generales referidos a la moral y a la ética permitió acceder a definiciones, bases legales y evolución histórica, a la vez que se profundiza en su repercusión en el sector salud y se desarrollan las peculiaridades del trabajo anatomopatológico desde sus manifestaciones en la actividad asistencial, docente e investigativa. Se concluye que los principios éticos generales de la conducta profesional y médica son aplicables al trabajo anatomopatológico en todas sus esferas; al igual que los de la bioética(AU)

The objective of the present study is directed to exhibit ethical peculiarities of the anatomical-pathological work in view of the historical-social reality. Theoretical and empirical methods are used and from the documentary analysis it occurs with modality in the contemporary approaches. The study of general aspects referred to the morality and to the ethics allowed to gain access to definitions, legal bases and historical evolution, simultaneously that deepens in its aftereffect in the sector health and the peculiarities of the anatomical-pathological work develop from its declarations in the welfare, teaching and investigative activity. One concludes that the general ethical beginning of the professional and medical conduct is applicable to the anatomical-pathological work in all its spheres; as those of the bioethics(AU)

Development of a consensus approach for return of pathology incidental findings in the Genotype-Tissue Expression (GTEx) project.

The active debate about the return of incidental or secondary findings in research has primarily focused on return to research participants, or in some cases, family members. Particular attention has been paid to return of genomic findings. Yet, research may generate other types of findings that warrant consideration for return, including findings related to the pathology of donated biospecimens. In the case of deceased biospecimen donors who are also organ and/or tissue transplant donors, pathology incidental findings may be relevant not to family members, but to potential organ or tissue transplant recipients. This paper will describe the ethical implications of pathology incidental findings in the Genotype-Tissue Expression (GTEx) project, the process for developing a consensus approach as to if/when such findings should be returned, possible implications for other research projects collecting postmortem tissues and how the scenario encountered in GTEx fits into the larger return of results/incidental findings debate.

La Anatomía Patológica: presente y futuro / Present and future Pathology

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Pathology Image-Sharing on Social Media: Recommendations for Protecting Privacy While Motivating Education.

There is a rising interest in the use of social media by pathologists. However, the use of pathology images on social media has been debated, particularly gross examination, autopsy, and dermatologic condition photographs. The immediacy of the interactions, increased interest from patients and patient groups, and fewer barriers to public discussion raise additional considerations to ensure patient privacy is protected. Yet these very features all add to the power of social media for educating other physicians and the nonmedical public about disease and for creating better understanding of the important role of pathologists in patient care. The professional and societal benefits are overwhelmingly positive, and we believe the potential for harm is minimal provided common sense and routine patient privacy principles are utilized. We lay out ethical and practical guidelines for pathologists who use social media professionally.

Una nueva figura en la anatomía patológica actual: el patólogo intervencionista / The interventional pathologist: a new role in modern pathology

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"Apologies" from pathologists: why, when, and how to say "sorry" after committing a medical error.

How pathologists communicate an error is complicated by the absence of a direct physician-patient relationship. Using 2 examples, we elaborate on how other physician colleagues routinely play an intermediary role in our day-to-day transactions and in the communication of a pathologist error to the patient. The concept of a "dual-hybrid" mind-set in the intermediary physician and its role in representing the pathologists' viewpoint adequately is considered. In a dual-hybrid mind-set, the intermediary physician can align with the patients' philosophy and like the patient, consider the smallest deviation from norm to be an error. Alternatively, they might embrace the traditional physician philosophy and communicate only those errors that resulted in a clinically inappropriate outcome. Neither may effectively reflect the pathologists' interests. We propose that pathologists develop strategies to communicate errors that include considerations of meeting with the patients directly. Such interactions promote healing for the patient and are relieving to the well-intentioned pathologist.

Prevalence and types of misrepresentation of publication record by pathology residency applicants.

