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Choosing Wisely Champions Spark Innovation in Health Care 明智选择冠军激发医疗保健创新
Pub Date : 2016-10-01 DOI: 10.1093/CRIVAL/VAW026
S. Montgomery
![Graphic][1] Unnecessary and wasteful practices in medicine continue to burden an already strained healthcare system. The current healthcare climate, however, provides pathologists and laboratory professionals a remarkable opportunity to lead the way in reducing unnecessary, often harmful testing while improving patient care.In collaboration with the American Board of Internal Medicine (ABIM) Foundation, ASCP would like to recognize several individual clinicians, as well as clinician teams, and their commitment to the ABIM Foundation's Choosing Wisely campaign. Since ASCP joined the Choosing Wisely campaign in 2013, many of its members have worked to advance the campaign's ideals, which intend to reduce waste in health care, in part by encouraging clinicians and patients to question which tests are really necessary, in order to decrease test overuse and improve the nation's healthcare system.“The Choosing Wisely Champions program recognizes clinicians for their contributions to the campaign, inspires clinicians seeking to implement Choosing Wisely in their own practices, and demonstrates how clinicians are driving change in health care,” says Lee H. Hilborne, MD, MPH, DLM(ASCP)CM, FASCP, chair of the ASCP Effective Test Utilization Subcommittee. “Clinicians can learn from one another by highlighting exemplars.”The Choosing Wisely Champions were chosen for advancing Choosing Wisely in their practice, playing a major role in the development of ASCP's recommendations, educating ASCP members about Choosing Wisely , conducting measurement of recommendations, validating research on the importance of recommendations, and demonstrating leadership of a local Choosing Wisely effort.Below are the honorees and a synopsis of their achievements.### Jason Baron, MD; Anand Dighe, MD; John Branda, MDThe Division of Laboratory and Molecular Medicine in the Department of Pathology at Massachusetts General Hospital (MGH) hosts a highly active, … [1]: /embed/inline-graphic-1.gif
[1]医学上不必要和浪费的做法继续加重本已紧张的医疗保健系统的负担。然而,目前的医疗环境为病理学家和实验室专业人员提供了一个非凡的机会,可以在改善患者护理的同时减少不必要的、往往有害的测试。ASCP与美国内科委员会(ABIM)基金会合作,希望表彰几位临床医生个人,以及临床医生团队,以及他们对ABIM基金会明智选择运动的承诺。自ASCP于2013年加入明智选择运动以来,其许多成员一直致力于推进该运动的理想,即减少医疗保健方面的浪费,部分方法是鼓励临床医生和患者质疑哪些测试是真正必要的,以减少测试的过度使用,改善国家的医疗保健系统。“明智选择冠军项目表彰临床医生对该运动的贡献,激励临床医生在自己的实践中寻求实施明智选择,并展示临床医生如何推动医疗保健变革,”医学博士、公共卫生硕士、DLM(ASCP)CM、FASCP、ASCP有效测试利用小组委员会主席Lee H. Hilborne说。“临床医生可以通过突出榜样来相互学习。”选择明智的冠军被选中是因为他们在实践中推进了选择明智,在ASCP建议的发展中发挥了重要作用,教育ASCP成员关于选择明智,进行建议的衡量,验证建议重要性的研究,并展示了当地选择明智的领导作用。以下是获奖名单和他们的成就摘要。杰森·巴伦,医学博士;阿南德·迪格,医学博士;约翰·布兰达,医学博士麻省总医院(MGH)病理学部的实验室和分子医学部门举办了一个非常活跃的…[1]:/embed/inline-graphic-1.gif
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引用次数: 0
Follow the Leader: Developing Great Leadership Skills 跟随领导:培养伟大的领导能力
Pub Date : 2016-10-01 DOI: 10.1093/CRIVAL/VAW024
A. Kurec
Leadership. Scanning the Internet, one finds thousands of articles, blogs, books, and webinars on how to be a leader or, more importantly, how to be a better leader. While each person may define leadership differently, he or she will likely hold a number of concepts in common. Much of what is written is based on practical and logical tactics, yet for many, these fall short of implementation, and thus become a source of failure. Great leaders, however, apply these tactics in conjunction with other innate skills to provide appropriate guidance for themselves and those around them.
