Impact of template-based synoptic reporting on completeness of surgical pathology reports.

Synoptic reporting increases completeness and standardization of surgical pathology reports and thereby contributes to an increased quality of clinical cancer care. Nevertheless, its widespread practical implementation remains a challenge, which is in part related to the effort required for setup and maintenance of database structures. This prompted us to assess the effect of a simple template-based, database-free system for synoptic reporting on completeness of surgical pathology reports. For this purpose, we analyzed 200 synoptic reports (100 colon and 100 lung cancer resections each) for completeness as required by the pertinent College of American Pathologists (CAP) protocols and compared these to a control dataset of 200 narrative reports. Introduction of template-based synoptic reporting resulted in improved completeness (98% of mandatory data elements) as compared to narrative reports (77%). Narrative reports showed a high degree of completeness for data elements covered by previously existing dictation templates. In conclusion, template-based synoptic reporting without underlying database structure can be a useful transitory phase in the implementation of synoptic reporting. It can result in a similar degree of completeness as reported in the literature for database solutions and provides other benefits of synoptic reporting while facilitating its implementation

Evaluation of MTAP and p16 immunohistochemical deficiency as surrogate marker for CDKN2A/B homozygous deletion in gliomas.

Homozygous deletion (HD) of the CDKN2A/B locus has emerged as an unfavourable prognostic marker in diffuse gliomas, both IDH-mutant and IDH-wild-type. Testing for CDKN2A/B deletions can be performed by a variety of approaches, including copy number variation (CNV) analysis based on gene array analysis, next generation sequencing (NGS) or fluorescence in situ hybridisation (FISH), but questions remain regarding the accuracy of testing modalities. In this study, we assessed: (1) the utility of S-methyl-5'-thioadenosine phosphorylase (MTAP) and cellular tumour suppressor protein pl61NK4a (p16) immunostainings as surrogate markers for CDKN2A/B HD in gliomas, and (2) the prognostic value of MTAP, across different histological tumour grades and IDH mutation status. One hundred consecutive cases of diffuse and circumscribed gliomas (Cohort 1) were collected, in order to correlate MTAP and p16 expression with the CDKN2A/B status in the CNV plot of each tumour. IDH1 R132H, ATRX and MTAP immunohistochemistry was performed on next generation tissue microarrays (ngTMAs) of 251 diffuse gliomas (Cohort 2) for implementing survival analysis. Complete loss of MTAP and p16 by immunohistochemistry was 100% and 90% sensitive as well as 97% and 89% specific for CDKN2A/B HD, respectively, as identified on CNV plot. Only two cases (2/100) with MTAP and p16 loss of expression did not demonstrate CDKN2A/B HD in CNV plot; however, FISH analysis confirmed the HD for CDKN2A/B. Moreover, MTAP deficiency was associated with shortened survival in IDH-mutant astrocytomas (n=75; median survival 61 vs 137 months; p<0.0001), IDH-mutant oligodendrogliomas (n=59; median survival 41 vs 147 months; p<0.0001) and IDH-wild-type gliomas (n=117; median survival 13 vs 16 months; p=0.011). In conclusion, MTAP immunostaining is an important complement for diagnostic work-up of gliomas, because of its excellent correlation with CDKN2A/B status, robustness, rapid turnaround time and low costs, and provides significant prognostic value in IDH-mutant astrocytomas and oligodendrogliomas, while p16 should be used cautiously

Laughter and humour for personal development: A systematic scoping review of the evidence

