![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/79/Enterobacter_cloacae_01.png/200px-Enterobacter_cloacae_01.png)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bb/Infiltrating_ductal_carcinoma_of_the_breast.jpg/200px-Infiltrating_ductal_carcinoma_of_the_breast.jpg)
Pathology (from Greek πάθος, pathos, "fate, harm"; and -λογία, -logia) is the study and diagnosis of disease through examination of organs, tissues, bodily fluids, and whole bodies (autopsies). The term also encompasses the related scientific study of disease processes, called General pathology.
Medical pathology is divided in two main branches, Anatomical pathology and Clinical pathology. Veterinary pathology is concerned with animal disease whereas Phytopathology is the study of plant diseases.
History of pathology
The history of pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age and in Western Europe during the Italian Renaissance.
Early systematic human dissections were carried out by the Ancient Greek physicians Herophilus of Chalcedon and Erasistratus of Chios in the early part of the third century BC.[1] The first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161). Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. Most early pathologists were also practicing physicians or surgeons.
Origins of pathology
Early understanding of the origins of diseases constitutes the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age[2] and in Western Europe during the Italian Renaissance.[3]
The Greek physician Hippocrates, the founder of scientific medicine, was the first to deal with the anatomy and the pathology of human spine.[4] Galen developed an interest in anatomy from his studies of Herophilus and Erasistratus.[5] The concept of studying disease through the methodical dissection and examination of diseased bodies, organs, and tissues may seem obvious today, but there are few if any recorded examples of true autopsies performed prior to the second millennium. Though the pathology of contagion was understood by Muslim physicians since the time of Avicenna (980–1037) who described it in The Canon of Medicine (c. 1020),[6] the first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161) who proved that the skin disease scabies was caused by a parasite, followed by Ibn al-Nafis (b. 1213) who used dissection to discover pulmonary circulation in 1242.[7] In the 15th century, anatomic dissection was repeatedly used by the Italian physician Antonio Benivieni (1443–1502) to determine cause of death.[3] Antonio Benivieni is also credited with having introduced necropsy to the medical field.[8] Perhaps the most famous early gross pathologist was Giovanni Morgagni (1682–1771). His magnum opus, De Sedibus et Causis Morborum per Anatomem Indagatis, published in 1761, describes the findings of over 600 partial and complete autopsies, organised anatomically and methodically correlated with the symptoms exhibited by the patients prior to their demise. Although the study of normal anatomy was already well advanced at this date, De Sedibus was one of the first treatises specifically devoted to the correlation of diseased anatomy with clinical illness.[9][10] By the late 1800s, an exhaustive body of literature had been produced on the gross anatomical findings characteristic of known diseases. The extent of gross pathology research in this period can be epitomized by the work of the Viennese pathologist (originally from Hradec Kralove in the Czech Rep.) Carl Rokitansky (1804–1878), who is said to have performed 20,000 autopsies, and supervised an additional 60,000, in his lifetime.[3][11]
Origins of microscopic pathology
Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. While the compound microscope had been invented approximately 150 years prior, Virchow was one of the first prominent physicians to emphasize the study of manifestations of disease which were visible only at the cellular level.[3][12] A student of Virchow's, Julius Cohnheim (1839–1884) combined histology techniques with experimental manipulations to study inflammation, making him one of the earliest experimental pathologists.[3] Cohnheim also pioneered the use of the frozen section procedure; a version of this technique is widely employed by modern pathologists to render diagnoses and provide other clinical information intraoperatively.[13]
Modern experimental pathology
As new research techniques, such as electron microscopy, immunohistochemistry, and molecular biology have expanded the means by which biomedical scientists can study disease, the definition and boundaries of investigative pathology have become less distinct. In the broadest sense, nearly all research which links manifestations of disease to identifiable processes in cells, tissues, or organs can be considered experimental pathology.[14]
Other Pertinent Topics
- History of medicine
- Anatomical pathology
- Surgical pathology
- List of pathologists
- United States and Canadian Academy of Pathology
References
- ^ Von Staden, H (1992). "The discovery of the body: human dissection and its cultural contexts in ancient Greece". The Yale Journal of Biology and Medicine. 65 (3): 223–41. PMC 2589595. PMID 1285450.
- ^ Toby E. Huff (2003), The Rise of Early Modern Science: Islam, China, and the West, p. 54, 246-247, 216-218. Cambridge University Press, ISBN 0-521-52994-8.
- ^ a b c d e [1] History of Pathology, at the USC School of Dentistry
- ^ Hippocrates: The Father of Spine Surgery : Spine
- ^ Greek Medicine - Galen
- ^ Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale.
- ^ Islamic medicine, Hutchinson Encyclopedia.
- ^ Rubin's Pathology, Fifth Edition. 2008. Ed. R. Rubin and D.S. Strayer
- ^ [2] A History of Medicine from the Biblioteca Centrale dell'Area Biomedica
- ^ Morgagni, GB (1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–7. PMC 1698114. PMID 18340813.
- ^ [3] Karl von Rokitansky at Whonamedit.com
- ^ [4] Rudolf Virchow at Whonamedit.com
- ^ [5] Jewish Encyclopedia entry on Julius Cohnheim
- ^ "Mission and History". Archived from the original on 2008-05-12. Retrieved 2008-04-23. Mission of the American Society for Investigative Pathology
General pathology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/79/Enterobacter_cloacae_01.png/200px-Enterobacter_cloacae_01.png)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bb/Infiltrating_ductal_carcinoma_of_the_breast.jpg/200px-Infiltrating_ductal_carcinoma_of_the_breast.jpg)
Pathology (from Greek πάθος, pathos, "fate, harm"; and -λογία, -logia) is the study and diagnosis of disease through examination of organs, tissues, bodily fluids, and whole bodies (autopsies). The term also encompasses the related scientific study of disease processes, called General pathology.
Medical pathology is divided in two main branches, Anatomical pathology and Clinical pathology. Veterinary pathology is concerned with animal disease whereas Phytopathology is the study of plant diseases.
History of pathology
The history of pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age and in Western Europe during the Italian Renaissance.
Early systematic human dissections were carried out by the Ancient Greek physicians Herophilus of Chalcedon and Erasistratus of Chios in the early part of the third century BC.[1] The first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161). Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. Most early pathologists were also practicing physicians or surgeons.