领导。浏览互联网,你会发现成千上万篇关于如何成为一名领导者的文章、博客、书籍和网络研讨会,更重要的是,如何成为一名更好的领导者。虽然每个人对领导力的定义不同,但他或她可能会有一些共同的概念。书中的许多内容都是基于实用和合乎逻辑的策略,但对许多人来说,这些策略无法实现,从而成为失败的根源。然而,伟大的领导者将这些策略与其他天生的技能结合起来,为自己和周围的人提供适当的指导。
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引用次数: 2
Innovative Technology and Collaboration Move Cancer Diagnostics to the Forefront in Sub‐Saharan Africa 创新技术和合作将撒哈拉以南非洲的癌症诊断推向前沿
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW012
S. Montgomery
ASCP President David N.B. Lewin, MD, FASCP, left, and ASCP CEO E. Blair Holladay, PhD, SCT(ASCP)™, review the first biopsied breast cancer image uploaded from Rwanda.As African economic development improves, the prevalence of non‐communicable diseases (NCDs) will increase, with cancer at the forefront. NCDs such as cardiovascular disease, cancer, chronic respiratory diseases, and diabetes are often associated with the “globalization of unhealthy lifestyles" such as unhealthy diets, physical inactivity, exposure to tobacco smoke, or the effects of alcohol.1Over the next five years, the annual number of new cancer cases is predicted to increase to 1 million.2 The economic costs associated with cancer—both immediate healthcare costs and loss of productivity—are threatening continued development and prosperity. Deaths from preventable cancers mean catastrophic health expenditures, lower household income, and potential impoverishment. Globally, the World Economic Forum projects that the NCD epidemic will inflict $21.3 trillion in losses in developing countries over the next two decades.3Pathology is important for diagnosing and treating cancer, but the countries in Sub‐Saharan Africa lack pathologists and trained laboratory personnel, infrastructure, and adequate opportunities for professional training.In October 2015, the American Society for Clinical Pathology (ASCP) and a coalition of partners committed to provide patients in underserved areas of Sub‐Saharan …
ASCP总裁David N.B. Lewin,医学博士,FASCP(左)和ASCP首席执行官E. Blair Holladay, SCT(ASCP)™博士,查看从卢旺达上传的第一张乳腺癌活检图像。随着非洲经济发展的改善,非传染性疾病(NCDs)的流行将会增加,而癌症首当其冲。心血管疾病、癌症、慢性呼吸系统疾病和糖尿病等非传染性疾病往往与“不健康生活方式的全球化”有关,如不健康的饮食、缺乏身体活动、接触烟草烟雾或酒精的影响。在今后五年中,预计每年新发癌症病例数将增加到100万例与癌症相关的经济成本——即时医疗成本和生产力损失——正威胁着持续的发展和繁荣。可预防癌症导致的死亡意味着灾难性的医疗支出、较低的家庭收入和潜在的贫困。在全球范围内,世界经济论坛预测,未来20年,非传染性疾病流行病将给发展中国家造成21.3万亿美元的损失。病理学对诊断和治疗癌症很重要,但撒哈拉以南非洲国家缺乏病理学家和训练有素的实验室人员、基础设施和充分的专业培训机会。2015年10月,美国临床病理学会(ASCP)和一个合作伙伴联盟承诺为撒哈拉以南地区服务不足地区的患者提供…
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引用次数: 0
A Changing Workforce Brings New Challenges, Opportunities 不断变化的劳动力带来新的挑战和机遇
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW017
H. C. Sullivan
![Graphic][1] “For last year's words belong to last year's language And next year's words await another voice .And to make an end is to make a beginning!' “Little Gidding,” T. S. EliotI am a creature of habit, uncomfortable with the idea of change. As I approach the end of my fellowship, my fellow cohorts, who started training with me five years ago, are all moving on to become practicing pathologists out there in the “real world.” While I am happy for them as they start this new chapter in their lives, I can't help feeling a bit sad to part ways after these years of camaraderie and friend-ship. Though saying goodbye is difficult, finding a job represents the crucial next step in every trainee's career. However, this can be an overwhelming task. I mean, I haven't had to apply for a job since high school, when I submitted an application to the local Ben and Jerry's. Like myself, other residents are just as nervous when it comes to looking for their first job out of training. In fact, when the American Society of Clinical Pathology (ASCP) Resident Council polled residents about issues that matter most, the top three were passing boards, applying for fellowships, … [1]: /embed/inline-graphic-1.gif
