Pathology Needs and Resources Ann Marie Nelson, MD What is the Goal - - PowerPoint PPT Presentation

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Sep 06, 2022 42 likes •203 views

A Pathologist s Perspective Pathology Needs and Resources Ann Marie Nelson, MD What is the Goal of Pathology ! Provide consistently high quality diagnoses ! This must be linked to ! Capacity to interpret and utilize information for ! Treatment

SLIDE 1

A Pathologists Perspective

Pathology Needs and Resources

Ann Marie Nelson, MD

SLIDE 2

What is the Goal of Pathology

! Provide consistently high quality diagnoses ! This must be linked to

! Capacity to interpret and utilize information for

! Treatment ! Follow-up ! Establishment of registries and biorepositories

SLIDE 3

Cycle of Quality Care

Primary Care Referral Center Pathology Cancer Registries

SLIDE 4

Number of People Per Pathologist: UK*: 15,108 US**: 19,232

*Royal College of Pathologists, 2012, **Anatomic and Clinical Pathologists, AAMC, 2007

Number of People Served By Each Pathologist in Sub-Saharan Africa

MAURITANIA MALI NIGER CHAD SUDAN ETHIOPIA

DJIBOUTI ERITREA

SOMALIA

KENYA TANZANIA

DEMOCRATIC (ZAIRE) CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO

NIGERIA

BENIN DTVOIRE SIERRA SENEGAL GHANA THE GUINEA LIBERIA CAMEROON SOUTH AFRICA

MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA

ANGOLA

UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA

REP. OF

TOGO COTE BURKINA GUINEA LEONE GAMBIA BISSAU Walvis Bay

SOUTH

REPUBLIC AFRICAN THE

AFRICA

No Active Pathologist >5.0 million 2.5-5.0 million 1.0-2.5 million 500,000-1 million 200,000-500,000 Data Not Available

SOUTH SUDAN

SLIDE 5

Issues in Africa

" Pathology infrastructure is inadequate:

" Workforce " Facilities and equipment " Immunohistology " Supply chain breaks lead to inadequate

resource availability.

" Clinicians adapt their clinical practice to

exclude pathology.

" Protocols and QA/QC practices may not be

ptimal.

SLIDE 6

Systems Needs

" Appropriate and timely fixation for routine

and special procedures.

" Efficient transfer of material to pathology " Receipt and documentation of specimens " Case tracking " Reporting " Archiving " Basic working equipment for tissue

evaluation and processing

" Uninterrupted supply chain of quality

reagents

SLIDE 7

Ideal Fixation

! Secure container ! Appropriate size

! Small coin (5mm x 2 cm)

! 10:1 volume of 10%

formalin to specimen

! Buffered to pH 7.2-7.4 ! 6 - 48 h ! Well-fixed tissue gives

good histology and will allow advanced testing

! Immunohistochemistry ! Molecular diagnostics

SLIDE 8

Poor fixation = Poor histology

SLIDE 9

Bad Histology does not always = Bad Fixation

! Dont reject a case based on poor histology

! Re-embed if necessary ! Recut and restain

SLIDE 10

Quality Assurance Needs

" Standard operating procedures and training

f personnel at all levels

" Quality control of specimen collection,

fixation, processing, tissue sections and staining

" Quality assurance of diagnosis - internal

and external review

" Documentation of errors with remediation " On-site assessment

SLIDE 11

Establish Best Practices

" Develop SOPs for the African setting

" Quantify the current state of pathology practices in Africa

using the Situational Analysis Survey (underway).

" Needs Assessment: Identify current QC/QA processes,

Determine feasibility, Establish best practices

" Establish an external quality assurance program " Create standards for telepathology including image

requirements, systems, costs, options for communication, etc.

" Develop Centers of Excellence demonstration

projects.

" Metrics for success and timelines for milestones

SLIDE 12

Education and Training

" Advocacy: Work with national health services,

ministries of health, policy- and decision- makers, and clinicians to advocate for the importance of pathology.

" Develop Histo- and Cyto-tech training. " Identify bursaries for pathologists to attend

relevant professional meetings.

" Promote opportunities for exchange of slides

r other training materials, and identify a

clearinghouse center that can coordinate this.

SLIDE 13

Adequate Pathology Resources Can:

" Benefit clinical services. " Inform cancer control efforts. " Aid the development and implementation

f national cancer control plans.

" Support cancer registration. " Support research on a number of levels,

including epidemiology, basic science, clinical trials, and translational research.

SLIDE 14

The Way Forward

! Use data on workforce to effect policy and

improve infrastructure and training

! Create standardized protocols and uniform

data collection instruments to provide comparable data on disease prevalence

! Reinforce the practice of evidence-based

medicine

! Cost of care is decreased and outcome improved

with the correct diagnosis

! Targeted health programs and pharmacopeia can

be established

SLIDE 15

On the Agenda

! International Academy of Pathology

! Cape Town Oct 1-5. 2012 ! >200 pathologists from SSA

! Proposed NCI meeting

! US in March 2013

! Aortic

! South Africa Fall 2013

SLIDE 16