Clinical pathology: Difference between revisions

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{{Memorization-worthy}} For the most likely types of cases and/or questions that you may be responsible for, know where to find local '''policies and procedures''', and have a good idea of '''[[Consultation|whom to ask]]''' for further advice. Make sure you have access and/or contact details for '''whenever and wherever''' you are likely to need them.

Preferably have at least a quick look at policies and procedures so that you have an idea of what kind of answers you will find there when needed.

==Hematopathology==

~~Even for [[learning pathology|learning]]~~ hematopathology, focus on the aspects of it that you may be expected to handle rather independently, mainly including '''[[peripheral blood smear]]s''' and general screening of '''[[lymph node]]s'''. Otherwise, a hematopathology workup is generally a very complex matter that should be performed by subspecialists thereof. In the unlikely event that you will end up at an institution without an internal arrangement for how to consult a hematopathologist, make such arrangement yourself, since it will save you a lot of time compared to even trying to learn yourself how to perform a modern hematology workup. <noinclude>Still, if you get the task as a trainee to make a draft of a bone marrow, see '''[[Bone marrow]]'''.</noinclude>

==Sample tube types==

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:*Identifying what questions needs answering

:*Asking proper expertise and/or looking up relevant information in proper sources (see [[learning pathology]]), which may include local protocols as well as policies of accrediting organizations of the department (which are generally more stringent than the national or regional laws).

For location-specific issues, it generally helps to personally '''come and see''' the location at hand.

{{Question|title=Retention time|subsection=yes}}(You may skip this question if you don't expect to ever be part of laboratory management in the US.)

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===Test indication===

In simplified terms, the indication for a test on an individual is primarily determined by its overall positive impact, referred to as the ''net benefit''. Tests are selected when the anticipated benefit outweighs the expected harm. The net benefit may roughly be estimated by:

*bn = Λp * ri * ( bi - hi ) - ht

, where:

* ''bn'' is the net benefit of conducting a test

* ''Λp'' which represents the absolute difference between the pre- and posttest probabilities of certain conditions, like diseases, that the test is expected to detect. This absolute difference is significantly influenced by the test's power, characterized by parameters such as sensitivity, specificity, or likelihood ratio. Additionally, the pre-test probability plays a role, with lower pre-test probabilities resulting in diminished absolute differences. This means that powerful tests may show a low absolute difference for unlikely conditions, while less powerful tests can still have a substantial impact on highly suspected conditions.

* ''ri'' is the rate of probability differences leading to changes in interventions. For instance, if a medical test primarily affects the likelihood of one disease over another but both diseases have the same treatment (or no available treatment), the impact on interventions is minimal, and the test may lack value in that aspect.

* ''bi'' is the benefit of ''changes in interventions'' for the individual

* ''hi'' is the harm of such changes for the individual, including side effects of medical treatment

* ''ht'' is the harm caused by the test itself.

Several other considerations impacting the decision on whether to conduct a medical test include factors such as the test's cost, the accessibility of supplementary tests, potential interference with subsequent tests (for example, abdominal palpation inducing intestinal sounds that may disrupt abdominal auscultation), the time required for the test, and various other practical or administrative aspects. It is also essential to evaluate the potential benefits of a diagnostic test in relation to the costs associated with unnecessary tests, subsequent follow-ups, and possibly unwarranted treatment of incidental findings.<ref name="pmid12783911">{{cite journal |vauthors=Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R |title=Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial |journal=JAMA |volume=289 |issue=21 |pages=2810–8 |year=2003 |pmid=12783911 |doi=10.1001/jama.289.21.2810|doi-access= |s2cid=22897506 }}</ref>

==Other clinical pathology articles==

*[[Common on-call topics]]

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*[[Platelet aggregation study]]

*[[Cytology]]

*[[Microbiology]]