Origins of pathology
Early understanding of the origins of diseases constitutes the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age[2] and in Western Europe during the Italian Renaissance.[3]
The Greek physician Hippocrates, the founder of scientific medicine, was the first to deal with the anatomy and the pathology of human spine.[4] Galen developed an interest in anatomy from his studies of Herophilus and Erasistratus.[5] The concept of studying disease through the methodical dissection and examination of diseased bodies, organs, and tissues may seem obvious today, but there are few if any recorded examples of true autopsies performed prior to the second millennium. Though the pathology of contagion was understood by Muslim physicians since the time of Avicenna (980–1037) who described it in The Canon of Medicine (c. 1020),[6] the first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161) who proved that the skin disease scabies was caused by a parasite, followed by Ibn al-Nafis (b. 1213) who used dissection to discover pulmonary circulation in 1242.[7] In the 15th century, anatomic dissection was repeatedly used by the Italian physician Antonio Benivieni (1443–1502) to determine cause of death.[3] Antonio Benivieni is also credited with having introduced necropsy to the medical field.[8] Perhaps the most famous early gross pathologist was Giovanni Morgagni (1682–1771). His magnum opus, De Sedibus et Causis Morborum per Anatomem Indagatis, published in 1761, describes the findings of over 600 partial and complete autopsies, organised anatomically and methodically correlated with the symptoms exhibited by the patients prior to their demise. Although the study of normal anatomy was already well advanced at this date, De Sedibus was one of the first treatises specifically devoted to the correlation of diseased anatomy with clinical illness.[9][10] By the late 1800s, an exhaustive body of literature had been produced on the gross anatomical findings characteristic of known diseases. The extent of gross pathology research in this period can be epitomized by the work of the Viennese pathologist (originally from Hradec Kralove in the Czech Rep.) Carl Rokitansky (1804–1878), who is said to have performed 20,000 autopsies, and supervised an additional 60,000, in his lifetime.[3][11]
Origins of microscopic pathology
Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. While the compound microscope had been invented approximately 150 years prior, Virchow was one of the first prominent physicians to emphasize the study of manifestations of disease which were visible only at the cellular level.[3][12] A student of Virchow's, Julius Cohnheim (1839–1884) combined histology techniques with experimental manipulations to study inflammation, making him one of the earliest experimental pathologists.[3] Cohnheim also pioneered the use of the frozen section procedure; a version of this technique is widely employed by modern pathologists to render diagnoses and provide other clinical information intraoperatively.[13]
Modern experimental pathology
As new research techniques, such as electron microscopy, immunohistochemistry, and molecular biology have expanded the means by which biomedical scientists can study disease, the definition and boundaries of investigative pathology have become less distinct. In the broadest sense, nearly all research which links manifestations of disease to identifiable processes in cells, tissues, or organs can be considered experimental pathology.[14]
Other Pertinent Topics
- History of medicine
- Anatomical pathology
- Surgical pathology
- List of pathologists
- United States and Canadian Academy of Pathology
References
- ^ Von Staden, H (1992). "The discovery of the body: human dissection and its cultural contexts in ancient Greece". The Yale Journal of Biology and Medicine. 65 (3): 223–41. PMC 2589595. PMID 1285450.
- ^ Toby E. Huff (2003), The Rise of Early Modern Science: Islam, China, and the West, p. 54, 246-247, 216-218. Cambridge University Press, ISBN 0-521-52994-8.
- ^ a b c d e [6] History of Pathology, at the USC School of Dentistry
- ^ Hippocrates: The Father of Spine Surgery : Spine
- ^ Greek Medicine - Galen
- ^ Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale.
- ^ Islamic medicine, Hutchinson Encyclopedia.
- ^ Rubin's Pathology, Fifth Edition. 2008. Ed. R. Rubin and D.S. Strayer
- ^ [7] A History of Medicine from the Biblioteca Centrale dell'Area Biomedica
- ^ Morgagni, GB (1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–7. PMC 1698114. PMID 18340813.
- ^ [8] Karl von Rokitansky at Whonamedit.com
- ^ [9] Rudolf Virchow at Whonamedit.com
- ^ [10] Jewish Encyclopedia entry on Julius Cohnheim
- ^ "Mission and History". Archived from the original on 2008-05-12. Retrieved 2008-04-23. Mission of the American Society for Investigative Pathology
General pathology
Template loop detected: General pathology
Pathology as a medical specialty
Template loop detected: Pathology as a medical specialty
Anatomical pathology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/71/Breast_invasive_scirrhous_carcinoma_histopathology_%281%29.jpg/200px-Breast_invasive_scirrhous_carcinoma_histopathology_%281%29.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Streptococcus_pneumoniae_meningitis%2C_gross_pathology_33_lores.jpg/200px-Streptococcus_pneumoniae_meningitis%2C_gross_pathology_33_lores.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/e/eb/End-stage_interstitial_lung_disease_%28honeycomb_lung%29.jpg/200px-End-stage_interstitial_lung_disease_%28honeycomb_lung%29.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg/200px-Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg)
Anatomical pathology (Commonwealth) or anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the 20th century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovanni Battista Morgagni from Forlì.[1]
Anatomical pathology is one of two branches of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids or tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology.[2] Similar specialties exist in veterinary pathology.
Differences with clinical pathology
Anatomic pathology relates to the processing, examination, and diagnosis of surgical specimens by a physician trained in pathological diagnosis. Clinical pathology involves the laboratory analysis of tissue samples and bodily fluids; procedures may include blood sample analysis, urinalysis, stool sample analysis, and analysis of spinal fluid. Clinical pathologists may specialize in a number of areas, including blood banking, clinical chemistry, microbiology, and hematology.[3]
Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology (breast, gynecological, endocrine, gastrointestinal, genitourinary, soft tissue, head and neck, dermatopathology), neuropathology, hematopathology cytopathology, and forensic pathology. To be licensed to practice pathology, one has to complete medical school and secure a license to practice medicine. An approved residency program and certification (in the U.S., the American Board of Pathology or the American Osteopathic Board of Pathology) is usually required to obtain employment or hospital privileges.[citation needed]
Skills and procedures
The procedures used in anatomic pathology include:
- Gross examination – the examination of diseased tissues with the naked eye. This is important especially for large tissue fragments, because the disease can often be visually identified. It is also at this step that the pathologist selects areas that will be processed for histopathology. The eye can sometimes be aided with a magnifying glass or a stereo microscope, especially when examining parasitic organisms.
- Histopathology – the microscopic examination of stained tissue sections using histological techniques. The standard stains are haematoxylin and eosin, but many others exist. The use of haematoxylin and eosin-stained slides to provide specific diagnoses based on morphology is considered to be the core skill of anatomic pathology. The science of staining tissues sections is called histochemistry.
- Immunohistochemistry – the use of antibodies to detect the presence, abundance, and localization of specific proteins. This technique is critical to distinguishing between disorders with similar morphology, as well as characterizing the molecular properties of certain cancers.
- In situ hybridization – Specific DNA and RNA molecules can be identified on sections using this technique. When the probe is labeled with fluorescent dye, the technique is called FISH.
- Cytopathology – the examination of loose cells spread and stained on glass slides using cytology techniques
- Electron microscopy – the examination of tissue with an electron microscope, which allows much greater magnification, enabling the visualization of organelles within the cells. Its use has been largely supplanted by immunohistochemistry, but it is still in common use for certain tasks, including the diagnosis of kidney disease and the identification of immotile cilia syndrome.
- Tissue cytogenetics – the visualization of chromosomes to identify genetic defects such as chromosomal translocation
- Flow immunophenotyping – the determination of the immunophenotype of cells using flow cytometry techniques. It is very useful to diagnose the different types of leukemia and lymphoma.
Subspecialties
Surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists. Surgical pathology increasingly requires technologies and skills traditionally associated with clinical pathology such as molecular diagnostics.
Oral and maxillofacial pathology
In the United States, subspecialty-trained doctors of dentistry, rather than medical doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.
Cytopathology
Cytopathology is a sub-discipline of anatomical pathology concerned with the microscopic examination of whole, individual cells obtained from exfoliation or fine-needle aspirates. Cytopathologists are trained to perform fine-needle aspirates of superficially located organs, masses, or cysts and are often able to render an immediate diagnosis in the presence of the patient and consulting physician. In the case of screening tests such as the Papanicolaou smear, non-physician cytotechnologists are often employed to perform initial reviews, with only positive or uncertain cases examined by the pathologist. Cytopathology is a board-certifiable subspecialty in the U.S.
Molecular pathology
Molecular pathology is an emerging discipline within anatomical and clinical pathology that is focused on the use of nucleic acid-based techniques such as in-situ hybridization, reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialized studies of disease in tissues and cells. Molecular pathology shares some aspects of practice with both anatomic and clinical pathology, and is sometimes considered a "crossover" discipline.