The accessibility of laughter and humour make them attractive choices for self-care, and integrative medicine. There is a growing body of literature, but both fields are fragmented and the overall evidence has not been systematically reviewed. The relationship between health and personal development is increasingly recognized. This review scopes the evidence for laughter and humour interventions from the perspective of their potential benefits on personal development. A systematic scoping review used Joanna Briggs guidelines and the Preferred Reporting Items for Systematic Reviews Scoping Review extension (PRISMA-ScR). All-population laughter and humour interventions described in primary and secondary research from 1970, and in English, were searched in Web of Science and PubMed/Medline. Analysis of 240 primary research articles (k), and 11 systematic reviews (K), identified k = 564 discrete articles with studies involving 574,611 participants (n). Twelve large studies (n >15,000) contributed 77% of participants. Classification analysis found more research relating to humour (k = 445, n = 334,996) than laughter (k = 119, n = 239,615) and identified diverse personal development outcomes associated with Biological, Psychological, Social, Environmental, and Behavioural (BPSE-B) factors. This review presents growing evidence for the diverse applications and benefits of laughter and humour. Multiple opportunities for self-care and interventional applications are described. The consideration of personal development outcomes may support tailored applications according to specific needs and objectives. An umbrella Personal Development Theory of laughter and humour, inclusive humour and laughter definitions, and a humour-laughter-affect model are proposed to unify the fields.N/

Code-free machine learning for classification of central nervous system histopathology images.

Machine learning (ML), an application of artificial intelligence, is currently transforming the analysis of biomedical data and specifically of biomedical images including histopathology. The promises of this technology contrast, however, with its currently limited application in routine clinical practice. This discrepancy is in part due to the extent of informatics expertise typically required for implementation of ML. Therefore, we assessed the suitability of 2 publicly accessible code-free ML platforms (Microsoft Custom Vision and Google AutoML), for classification of histopathological images of diagnostic central nervous system tissue samples. When trained with typically 100 to more than 1000 images, both systems were able to perform nontrivial classifications (glioma vs brain metastasis; astrocytoma vs astrocytosis, prediction of 1p/19q co-deletion in IDH-mutant tumors) based on hematoxylin and eosin-stained images with high accuracy (from ∼80% to nearly 100%). External validation of the predicted accuracy and negative control experiments were found to be crucial for verification of the accuracy predicted by the algorithms. Furthermore, we propose a possible diagnostic workflow for pathologists to implement classification of histopathological images based on code-free machine platforms

Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review

Background: The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. Objective/Methods: In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. Results: We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author&rsquo;s interpretation of the intervention success. Conclusions: Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention

N-Acetyltransferase and sulfotransferase activity in human prostate:potential for carcinogen activation

Background N-Acetyltransferases (NATs) and sulfotransferases (SULTs) are key phase 11 metabolizing enzymes that can be involved both in the detoxification and in the activation of many human promutagens and procarcinogens. Methods and results We investigated the expression of NATs and SULTs in human prostate and tested their role in the activation the N-hydroxy (N-OH) metabolite of 2-amino-3-methylimidazo[4,5-f]quinoline (IQ), a dietary carcinogen, to form DNA adducts. Western blotting showed detectable levels of NAT1, SULT1A1 and SULT1A3 with marked inter-individual variation. NAT2 and other SULT enzymes were not detectable. NAT1 was localized by immunohistochemistry to the cytoplasm of epithelial cells. The presence of acetyl Co-enzyme A (acetyl CoA) and 3’-phosphoadenosine-5’-phosphosulfate (PAPS), NAT and SULT cofactors, respectively, significantly increased the level of DNA adducts, detected by (32)P-postlabelling analysis, in calf thymus DNA incubated with N-OH-IQ and prostate cytosolic fractions. The enhancement in the level of DNA adducts in the presence of PAPS correlated with the level of SULT1A1 protein. A single prostate cytosol with the SULT1A1 *2/*2 genotype produced less DNA adducts than cytosols with the *1/*2 and *1/*1 genotypes. No significant correlation was observed between NAT1 protein level and the formation of DNA adducts, even in the presence of acetyl CoA. Conclusions In conclusion, we demonstrated that NAT1, SULT1A1 and SULT1A3 are present in human prostate and that both enzyme classes significantly contribute to the activation of N-hydroxylated heterocyclic amines to DNA-damaging species in this tissue. Variation in expression levels, in combination with dietary and/or environmental exposure to carcinogens, could be influential in determining individual susceptibility to prostate cancer. (C) 2006 Lippincott Williams & Wilkins