</noinclude>

~~{{Bottom}}~~

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 |author2=
 }}
 {{Memorization-worthy}} For the most likely types of cases and/or questions that you may be responsible for, know where to find local '''policies and procedures''', and have a good idea of '''[[Consultation|whom to ask]]''' for further advice. Make sure you have access and/or contact details for '''whenever and wherever''' you are likely to need them.
+Preferably have at least a quick look at policies and procedures so that you have an idea of what kind of answers you will find there when needed.
 <noinclude>
 ==Hematopathology==
-Even for [[learning pathology|learning]] hematopathology, focus on the aspects of it that you may be expected to handle rather independently, mainly including '''[[peripheral blood smear]]s''' and general screening of '''[[lymph node]]s'''. Otherwise, a hematopathology workup is generally a very complex matter that should be performed by subspecialists thereof. In the unlikely event that you will end up at an institution without an internal arrangement for how to consult a hematopathologist, make such arrangement yourself, since it will save you a lot of time compared to even trying to learn yourself how to perform a modern hematology workup. <noinclude>Still, if you get the task as a trainee to make a draft of a bone marrow, see '''[[Bone marrow]]'''.</noinclude>
+{{Learning hematopathology}}
 ==Sample tube types==
@@ Line 62: / Line 63: @@
 :*Identifying what questions needs answering
 :*Asking proper expertise and/or looking up relevant information in proper sources (see [[learning pathology]]), which may include local protocols as well as policies of accrediting organizations of the department (which are generally more stringent than the national or regional laws).
+For location-specific issues, it generally helps to personally '''come and see''' the location at hand.
 {{Question|title=Retention time|subsection=yes}}(You may skip this question if you don't expect to ever be part of laboratory management in the US.)
@@ Line 112: / Line 113: @@
 |}
 {{Question-end}}
+<noinclude>
+===Test indication===
+In simplified terms, the indication for a test on an individual is primarily determined by its overall positive impact, referred to as the ''net benefit''. Tests are selected when the anticipated benefit outweighs the expected harm. The net benefit may roughly be estimated by:
+*b<sub>n</sub> = Λp * r<sub>i</sub> * ( b<sub>i</sub> - h<sub>i</sub> ) - h<sub>t</sub>
+, where:
+* ''b<sub>n</sub>'' is the net benefit of conducting a test
+* ''Λp'' which represents the absolute difference between the pre- and posttest probabilities of certain conditions, like diseases, that the test is expected to detect. This absolute difference is significantly influenced by the test's power, characterized by parameters such as sensitivity, specificity, or likelihood ratio. Additionally, the pre-test probability plays a role, with lower pre-test probabilities resulting in diminished absolute differences. This means that powerful tests may show a low absolute difference for unlikely conditions, while less powerful tests can still have a substantial impact on highly suspected conditions.
+* ''r<sub>i</sub>'' is the rate of probability differences leading to changes in interventions. For instance, if a medical test primarily affects the likelihood of one disease over another but both diseases have the same treatment (or no available treatment), the impact on interventions is minimal, and the test may lack value in that aspect.
+* ''b<sub>i</sub>'' is the benefit of ''changes in interventions'' for the individual
+* ''h<sub>i</sub>'' is the harm of such changes for the individual, including side effects of medical treatment
+* ''h<sub>t</sub>'' is the harm caused by the test itself.
+Several other considerations impacting the decision on whether to conduct a medical test include factors such as the test's cost, the accessibility of supplementary tests, potential interference with subsequent tests (for example, abdominal palpation inducing intestinal sounds that may disrupt abdominal auscultation), the time required for the test, and various other practical or administrative aspects. It is also essential to evaluate the potential benefits of a diagnostic test in relation to the costs associated with unnecessary tests, subsequent follow-ups, and possibly unwarranted treatment of incidental findings.<ref name="pmid12783911">{{cite journal |vauthors=Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R |title=Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial |journal=JAMA |volume=289 |issue=21 |pages=2810–8 |year=2003 |pmid=12783911 |doi=10.1001/jama.289.21.2810|doi-access= |s2cid=22897506 }}</ref>
 ==Other clinical pathology articles==
 *[[Common on-call topics]]
@@ Line 121: / Line 138: @@
 *[[Platelet aggregation study]]
 *[[Cytology]]
+*[[Microbiology]]
+{{Bottom}}
 </noinclude>
-{{Bottom}}

Clinical pathology: Difference between revisions

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