Forensic pathology
Forensic pathologists receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died suddenly with no known medical condition, those who die from non-natural causes, as well as those dying as a result of homicide, or other criminally suspicious deaths. A majority of the forensic pathologists cases are due to natural causes. Often, additional tests such as toxicology, histology, and genetic testing will be used to help the pathologist determine the cause of death. Forensic pathologists will often testify in courts regarding their findings in cases of homicide and suspicious death. They also play a large role in public health, such as investigating deaths in the workplace, deaths in custody, as well as sudden and unexpected deaths in children. Forensic pathologists often have special areas of interest within their practice, such as sudden death due to cardiac pathology, deaths due to drugs, or Sudden Infant Death (SIDS), and various others.
Training and certification
Australia
- (Also New Zealand, Hong Kong, Singapore, Malaysia, and Saudi Arabia)
Anatomical Pathology is one of the specialty training programs offered by the Royal College of Pathologists of Australasia (RCPA). The RCPA. To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised undergraduate or postgraduate medical qualification and then complete a minimum of 2 years of clinical medical experience as a prerequisite to selection as a training registrar. The training program is a minimum of 5 years, served in at least two laboratories, and candidates must pass a Basic Pathological Sciences examination (usually in first year), the Part 1 examinations (not before 3rd year) and the Part 2 examinations (not before 5th year). Fellows may then continue into subspecialty training.
Canada
Anatomical Pathology (AP) is one of the specialist certificates granted by the Royal College of Physicians and Surgeons of Canada. Other certificates related to pathology include general pathology (GP), hematopathology, and neuropathology. Candidates for any of these must have completed four years of medical school and five years of residency training.
United States
Anatomic Pathology (AP) is one of the two primary certifications offered by the American Board of Pathology (the other is Clinical Pathology (CP))[4] and one of three primary certifications offered by the American Osteopathic Board of Pathology.[5] To be certified in anatomic pathology, the trainee must complete four years of medical school followed by three years of residency training. Many U.S. pathologists are certified in both AP and CP, which requires a total of four years of residency. After completing residency, many pathologists enroll in further years of fellowship training to gain expertise in a subspecialty of AP or CP. Pathologists' Assistants are highly trained medical professionals with specialized training in Anatomic and Forensic pathology. To become a Pathologists' Assistant one must enter and successfully complete a NAACLS accredited program and pass the ASCP Board of Certification Exam.
Practice settings
- Academic anatomical pathology is practiced at university medical centers by pathologists who are also university faculty. As such, they often have diverse responsibilities that may include training pathology residents, teaching medical students, conducting basic, clinical, or translational research, or performing administrative duties, all in addition to the practice of diagnostic anatomical pathology. Pathologists in academic settings often sub-specialize in a particular area of anatomic pathology and may serve as consultants to other pathologists regarding cases in their specific area of expertise.
- Group practice is the most traditional private practice model. In this arrangement, a group of senior pathologists will control a partnership that employs junior pathologists and contracts independently with hospitals to provide diagnostic services, as well as attracting referral business from local clinicians who practice in the outpatient setting. The group often owns a laboratory for histology and ancillary testing of tissue, and may hold contracts to run hospital-owned labs. Many pathologists who practice in this setting are trained and certified in both anatomical pathology and clinical pathology, which allows them to supervise blood banks, clinical chemistry laboratories, and medical microbiology laboratories as well.
- Large corporate providers of anatomical pathology services, such as AmeriPath in the United States. In this model, pathologists are employees, rather than independent partners. This model has been criticized for reducing physician independence, but defenders claim that the larger size of these practices allows for economies of scale and greater specialization, as well a sufficient volume to support more specialized testing methods.
- Multispecialty groups, composed of physicians from clinical specialties as well as radiology and pathology, are another practice model. In some case, these may be large groups controlled by an HMO or other large health care organization. In others, they are in essence clinician group practices that employ pathologists to provide diagnostic services for the group. These groups may own their own laboratories, or, in some cases may make controversial arrangements with "pod labs" that allow clinician groups to lease space, with the clinician groups receiving direct insurance payments for pathology services.[6] Proposed changes to Medicare regulations may essentially eliminate these arrangements in the United States.[7]
See also
Notes and references
- ^ Morgagni, G. B. (October 1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–277. ISSN 0898-1868. PMC 1698114. PMID 18340813.
- ^ "Pathology Specialty Description". American Medical Association. Retrieved 5 October 2020.
- ^ "Clinical Pathology Overview - Health Encyclopedia - University of Rochester Medical Center". www.urmc.rochester.edu. Retrieved 2024-01-23.
- ^ "ABP Home". Archived from the original on 2007-06-30. Retrieved 2006-01-11.
- ^ "Specialties & Subspecialties". AOA. Archived from the original on 2015-08-13. Retrieved 2 October 2012.
- ^ "Out of joint?OIG takes dim view of pod lab setup - College of American Pathologists". Archived from the original on 2005-03-08. Retrieved 2007-05-20. Congress of American Pathologists Feature story - "Out of joint OIG takes dim view of pod lab setup" January 2005 (Accessed May 19, 2007)
- ^ "Archived copy" (PDF). Archived from the original (PDF) on 2007-09-28. Retrieved 2007-05-20.
{{cite web}}
: CS1 maint: archived copy as title (link) Foster, Swift, Collins, and Smith, P.C. - Health Care Alert, August 2006.
External links
- "Conversations with Pathologists", a website based on a book project by Sue Armstrong, sponsored by Genentech and The Pathological Society of Great Britain and Ireland
- PathReports.in: Make Anatomical pathology reporting paperless and save trees.
- PathMax, a collection of online Pathology resources
- MyBiopsy.org, information on more than 25 of the most common cancers and cancer-related conditions
- The Doctor's doctor, a very useful web site for patients and pathologists
- Pathologie Online, online Pathology resources (in German)
- Pathology Outlines, an online textbook of anatomic pathology
- College of American Pathologists
- American Board of Pathology
- CYTOPATHNET Online Resource Center for Cytopathology
- Histology Group of Victoria Incorporated
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- Pathtalk.org: A multiple-author weblog by and for anatomic pathologists, with illustrative cases and specialty-related discussions.
- PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist as well as Pathology Trainees.
Clinical pathology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Blood_film_01.jpg/200px-Blood_film_01.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/79/Enterobacter_cloacae_01.png/200px-Enterobacter_cloacae_01.png)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/6/67/Gram_escherichia_coli_und_micrococcus_luteus.jpg/200px-Gram_escherichia_coli_und_micrococcus_luteus.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cc/Konelab60i.png/200px-Konelab60i.png)
Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates or extracts using the tools of chemistry, microbiology, hematology, molecular pathology, and Immunohaematology. This specialty requires a medical residency.
Clinical pathology is a term used in the US, UK, Ireland, many Commonwealth countries, Portugal, Brazil, Italy, Japan, and Peru; countries using the equivalent in the home language of "laboratory medicine" include Austria, Germany, Romania, Poland and other Eastern European countries; other terms are "clinical analysis" (Spain) and "clinical/medical biology (France, Belgium, Netherlands, North and West Africa).[1]
Licensing and subspecialities
The American Board of Pathology certifies clinical pathologists, and recognizes the following secondary specialties of clinical pathology:
- Chemical pathology, also called clinical chemistry
- Hematopathology
- Blood banking - Transfusion medicine
- Clinical microbiology
- Cytogenetics
- Molecular genetics pathology.