CONTEXT: Publication misrepresentation among residency applicants has been demonstrated in various specialties. This study examines the prevalence of publication misrepresentation among US-trained and non-US-trained pathology residency applicants. OBJECTIVE: To determine the prevalence of publication misrepresentation in the pathology applicant pool at our institution, to compare the rates of misrepresentation among US-trained and non-US-trained applicants, and to compare results to published results from other medical specialties. DESIGN: All peer-reviewed journal articles reported on applications to our program in 2010 and 2011 were examined for veracity. Applications from current or past trainees and applications with unverifiable manuscripts were excluded. The type of misrepresentation and the country in which the applicant trained were recorded. RESULTS: Seven hundred applications were reviewed. Of 319 (46%) reported publications, 25 were from US graduates (8%) and 294 (92%) were from non-US graduates. Eighty-six applications were excluded owing to unverifiable manuscripts. Publication misrepresentations were found in 42 (18%) of the remaining 233 applications. The most common misrepresentations were omission of authors (69%), nonauthorship (14%), and self-promotion on the author list (12%). A significantly higher percentage of foreign medical graduates listed publications (P < .001). The misrepresentation rate by foreign graduates (19%) did not differ significantly from that of US-trained graduates (13%) (P = .45). CONCLUSIONS: Publication misrepresentation was present among pathology residency applicants. Similar rates were seen among US and non-US applicants. Percentages of misrepresentation among applicants to our pathology program and applicants to other medical specialties (18% and 17%, respectively) were comparable.

[Current medicolegal and ethical issues in pathology]. / Aktuelle medizinrechtliche und -ethische Herausforderungen der Pathologie.

The increase in density of information available in relation to patients and research participants, in particular in the context of genetic diagnostics and analysis, results in an increased potential for uncovering details which were unexpected but are of particular significance for the patient. Deciding how this information is dealt with and who is entitled to receive this information, is a medicolegal and ethical balancing act. Incidental findings and the challenges posed by the advent of personalised medicine are but two areas which increasingly impact medical disciplines that do not conventionally work directly with patients. Both areas raise questions of what is legally required and morally necessary. The authors briefly sketch these two areas and the medicolegal and ethical implications for diagnostics and research in pathology.

Ethical issues in dermatopathology.

Some of the most contentious and relevant ethical issues in dermatopathology include client billing, the practice of dermatopathology by physicians without board certification in dermatopathology, and the practice of including recommendations regarding further surgery in dermatopathology reports. Client billing is a system in which clinicians directly compensate laboratories for pathology services and directly bill patients and/or third-party payers. Although proponents argue that this system can reduce health care costs and increase efficiency, others have argued that it creates an environment that fosters unethical, and potentially illegal, behavior. The development of various types of laboratory models, commonly referred to as "contractual joint ventures," has served to expand client billing. Although the field of dermatopathology is considered a subspecialty of both clinical dermatology and anatomic pathology, dermatopathology is commonly practiced by clinical dermatologists and general anatomic pathologists who are not board certified in dermatopathology. Although these physicians are legally entitled to practice dermatopathology, some have questioned the ethics of this situation, especially when board-certified dermatopathologists are available. Finally, dermatopathology reports, on occasion, include suggestions regarding the need for additional surgery or other clinical courses of action. Although established guidelines do not fully endorse or discourage this practice, various opinions exist regarding its affect on patient care.

Linfangioleiomiomatosis: presentación de 6 casos y revisión de la literatura / Six cases of lymphangioleiomyomatosis and a review of the literature

Dentro del grupo de enfermedades intersticiales pulmonares, la linfangioleiomiomatosis (LAM) representa una rara entidad, de etiología desconocida que afecta principalmente a mujeres. La proliferación de células inmaduras de estirpe muscular en el pulmón, y la posterior formación de espacios quísticos, eventualmente condicionan la instauración de insuficiencia respiratoria. Hasta el momento no se dispone de opciones efectivas para el tratamiento de esta condición progresiva, y sólo el trasplante pulmonar ofrece una alternativa terapéutica. Presentamos una serie de 6 casos de LAM vistos en nuestro servicio entre los a˜nos 2002 a 2009, así como una revisión de la literatura(AU)

Within the group of pulmonary interstitial lesions, lymphangioleiomyomatosis (LAM) is a rare disease of unknown aetiology principally affecting females. The proliferation of immature muscle cells in the lung, together with subsequent cyst formation, eventually triggers respiratory failure. To the best of our knowledge, there is as yet no effective treatment for this progressive condition except lung transplant in severe cases. We report 6 cases of LAM from our archives between the years 2002 and 2009, together with a review of the literature(AU)

En busca de una solución al papel del patólogo ante los retos de la nefropatología y otras subespecialidades / In search of a solution for the role of the pathologist in nephropathology and other sub-specialities

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