[1]“因为去年的话属于去年的语言,明年的话等待着另一种声音。结束就是开始!”——《小吉丁》t·s·艾略特我是个墨守成规的人,不喜欢改变。随着我的研究接近尾声,我的同事们,他们五年前开始和我一起训练,都在“现实世界”中成为执业病理学家。虽然我为他们开始人生的新篇章而感到高兴,但在这些年来的同志情谊和友谊之后,我不禁感到有点难过。虽然说再见很难,但找工作是每个实习生职业生涯中至关重要的下一步。然而,这可能是一项艰巨的任务。我高中毕业后就没找过工作了,那时候我向当地的本杰里餐厅递交了求职申请。和我一样,其他住院医生在培训结束后找第一份工作时也同样紧张。事实上,当美国临床病理学会(ASCP)居民委员会就最重要的问题对居民进行调查时,排名前三的是通过委员会,申请奖学金,…[1]:/embed/inline-graphic-1.gif
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引用次数: 2
The Quest to be the Best-In-Value Clinical Laboratory 追求成为最有价值的临床实验室
Pub Date : 2016-07-01 DOI: 10.1093/crival/vaw018
G. Sharma
![Graphic][1] Our nation's healthcare system is undergoing a massive transformation and reorganization. Along with changing regulations and delivery models, the average patient is more connected to and involved in his or her care, more and more providers are utilizing electronic medical records to coordinate treatment, and insurance companies are leveraging analytical tools to study the pools of subscribers covered.Amidst this change, a slow but steady movement towards “smart” and “value‐added” care is underway. Pathologists and clinical laboratory administrators realize that the transactional fee‐for‐service (FFS) model is on the decline, while value‐based care and testing is on the rise. The Department of Pathology and Laboratory Medicine at Henry Ford Health System, Detroit (PALM HFHS) has taken innovative steps in placing and presenting the value proposition of its laboratory services.In the traditional healthcare delivery model, patient care is delivered through a physician‐led team. All services are transactional and often delivered in silos (clinic, laboratory, radiology, pharmacy, etc.), as requested by the clinical team. Critics of this model have often termed this “sickcare,” rather than healthcare, as the entire delivery mechanism seems to be focused on treating patients rather than keeping populations healthy.![Graphic][2] ![Graphic][3] However, with looming shortfalls in the ability of our nation to fund its burgeoning healthcare costs, recent legislation and healthcare reforms have forced a reconfiguration of this model from an episodic and individualcentric approach to a long‐term and population‐centric approach. The latter is a preventive model of care, where the emphasis is in keeping the patient out of the hospital, and delivering care in the most seamless and cost‐ effective manner.This will also help in addressing the shortage in the trained and skilled personnel needed to sustain the existing care model. In the future, providers and hospitals will be reimbursed and incentivized (and penalized) based on multiple quality … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
[1]我国的医疗体系正在经历大规模的转型和重组。随着法规和交付模式的变化,普通患者与他或她的护理之间的联系和参与程度越来越高,越来越多的医疗服务提供者正在利用电子医疗记录来协调治疗,保险公司正在利用分析工具来研究所覆盖的用户群。在这种变化中,一种缓慢但稳定的“智能”和“增值”护理正在进行中。病理学家和临床实验室管理人员意识到,交易收费服务(FFS)模式正在下降,而基于价值的护理和检测正在上升。底特律亨利福特卫生系统(PALM HFHS)的病理学和实验室医学系在放置和展示其实验室服务的价值主张方面采取了创新措施。在传统的医疗保健服务模式中,患者护理是通过医生领导的团队提供的。根据临床团队的要求,所有服务都是事务性的,并且通常在竖井(诊所、实验室、放射科、药房等)中交付。批评这种模式的人通常将其称为“疾病护理”,而不是医疗保健,因为整个提供机制似乎侧重于治疗患者,而不是保持人群健康。[图][2][图][3]然而,随着我国为迅速增长的医疗成本提供资金的能力日益不足,最近的立法和医疗改革迫使这一模式从以偶然性和个人为中心的方法重新配置为以长期和人口为中心的方法。后者是一种预防性护理模式,其重点是不让患者住院,并以最无缝和最具成本效益的方式提供护理。这也将有助于解决维持现有护理模式所需的训练有素和熟练人员短缺的问题。未来,医疗服务提供者和医院将根据多重质量获得补偿和奖励(和惩罚)…[1]:/embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
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引用次数: 0
If a Patient's Cancer Is So Advanced, Who Decides Whether to Provide Palliative Care or Aggressively Treat It? 如果病人的癌症如此严重,谁来决定是提供姑息治疗还是积极治疗?