In some countries other sub specialities fall under certified Clinical Biologists responsibility:[2]
- Reproductive biology including Assisted reproductive technology, Sperm bank and Semen analysis
- Immunopathology
Organization
Clinical pathologists are often medical doctors. In some countries in South-America, Europe, Africa or Asia, this specialty can be practiced by non-physicians, such as Ph.D. or Pharm.D. after a variable number of years of residency.
In United States of America
Clinical pathologists work in close collaboration with clinical scientists (clinical biochemists, clinical microbiologists, etc.), medical technologists, hospital administrators, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.
Clinical pathology is one of the two major divisions of pathology, the other being anatomical pathology. Often, pathologists practice both anatomical and clinical pathology, a combination sometimes known as general pathology. Similar specialties exist in veterinary pathology.
Clinical pathology is itself divided into subspecialties, the main ones being clinical chemistry, clinical hematology/blood banking, hematopathology and clinical microbiology and emerging subspecialties such as molecular diagnostics and proteomics. Many areas of clinical pathology overlap with anatomic pathology. Both can serve as medical directors of CLIA certified laboratories. Under the CLIA law, only the US Department of Health and Human Services approved Board Certified Ph.D., DSc, or MD and DO can perform the duties of a Medical or Clinical Laboratory Director. This overlap includes immunoassays, flow cytometry, microbiology and cytogenetics and any assay done on tissue. Overlap between anatomic and clinical pathology is expanding to molecular diagnostics and proteomics as we move towards making the best use of new technologies for personalized medicine.[3]
In Europe
Recently, EFLM has chosen the name of "Specialists in Laboratory Medicine" to define all European Clinical pathologists, regardless of their training (M.D., Ph.D. or Pharm.D.).[4]
In France, Clinical Pathology is called Medical Biology ("Biologie médicale") and is practiced by both M.D.s and Pharm.D.s. The residency lasts four years. Specialists in this discipline are called "Biologiste médical" which literally translates as Clinical Biologist rather than "Clinical pathologist".[5]
Tools
Microscopes, analyzers, strips, centrifuges
Macroscopic examination
The visual examination of the taken liquid is a first main indication for the pathologist or the physician. The aspect of the liquid, in addition, conditions the analytical assumption of responsibility that follow and the validity of the end-results.
Microscopical examination
Microscopic analysis is an important activity of the pathologist and the laboratory assistant. They have many different colorings at their disposal (GRAM, MGG, Grocott, Ziehl–Neelsen, etc.). Immunofluorescence, cytochemistry, the immunocytochemistry, and FISH are also used in order make a correct diagnosis.
This stage allows the pathologist to determine the character of the liquid: "normal", tumoral, inflammatory, or even infectious. Microscopic examination can also determine the causal infectious agent – often a bacterium, mould, yeast, parasite, or (rarely) virus.
Physical Analyzers
Automated analysers, by the association of robotics and spectrophotometry, have allowed these last decades better reproducibility of the results of proportionings, in particular in medical biochemistry and hematology[clarification needed].
The companies of in vitro diagnosis henceforth try to sell chains of automats, i.e. a system allowing the automatic transfer of the tubes towards the various types of automats of the same mark. These systems can include the computer-assisted management of a serum library.
These analysers must undergo daily controls to guarantee a result just possible, one speaks about quality control. These analysers must also undergo daily, weekly and monthly maintenance.
Cultures
A big part of the examinations of clinical pathology, primarily in medical microbiology, use culture media. Those allow, for example, the description of one or several infectious agents responsible of the clinical signs.
Values known as "normal" or reference values
Detailed article: Reference range.
See also
Notes and references
- ^ "Textes Généraux, Ministère de la Santé et des Sports". Journal Officiel de la République Française. Décrets, arrêtés, circulaires (Texte 15 sur 54). 20 June 2010. Retrieved 4 December 2019. Note: This document does not cover all countries listed.
- ^ "Bulletin officiel du n°32 du 4 septembre 2003 - MENS0301444A". www.education.gouv.fr. Retrieved 2023-02-21.
- ^ Description of Pathology in USA
- ^ Zerah Simone, Murray Janet, Rita Horvath Andrea (2012). "EFLM Position Statement – Our profession now has a European name: Specialist in Laboratory Medicine". Biochemia Medica. 22 (3): 272–273. doi:10.11613/BM.2012.029. PMC 3900053. PMID 23092058.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Reglementation for French Residency in Clinical Pathology Archived 2008-02-28 at the Wayback Machine
External links
- American Association for Clinical Chemistry
- American Society for Clinical Pathology
- American Board of Pathology
- College of American Pathologists
- European Federation of Clinical Chemistry and Laboratory Medicine
Forensic pathology
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Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Duties
Forensic pathology is an application of medical jurisprudence. A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology.[1] The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below.
The forensic pathologist performs autopsies/postmortem examinations with the goal of determining the cause of death as well as the possible manner of death. The autopsy report contains conclusions made relating to the following:
- The pathological process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called the mechanism of death), such as a bullet wound to the head, exsanguination caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.)
- The manner of death, the circumstances surrounding the cause of death, which, in most jurisdictions, include the following:[2]
- Homicide
- Accidental
- Natural
- Suicide
- Undetermined
The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased. Autopsies are performed when a death occurs, when an unexpected death occurs, when someone dies while not under the care of a physician, to solve criminal cases, when a mass disaster occurs and requires the identification of the victims[3] and upon request by the family or loved ones of the deceased. Typically, autopsies can cost anywhere from $3,000 to $5,000, however the price can vary from country to country.[4]
The forensic pathologist examines and documents wounds and injuries, along with the possible causation of those injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.
Forensic pathologists collect and examine tissue specimens under the microscope (histology) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).
In mass disaster settings, forensic pathologists will work alongside Forensic Odontologists, Forensics Anthropologists as well as other forensic specialties with the goal of identifying the victims of the disaster.[3] The process of identification involves the recovery of the victims, the collection of antemortem data, the initial examination along with the collection of any postmortem evidence, and finally the comparison of the antemortem and postmortem data gathered in order to identify those victims.[3]
They serve as expert witnesses in courts of law testifying in civil or criminal law cases.
In an autopsy, the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).
Forensic physicians sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty.
In the United Kingdom, membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert. Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009, which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.
Forensic pathologists make great contributions to public health and preventative medicine by studying the dead. By using their findings during autopsies, they can use their knowledge to prevent the death of another person.[1]
Investigation of death
![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/03/B%E1%BA%A3n_t%C3%BAc_tr%C3%ACnh_c%E1%BB%A7a_Nha_H%E1%BB%99_th%C3%A0nh_kh%C3%A1m_nghi%E1%BB%87m_t%E1%BB%AD_thi_b%E1%BB%8B_gi%E1%BA%BFt_ch%E1%BA%BFt_n%C4%83m_B%E1%BA%A3o_%C4%90%E1%BA%A1i_th%E1%BB%A9_5_%281930%29_02.jpg/220px-B%E1%BA%A3n_t%C3%BAc_tr%C3%ACnh_c%E1%BB%A7a_Nha_H%E1%BB%99_th%C3%A0nh_kh%C3%A1m_nghi%E1%BB%87m_t%E1%BB%AD_thi_b%E1%BB%8B_gi%E1%BA%BFt_ch%E1%BA%BFt_n%C4%83m_B%E1%BA%A3o_%C4%90%E1%BA%A1i_th%E1%BB%A9_5_%281930%29_02.jpg)
Pathologists determine the cause of death through postmortem examination or autopsy. There are three stages of death investigation: examination, correlation, and interpretation. Deaths where there is an unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.
Methods
Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body.[5] While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.
Terminology inconsistencies across jurisdictions
In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.
Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.
Canadian coroners
In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems[6][7]
Coroners and medical examiners in the United States
In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).
In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.
History
Forensic pathology was founded by Rudolf Virchow, a German pathologist, who developed the Virchow method which is one of the main and popular techniques still used by forensic pathologists today. The Virchow method is of doing autopsies as well as instituting cell theory which would shed light on the effects and damage of disease on the human body. Rudolf Virchow began the practice of regulated autopsies where the entire body would be inspected rather than a particular area of interest which would expose additional damage that injuries and ailments inflicted on the human body.[8] In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu, Johann Ludwig Casper and Carl Liman made great efforts to develop forensic pathology into a science based on empirics.
Ambroise Paré is also considered one of the fathers of modern forensic pathology and surgery. His inventions in the early 16th century include surgical instruments and techniques. He pioneered battlefield medicine and treatments of wounds. One technique he used was pouring boiling oil into wounds.[9]
This history of forensic pathology can be traced all the way back to the fourth century BC in Babylonia but instead of practicing on deceased human bodies, the practice of forensic pathology was strictly practiced on animals. This was said to be done only to animals since humans during this era were believed to be sacred. Later on, in forensic pathology history, forensic pathology would be practiced among those who live in Asia. Muslim doctors would discover infectious diseases and as a result, would operate on deceased bodies; one of those doctors being Ibn Zuhr. Zuhr would go on to performing autopsies on bodies in postmortem and research diseases such as leprosy, mange, and sexually transmitted diseases.
While Zuhr was busy learning about contagious diseases, Yee Siung, a Chinese government official was assembling a group of physicians who were in charge of dissecting criminal murder victims. These victims’ cause of death would be investigated alongside the actual case itself and this would be the first time pathology would be used to help solve criminal cases.[10]
Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959 after toxicology and pathology had been used to solve thousands of criminal cases worldwide for years.[11][12]
In Canada, it was formally recognized in 2003,[13][14] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.[15]
Education
In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country, however, it is common for pathologists to study at a medical school and then go on to study pathology. Many forensic pathologists practice as a histo (hospital) pathologists before moving onto forensic science. Another requirement for forensic pathologists includes having a working knowledge of specific fields of study like toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology.[16]
Australia
There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).[citation needed]
Canada
In Canada,[17] individuals must complete an undergraduate science degree, followed by a doctor of medicine degree from one of the seven medical schools in Canada. After these are completed individuals may enter the Royal College of Physicians and Surgeons (RCPSC) which requires the completion of residency training.[18] Anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the RCPSC. As of 2022, there are three schools in Canada that offer the forensic pathology training program. These schools are the University of Alberta, the University of Ottawa[19] and the University of Toronto. McMaster University ceased their training program in 2019.
Germany
Once students have acquired the "Abitur" diploma and completed all the requirements, they can study medicine at a university. Within the medical education system, there are four subdivisions individuals must partake in prior to moving into a specialization.
The first section is a two year preclinical study period where individuals are introduced to the basics. A two month work period at a hospital must be completed between each semester in order to become familiar with everyday life in a hospital. A final exam on the basics concludes this portion.
The second section is a one year clinical period to familiarize the students with the basics of clinical practice. The students complete the first part of the physician's exam at the end of this period.
The third section is another clinical period which lasts for two years, which practices non-surgical, surgical, neurological, ecological and general medicine domains. Here is where forensic medicine is first introduced. Between the first and second clinical sections, four months of medical clerkship are required, which consists of two months in a hospital and two months at any other medical institution. Students complete the second part of the physician's exam at the end of this period.
The final section is a one year practical period where students partake in three 4 month practicums: four months of internal medicine, four months of surgery and four months of clinical practical study of their choice. Students write the final part of the physician's exam before this period and have the oral part afterwards.
Once individuals have completed their medical studies, there is a minimum of six extra years of specialization training for forensic pathology. During this training individuals must complete at least three years and six months working for a legal medicine institution, focusing on clinical forensic pathology training. Then, at least one year of pathology work at a specialized institute is required partaking in autopsy technical training. As well, a minimum of 6 months working with forensic psychiatrists is also required. Finally, a single year of work in any field of medicine or legal medicine must be completed. During these work periods, it is required that these physicians write a number of opinions on their post-mortem examinations, crime scene investigations, crime scene reconstructions and insurance medical cases. There is also a minimum number of reports consisting of their own autopsies, police inquiries, histological investigation and other investigative results. Finally, the practicing physician must complete a certain number of oral court proceedings. Once all of this has been completed, an oral examination, overseen by the Chamber of Physicians (also known as the German Medical Association) is to be completed which allows individuals to officially become a forensic pathologist upon completion.[20]
India
In India, the specialty is commonly referred to as Forensic Medicine and Toxicology, or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to the award of a degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by the National Board of Examinations Archived 2021-06-03 at the Wayback Machine, leading to awarding of Diplomate of National Board (DNB).
The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader), and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this, clinical forensic examinations constitute a major part of the work and the number of cases can run up to ten thousand a year in an average institution.
The largest association of the specialty is Indian Academy of Forensic Medicine [16] (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine [17] regularly. This association has a specialist member strength of more than 1000.
Indonesia
In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years. It was first introduced through the Dutch colonial criminal justice system in the early twentieth century.
Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.
Japan
In Japan, the profession of forensic pathology is not commonly pursued compared to other medical professions such as clinicians and doctors. In Japan, there are 33 of 42 universities that have a department of pathology established on their campuses yet, even so, only 21 of the 42 universities offer residency programs pertaining to forensic pathology.[21]
To become a forensic pathologist, it requires individuals to pursue a four year undergraduate degree. After completing their undergraduate career, it is then required for individuals to attend medical school to either earn their Masters or Doctorates degree. After completing medical school, individuals are then required to have 2 years of mandatory postgraduate clinical education where they learn important clinical skills such as communication skills, common laboratory procedures such as Gram’s stain and urinalysis. When the two year mandatory clinical training is completed, another 3-4[21] years of training is needed to focus more on surgical procedures which is especially for forensic pathologists. During these last 3–4 years of training, forensic pathologists will learn more about specified human anatomy and they will also have the chance to interact with real patients as well as interacting with other forensic pathologists as well. The department of Forensic Medicine at Kyoto University in Japan has a legacy that can be traced back to 1899 when the department of forensic was first founded. The department has been active forces in promoting the significance of forensic medicine through its innovative programs, research, and analysis.
When their training is completed, forensic pathologists in Japan will then have the opportunity to receive their certificate of pathology awarded by the Japanese Society of Pathology[22]
United Kingdom
In the UK, forensic histopathology is a five-year training programme, consisting of two years of histopathology followed by three years of forensic histopathology. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC), which is a requirement to work as a consultant forensic pathologist.
Entry to forensic histopathology specialty training requires completion of the UK Foundation Programme, stages A and B of histopathology specialty training, and a pass in the FRCPath Part 1 examination in histopathology. Candidates are in year 3 of specialty training (ST3) when entering forensic histopathology and progress immediately to stage C. Completion of stages C and D (a minimum of 36 months), and a pass in the FRCPath Part 2 examination in forensic histopathology allow the candidate to apply for the Certificate of Completion of Training (CCT).[23]
Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)) or the Diploma in Medical Jurisprudence (DMJ). In England and Wales, the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.
Currently approved centers for forensic pathology training include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow, and Dundee. Not all the posts are currently actively training.
Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises. The Royal College has not yet issued their response to this matter.
United States
In the United States, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.
In the United States, all told, the education after high school is typically 13–15 years in duration (4 years of undergraduate training + 4 years of medical school + 4–5 years of residency [anatomic and clinical pathology combined] + 1–2 years of forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require the American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field.[24]
In popular culture
Pathologists often feature in crime fiction. The following television series are listed alphabetically by the character's name:
- Dr George Bullard of Causton in Midsomer Murders
- Jordan Cavanaugh M.D., is a forensic pathologist in the Massachusetts Office of the Chief Medical Examiner, in the series Crossing Jordan
- Dr Ravi Chakrabarti, Medical Examiner with the King County Medical Examiner's Office, in the series iZombie
- Dr Max Debryn, Home Office forensic pathologist in detective series Endeavour and Inspector Morse
- Dr Laura Hobson, pathologist and eventual love interest of D.I. Robbie Lewis in later episodes of Inspector Morse and in Lewis
- Dr. Maura Isles, Chief Medical Examiner of the Commonwealth of Massachusetts, in the series Rizzoli & Isles
- Isabelle Lightwood, said to be the best forensic pathologist in New York the TV series, Shadowhunters
- Dr. Donald "Ducky" Mallard, the Chief Medical Examiner for the NCIS Major Case Response Team in NCIS
- Sven Nyberg, Ystad police department's forensic pathologist in the Swedish and British TV series Wallander
- Dr. James "Jimmy" Palmer, former Medical Examiner Assistant and now Chief Medical Examiner (after Dr. Mallard's retirement) in NCIS
- Dr Marco Pasquano, Vigàta's local forensic pathologist in the Italian series, Inspector Montalbano
- Dr R. Quincy, Chief medical examiner for Los Angeles County in the US TV series Quincy, M.E.
- Dr Samantha Ryan, forensic pathologist, the primary character (Series 1 - 8) in the British crime drama series Silent Witness
- Dr Nikki Alexander, forensic pathologist (since Series 8) and the primary character since Series 24 in the British crime drama series Silent Witness
- Dr. Camille Saroyan, head of the Forensic Division of the Jeffersonian in Bones
- Ambrose Spellman, coroner for the Spellman Sisters' Mortuary and main character in the Netflix supernatural horror series Chilling Adventures of Sabrina
- Dr Misumi Mikoto, a forensic pathologist at the fictional Unnatural Death Investigation Laboratory (UDI Lab) in Tokyo, is the protagonist of the Japanese drama Unnatural (2018)
See also
References
- ^ a b "What is a Forensic Pathologist?". University of New Mexico Health Sciences. Retrieved 4 October 2020.
- ^ DiMaio, Dominick (28 June 2001). Forensic Pathology (2nd ed.). Florida: CRC Press LLC. pp. 3–6. ISBN 0-8493-0072-X.
- ^ a b c Schuliar, Yves; Knudsen, Peter Juel Thiis (2012-06-01). "Role of forensic pathologists in mass disasters". Forensic Science, Medicine, and Pathology. 8 (2): 164–173. doi:10.1007/s12024-011-9300-3. ISSN 1556-2891. PMID 22160735. S2CID 40971570.
- ^ "Post Mortem - Autopsy 101". FRONTLINE. Retrieved 2022-03-05.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-03-03.
- ^ The Coroner System. USW. http://www.usw.ca/program/content/3179.php Archived 2009-11-13 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ Coroners' law resource. King's College London. http://www.kcl.ac.uk/depsta/law/research/coroners/canada.html Archived 2009-02-03 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ "Rudolf Virchow | Biography, Discovery, & Facts | Britannica". www.britannica.com. Retrieved 2022-03-03.
- ^ "Ambroise Paré - Advances in medical knowledge – WJEC - GCSE History Revision - WJEC". BBC Bitesize. Retrieved 2022-03-05.
- ^ Choo, Tae M.; Choi, Young-Shik (2012). "Historical Development of Forensic Pathology in the United States". Korean Journal of Legal Medicine. 36 (1): 15–21. doi:10.7580/KoreanJLegMed.2012.36.1.15.
- ^ Eckert WG (1988). "The forensic pathology specialty certifications". The American Journal of Forensic Medicine and Pathology. 9 (1): 85–9. doi:10.1097/00000433-198803000-00023. PMID 3354533.
- ^ "History of Forensic Pathology". 17 December 2011. Retrieved 2022-03-05.
- ^ Lett D (July 2007). "National standards for forensic pathology training slow to develop". CMAJ. 177 (3): 240–1. doi:10.1503/cmaj.070881. PMC 1930175. PMID 17664437.
- ^ Royal College of Physicians and Surgeons of Canada. Information by Specialty or Subspecialty. Available at: http://rcpsc.medical.org/information/index.php?specialty=417&submit=Select.[dead link] Accessed on: 15 July 2008.
- ^ "2 new pathologists to restart Ottawa forensic unit". CBC News. 11 January 2008.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-02-16.
- ^ Residency Training Programs. Dalhousie University. URL: http://pathology.medicine.dal.ca/anatomical.html. Accessed on: 7 June 2007.
- ^ "Forensic Science in Canada - PDF Free Download". docplayer.net. Retrieved 2022-03-30.
- ^ University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. Retrieved 2022-03-28.
- ^ Bockholdt, Britta; Rothschild, Marcus A.; Ehrlich, Edwin; Maxeiner, Helmut; Schneider, Volkmar (2001-06-01). "Medical studies and training duration for forensic pathologists in Germany". Legal Medicine. 3 (2): 104–108. doi:10.1016/S1344-6223(01)00017-7. ISSN 1344-6223. PMID 12935530.
- ^ a b Nonomura, A; Minato, H; Koike, M (April 2002). "[Postgraduate medical training in anatomical pathology in Japanese national universities]". Rinsho Byori. 50 (4): 347–352. PMID 12014012.
- ^ Kumasaka, K (April 2002). "[Postgraduates' training as laboratory physicians/clinical pathologists in Japan--board certification of JSLM as a mandatory requirement for chairpersons of laboratory medicine]". Rinsho Byori. 50 (4): 353–357. PMID 12014013.
- ^ Pathologists, The Royal College of. "Forensic Histopathology". www.rcpath.org. Archived from the original on 2021-07-09. Retrieved 2021-07-09.
- ^ "Top 10 Things to Look For in Finding a Qualified Forensic Pathologist Expert Witness". Archived from the original on 2012-03-08. Retrieved 2011-11-07.
Sources
- Bartos, Leah, "No Forensic Background? No Problem", ProPublica, April 17, 2012.
- Payne-James, Jason (ed.; et al.) (2005). Encyclopedia of Forensic & Legal Medicine. Amsterdam; Boston: Elsevier Academic Press. ISBN 0-12-547970-0. OCLC 60834620.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Payne-James, Jason; Busuttil, Anthony; Smock, William S. (eds.) (2003). Forensic Medicine: Clinical and Pathological Aspects. London; San Francisco: Greenwich Medical Media. ISBN 1-84110-026-9. OCLC 51678652.
{{cite book}}
:|first3=
has generic name (help) - Saukko, Pekka J.; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). London: Edward Arnold (Publishers). ISBN 0-340-76044-3. OCLC 56440239.
- Spitz, Werner U.; Spitz, Daniel J. (eds.) (2006). Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation (4th ed.). Springfield, Ill.: Charles C. Thomas Publisher. ISBN 0-398-07544-1. OCLC 56614481.