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW013
S. Montgomery
![Graphic][1] ![Graphic][2] Aron Rose, MD, is an ophthalmologist specializing in cataract and glaucoma surgery. He has treated patients and been invited to teach worldwide, including in China, Uzbekistan, India, Mongolia, Bhutan, Indonesia, Ghana, Myanmar, Gambia, and Liberia, and is an expert on blindness prevention and treatment in the developing world. The previous director of residency training and an associate clinical professor at the Yale University Schools of Medicine and Nursing, Dr. Rose also lectures regularly at the Yale Multidisciplinary Center for Bioethics.![Graphic][3] He also chairs the Bioethics Steering Committee of the American Society for Clinical Pathology (ASCP)‐led Partners for Cancer Diagnosis and Treatment in Africa, a Clinton Global Initiative: Commitment to Action that provides patients in underserved areas of Sub‐Saharan Africa access to rapid cancer diagnostics and appropriate care and treatment.Annually, approximately 650,000 people develop cancer and about 510,000 cancer deaths occur in Africa due to limited treatment and resources. More than one‐third of cancer deaths in Africa are from cancers that are easily preventable and/or treatable, if detected early. This initiative brings together organizations with the expertise necessary to diagnose cancer earlier and provide appropriate treatment, as well as establish a sustainable laboratory infrastructure to address these issues in the future.By leveraging leapfrog technology, and the skills and experience of ASCP members, clinicians in Sub‐Saharan Africa can have access to … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
医学博士阿伦·罗斯是一位专门从事白内障和青光眼手术的眼科医生。他治疗过病人,并应邀到世界各地进行教学,包括中国、乌兹别克斯坦、印度、蒙古、不丹、印度尼西亚、加纳、缅甸、冈比亚和利比里亚,他是发展中国家预防和治疗失明的专家。Rose博士是耶鲁大学医学院和护理学院的前任住院医师培训主任和临床副教授,他还定期在耶鲁大学多学科生物伦理学中心讲课。他还是美国临床病理学会(ASCP)领导的非洲癌症诊断和治疗合作伙伴的生物伦理指导委员会主席,这是一项克林顿全球倡议:承诺采取行动,为撒哈拉以南非洲地区服务不足地区的患者提供快速的癌症诊断和适当的护理和治疗。由于治疗和资源有限,非洲每年约有65万人患癌症,约有51万人死于癌症。在非洲,超过三分之一的癌症死亡是由早期发现的很容易预防和/或治疗的癌症造成的。这一倡议汇集了具有早期诊断癌症和提供适当治疗所需专业知识的组织,并建立了可持续的实验室基础设施,以在未来解决这些问题。通过利用跨越式技术,以及ASCP成员的技能和经验,撒哈拉以南非洲的临床医生可以访问…[1]:/embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
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引用次数: 0
Investing in Employees, Investing in the Future 投资员工,投资未来
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW019
Rex F. Famitangco
![Graphic][1] ![Graphic][2] The medical laboratory workforce plays a vital, yet often overlooked, role in the healthcare system. Medical laboratory professionals aid in detecting and diagnosing disease or pre‐disease states, as well as in monitoring the progress and results of treatment. Much of the healthcare industry thrives on testing and analyzing medical laboratory data; therefore, medical laboratory professionals are in high demand as the medical field continues to increase the use of laboratory testing for early diagnosis, treatment, and prevention of disease.1Technologies are ever advancing, and in tandem, laboratories are growing to accommodate new tests and testing methodologies. Breakthrough changes in science and medicine allow laboratories to be on the cutting edge of these medical advancements, and because of this, the industry itself is also growing constantly. Furthermore, the face of health care itself is changing. With the emergence of major legislation such as … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
[图][1][图][2]医学实验室工作人员在医疗保健系统中发挥着至关重要的作用,但往往被忽视。医学实验室专业人员帮助检测和诊断疾病或疾病前期状态,以及监测治疗的进展和结果。许多医疗保健行业都在测试和分析医学实验室数据;因此,随着医学领域不断增加对早期诊断、治疗和预防疾病的实验室检测的使用,对医学实验室专业人员的需求很高。技术在不断进步,与此同时,实验室也在不断发展,以适应新的测试和测试方法。科学和医学的突破性变化使实验室处于这些医学进步的前沿,正因为如此,该行业本身也在不断发展。此外,医疗保健本身的面貌也在发生变化。[1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
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引用次数: 4
The Future of the Pathology Workforce 病理学工作者的未来
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW015
D. Lewin