{{cite book}}
:|first2=
has generic name (help) - The Real CSI, PBS Frontline documentary, April 17, 2012
- Syukriani, Yoni Fuadah; Novita, Nita; Sunjaya, Deni K. (1 August 2018). "Development of forensic medicine in post reform Indonesia". Journal of Forensic and Legal Medicine. 58: 56–63. doi:10.1016/j.jflm.2018.05.001. PMID 29751222. S2CID 21709263.
- https://www.med.kyoto-u.ac.jp/en/organization-staff/research/doctoral_course/r-011/ Archived 2022-03-03 at the Wayback Machine
- University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. https://med.uottawa.ca/pathology/education/postgraduate-medical-education/forensic-pathology-residency-training-program Retrieved 2022-03-28.
External links
- National Association of Medical Examiners (NAME)
- American Academy of Forensic Sciences
- Forensic Science Society
- British Association in Forensic Medicine
- British Association for Human Identification
- British Academy of Forensic Science
- Forensic Medicine for Medical Students - a website providing educational resources in forensic medicine
- Faculty of Forensic & Legal Medicine of the Royal College of Physicians
- Royal College of Pathologists of Australasia
- Forensic Oral Pathology Journal - FOPJ
- Punjab Academy of Forensic Medicine & Toxicology Archived 2021-02-11 at the Wayback Machine
- 2011 books for forensic pathology.
- Indian Congress of Forensic Medicine and Toxicology
- Forensic Medicine Online Master's Degree at the University of Florida- the first fully online advanced degree program in forensic medicine in the United States
- A career in forensic pathology Archived 2021-02-06 at the Wayback Machine - educational website on career pathways for forensic pathology in the UK and USA
- So, you want to be a forensic scientist? - Simon Fraser University.
- When I grow up: becoming a pathologist by G. William Moore, MD, PhD. - netautopsy.org.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Forensic Pathology Resource
- Royal College of Pathologists of Australasia - Follow the "Careers and Training" Link, & go to "Disciplines and Career Brochures", or go to this page directly
- Royal College of Pathologists UK
- Forensic Pathology by David Webb, University of Huddersfield
- Forensic Pathology Pathway in Residency and fellowship - USMLE Forums
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Veterinary pathology
Veterinary pathologists are veterinarians who specialize in the diagnosis of diseases through the examination of animal tissue and body fluids.[1] Like medical pathology, veterinary pathology is divided into two branches, anatomical pathology and clinical pathology. Other than the diagnosis of disease in food-producing animals, companion animals, zoo animals and wildlife, veterinary pathologists also have an important role in drug discovery and safety as well as scientific research.[1]
Veterinary anatomical pathology
Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is concerned with the diagnosis of disease based on the gross examination, microscopic, and molecular examination of organs, tissues, and whole bodies (necropsy). Veterinary pathology also takes into account the structure and function of the body and how particular cells were injured.[2][page needed] The Indian, European, Japanese, and American Colleges of Veterinary Pathologists certify veterinary pathologists through a certifying exam after completing a residency program. After completing the residency and the exam, a certificate will be given out to display specialization in veterinary pathology.[3] The American College of Veterinary Pathologist certification exam consists of four parts, - gross pathology, microscopic pathology, veterinary pathology, and general pathology. Only the general pathology section is shared between the anatomic and clinical pathology examinations.[4] Veterinary pathologists are employed in several different positions, including diagnostics, teaching, research, and the pharmaceutical industry.[5]
Veterinary clinical pathology
Clinical pathology is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood, urine or cavitary effusions, or tissue aspirates using the tools of chemistry, microbiology, hematology, and molecular pathology.[6] Clinical pathology labs offer many services including hematology, hemostasis, urinalysis, cytology, and clinical biochemistry tests. [6] Many clinical pathology tests can be done "in" or "out" of house, meaning that the test can be done in that particular clinic or sent to a further specialized outside laboratory. Many patients have the desire to do "in-house" tests because it is usually cheaper.[7] Ultimately, veterinary pathology consists of most of the behind-the-scenes laboratory work that studies virus, infections, bacteria, and much more. Without veterinary pathologists, illness would spread throughout many species of animals much quicker than in the present day.[8]
See also
References
- ^ a b "What is veterinary pathology?". American College of Veterinary Pathology. Archived from the original on October 24, 2013. Retrieved October 3, 2013.
- ^ Cheville, Norman F. (2001). Introduction to Veterinary Pathology (2nd ed.). Wiley. ISBN 978-0-813-82488-8.
- ^ "Veterinary Pathology (ACVP) FAQs". AKVNA. Retrieved 2024-03-07.
- ^ "American College of Veterinary Pathologists" (PDF). 2024 Phase 1 Certifying Examination Candidate Handbook. March 7, 2024.
- ^ "What is Veterinary Pathology? - American College of Veterinary Pathologists". www.acvp.org. Retrieved 2024-03-07.
- ^ a b "Clinical Pathology". The College of Veterinary Medicine at Michigan State University. Retrieved 2024-03-07.
- ^ "Overview of Diagnostic Procedures for the Private Practice Laboratory - Clinical Pathology and Procedures". MSD Veterinary Manual. Retrieved 2024-03-07.
- ^ Papajeski, Barbie (February 2022). "Specialty Spotlight" (PDF). VTS in Clinical Pathology.
External links
- American College of Veterinary Pathologists
- European College of Veterinary Clinical Pathology
- European College of Veterinary Pathologists
Plant pathology
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Plant pathology or phytopathology is the scientific study of plant diseases caused by pathogens (infectious organisms) and environmental conditions (physiological factors).[1] Plant pathology involves the study of pathogen identification, disease etiology, disease cycles, economic impact, plant disease epidemiology, plant disease resistance, how plant diseases affect humans and animals, pathosystem genetics, and management of plant diseases.
Plant pathogenicity
Plant pathogens, organisms that cause infectious plant diseases, include fungi, oomycetes, bacteria, viruses, viroids, virus-like organisms, phytoplasmas, protozoa, nematodes and parasitic plants.[2] In most plant pathosystems, virulence depends on hydrolases and enzymes that degrade the cell wall. The vast majority of these act on pectins (for example, pectinesterase, pectate lyase, and pectinases). For microbes, the cell wall polysaccharides are both a food source and a barrier to be overcome. Many pathogens grow opportunistically when the host breaks down its own cell walls, most often during fruit ripening.[3] Unlike human and animal pathology, plant pathology usually focuses on a single causal organism; however, some plant diseases have been shown to be interactions between multiple pathogens.[4]
To colonize a plant, pathogens have specific pathogenicity factors, of five main types: uses of cell wall–degrading enzymes, toxins, effector proteins, phytohormones, and exopolysaccharides.
- Cell wall-degrading enzymes: These are used to break down the plant cell wall in order to release the nutrients inside and include esterases, glycosyl hydrolases, lyases and oxidoreductases.[5]
- Toxins: These can be non-host-specific, which damage all plants, or host-specific, which cause damage only on a host plant.
- Effector proteins: These can be secreted by pathogens such as bacteria, fungi, and oomycetes[6][7] into the extracellular environment or directly into the host cell, often via the Type three secretion system. Some effectors are known to suppress host defense processes. This can include reducing the plant's internal signaling mechanisms or reduction of phytochemicals production.[8]
- Phytohormones are chemicals used by plants for signaling; pathogens can produce these to modify plant growth to their own advantage.
- Exopolysaccharides are mostly small chains of sugars that help pathogens to adhere to a plant's surface, enabling them to begin the process of infection.