![Graphic][1] ![Graphic][2] As I sit writing this column during Lab Week, I reflect on the difficulties pathology encounters in its workforce, both in the United States and abroad. I have had the opportunity to attend a number of collaborative meetings where we looked at the workforce from a variety of different angles.In the US, the most pressing challenge is the impending shortage in the laboratory professional workforce. The 2014 ASCP Vacancy Survey1 reveals increased vacancy rates (compared to 2012 data) in all areas of the laboratory except cytology and cytogenetics. Additionally, it is anticipated that as Baby Boomers retire, the increased number of retirees will further exacerbate the shortage. Unfortunately the capacity to train new laboratory professionals has been in decline, with the closure of a significant number of laboratory technology training programs (leading to a decrease from 593 programs in 1996 … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
当我在“实验室周”写这篇专栏时,我反思了病理学在美国和国外的工作人员中遇到的困难。我有机会参加了一些合作会议,我们从各种不同的角度看待劳动力。在美国,最紧迫的挑战是即将到来的实验室专业人员短缺。2014年ASCP空缺调查1显示,除细胞学和细胞遗传学外,实验室所有领域的空缺率(与2012年数据相比)均有所增加。另外,随着婴儿潮一代的退休,预计退休人员的增加将进一步加剧劳动力短缺问题。不幸的是,随着大量实验室技术培训项目的关闭(导致1996年的593个项目减少),培训新实验室专业人员的能力一直在下降。[1]:/embed/ in- graph1-1.gif [2]: /embed/ in- graph1-2.gif
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引用次数: 1
Clinical Laboratory Professions Are My Next 临床实验室是我的下一个目标
Pub Date : 2016-07-01 DOI: 10.1093/CRIVAL/VAW016
Rezvaneh Parsa
![Graphic][1] ![Graphic][2] In 2015, the American Society for Clinical Pathology (ASCP) launched “What's My Next” an interactive campaign to address the workforce shortage in laboratory medicine. An important part of “What's My Next” is the Lab Hero program (formerly known as the Career Ambassador program). Since 2009, the Lab Hero program has put laboratory professionals and pathologists in classrooms across the country to teach students about career opportunities in laboratory medicine. Here, Rezvaneh Parsa talks about her experience in the program .My journey to the Lab Hero program began about five years ago, when I was having lunch in the break room of the laboratory where I worked, and I overheard a couple of my histotechnologist colleagues talking about an interesting volunteer opportunity through the Lab Hero program with ASCP. I researched the ASCP website and discovered more about this program, that seemed like a wonderful way to get involved. You can imagine my excitement when I was accepted into the ASCP Lab Hero program for the 20112012 school year.After the program's orientation, I thought about ways to spread the word about my career. I sent a round of emails and letters to the principals, counselors, science teachers, and biology department heads at my daughters' schools in Frisco Independent School District in Frisco, Texas. Those messages … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
2015年,美国临床病理学会(ASCP)发起了一项名为“我的下一步是什么”(What's My Next)的互动活动,以解决检验医学的劳动力短缺问题。“我的下一步是什么”的一个重要组成部分是实验室英雄计划(以前称为职业大使计划)。自2009年以来,实验室英雄项目将实验室专业人员和病理学家放在全国各地的教室里,向学生讲授实验室医学的职业机会。我参加“实验室英雄”项目的经历始于大约五年前,当时我正在实验室的休息室里吃午饭,无意中听到我的几个组织技术专家同事在谈论一个有趣的志愿者机会,通过“实验室英雄”项目与ASCP合作。我研究了ASCP的网站,发现了更多关于这个项目的信息,这似乎是一个很好的参与方式。你可以想象当我被ASCP实验室英雄项目录取为2011 - 2012学年时我的兴奋之情。培训结束后,我开始思考如何传播我的职业。我给女儿们在德克萨斯州弗里斯科市的弗里斯科独立学区上学的校长、辅导员、科学老师和生物系主任发了一系列的电子邮件和信件。[2]: /embed/inline-graphic-2.gif
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引用次数: 0
Workforce and Technology 劳动力和技术
Pub Date : 2016-07-01 DOI: 10.1093/crival/vaw014
E. Holladay
![Graphic][1] In the past decade, the laboratory has undergone changes so profound that it may appear almost unrecognizable to some today. We as pathologists and laboratory scientists are changing the face of healthcare. The work we do accounts for 70 percent of a patient's medical record, and influences diagnostic procedures and treatments. The many advances in laboratory technology in recent years have streamlined many pathology and laboratory services, and in turn have enabled us to provide better, more precise patient care.Some worry that this progress could replace the need for people in the laboratory. But even the most … [1]: /embed/inline-graphic-1.gif
[1]在过去的十年里,实验室经历了如此深刻的变化,以至于今天的一些人可能几乎认不出它来。我们作为病理学家和实验室科学家正在改变医疗保健的面貌。我们所做的工作占病人医疗记录的70%,并影响诊断程序和治疗。近年来,实验室技术的许多进步简化了许多病理学和实验室服务,反过来又使我们能够提供更好,更精确的患者护理。一些人担心,这一进展可能会取代对实验室人员的需求。但即使是最…[1]:/embed/inline-graphic-1.gif
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引用次数: 0
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