Physiological plant disorders
Some abiotic disorders can be confused with pathogen-induced disorders. Abiotic causes include natural processes such as drought, frost, snow and hail; flooding and poor drainage; nutrient deficiency; deposition of mineral salts such as sodium chloride and gypsum; windburn and breakage by storms; and wildfires. [9]
Epidemiology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Plant_Disease_Triangle.svg/220px-Plant_Disease_Triangle.svg.png)
Epidemiology is the study of factors affecting the outbreak and spread of infectious diseases.[10]
A disease triangle describes the basic factors required for plant diseases. These are the host plant, the pathogen, and the environment. Any one of these can be modified to control a disease.[11]
Disease resistance
Plant disease resistance is the ability of a plant to prevent and terminate infections from plant pathogens. Structures that help plants prevent pathogens from entering are the cuticular layer, cell walls and stomata guard cells. Once pathogens have overcome these barriers, plant receptors initiate signaling pathways to create molecules to compete against the foreign molecules. These pathways are influenced and triggered by genes within the host plant and can manipulated by genetic breeding to create resistant varieties.[12]
Management
Detection
Ancient methods of leaf examination and breaking open plant material by hand are now augmented by newer technologies. These include molecular pathology assays such as polymerase chain reaction (PCR), RT-PCR and loop-mediated isothermal amplification (LAMP).[13] Although PCR can detect multiple molecular targets in a single solution there are limits.[13] Bertolini et al 2001, Ito et al 2002 and Ragozzino et al 2004 developed PCR methods for multiplexing six or seven plant pathogen molecular products and Persson et al 2005 for multiplexing four with RT-PCR.[13] More extensive molecular diagnosis requires PCR arrays.[13] The primary detection method used worldwide is enzyme linked immunosorbent assay.[14]
Biological
Crop rotation is a traditional and sometimes effective means of preventing a parasitic population from becoming well-established. For example, protection against infection by Agrobacterium tumefaciens, which causes gall diseases in many plants, by dipping cuttings in suspensions of Agrobacterium radiobacter before inserting them in the ground to take root.[15]
History
Plant pathology has developed from antiquity, starting with Theophrastus in the ancient era, but scientific study began in the Early Modern period with the invention of the microscope, and developed in the 19th century.[16]
See also
- American Phytopathological Society
- Australasian Plant Pathology Society
- British Society for Plant Pathology
- Forest pathology
- Gene-for-gene relationship
- Global Plant Clinic
- Glossary of phytopathology
- Horsfall-Barratt scale
- List of phytopathology journals
- Microbial inoculant
- Phytopharmacology
- Plant disease forecasting
- Stunting
Notes
References
- ^ Agrios GN (1972). Plant Pathology (3rd ed.). Academic Press.
- ^ Nazarov PA, Baleev DN, Ivanova MI, Sokolova LM, Karakozova MV (2020-10-27). "Infectious Plant Diseases: Etiology, Current Status, Problems and Prospects in Plant Protection". Acta Naturae. 12 (3): 46–59. doi:10.32607/actanaturae.11026. PMC 7604890. PMID 33173596.
- ^ Cantu D, Vicente AR, Labavitch JM, Bennett AB, Powell AL (November 2008). "Strangers in the matrix: plant cell walls and pathogen susceptibility". Trends in Plant Science. 13 (11). Cell Press: 610–617. doi:10.1016/j.tplants.2008.09.002. hdl:11336/148749. PMID 18824396. (ARV ORCID: 0000-0003-1289-9554).
- ^ Lamichhane JR, Venturi V (2015). "Synergisms between microbial pathogens in plant disease complexes: a growing trend". Frontiers in Plant Science. 6 (385): 385. doi:10.3389/fpls.2015.00385. PMC 4445244. PMID 26074945.
- ^ Giovannoni M, Gramegna G, Benedetti M, Mattei B (2020). "Industrial Use of Cell Wall Degrading Enzymes: The Fine Line Between Production Strategy and Economic Feasibility". Frontiers in Bioengineering and Biotechnology. 8: 356. doi:10.3389/fbioe.2020.00356. PMC 7200985. PMID 32411686.
- ^ Davis N (September 9, 2009). "Genome of Irish potato famine pathogen decoded". Haas et al. Broad Institute of MIT and Harvard. Retrieved 24 July 2012.
- ^ "1st large-scale map of a plant's protein network addresses evolution, disease process". Dana-Farber Cancer Institute. July 29, 2011. Archived from the original on 12 May 2012. Retrieved 24 July 2012.
- ^ Ma, Winbo (March 28, 2011). "How do plants fight disease? Breakthrough research by UC Riverside plant pathologist offers a clue". UC Riverside.
- ^ Schutzki, R.E.; Cregg, B. (2007). "Abiotic plant disorders: Symptoms, signs and solutions. A diagnostic guide to problem solving" (PDF). Michigan State University Department of Horticulture. Michigan State University. Archived from the original (PDF) on 24 September 2015. Retrieved 10 April 2015.
- ^ "American Phytopathological Society". American Phytopathological Society. Retrieved 2019-03-26.
- ^ "Disease Triangle". Oregon State University. 25 April 2014. Retrieved 31 December 2023.
- ^ Andersen EJ, Ali S, Byamukama E, Yen Y, Nepal MP (July 2018). "Disease Resistance Mechanisms in Plants". Genes. 9 (7): 339. doi:10.3390/genes9070339. PMC 6071103. PMID 29973557.
- ^ a b c d Mumford R, Boonham N, Tomlinson J, Barker I (2006-07-13). "Advances in molecular phytodiagnostics - new solutions for old problems". European Journal of Plant Pathology. 116 (1). European Foundation for Plant Pathology (Springer): 1–19. Bibcode:2006EJPP..116....1M. doi:10.1007/s10658-006-9037-0. PMC 7087944. PMID 32214677.
- ^ Current and emerging trends in techniques for plant pathogen detection Frontiers in Plant Science
- ^ Ryder MH, Jones DA (1991-10-01). "Biological Control of Crown Gall Using Using Agrobacterium Strains K84 and K1026". Functional Plant Biology. 18 (5): 571–579. doi:10.1071/pp9910571.
- ^ Aisnworth GC (1981). Introduction to the History of Plant Pathology. Cambridge University Press. ISBN 978-0-521-23032-2.
External links
- International Society for Plant Pathology
- Australasian Plant Pathology Society
- American Phytopathological Society
- British Society for Plant Pathology
- Erwin Frink Smith Papers Index to papers of Smith (1854–1927) who was considered the "father of bacterial plant pathology" and worked for the United States Department of Agriculture for over 40 years.
- Plant Health Progress, Online journal of applied plant pathology
- Pacific Northwest Fungi, online mycology journal with papers on fungal plant pathogens
- Rothamsted Plant Pathology and Microbiology Department
- New Mexico State University Department of Entomology Plant Pathology and Weed Science
- Pathogen Host Interactions Database (PHI-base)
- Grape Virology
- Opportunity in Plant Pathology
- Facebook page for Asian Association of Societies for Plant Pathology
See also
References
External links
- Association of Clinical Biochemistry (UK)
- American Society for Investigative Pathology
- American Society of Cytopathology
- British Neuropathological Society
- Case Records of the Massachusetts General Hospital - Clinicopathological Conference
- College of American Pathologists
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- HistoPathology Atlas
- humpath.com (Atlas in Human Pathology)
- Immunohistochemistry protocols and troubleshooting
- Traditional Chinese medicine Pathology
- Mybiopsy.org
- Neuropathology blog
- Pathological Society of Great Britain and Ireland
- Royal College of Pathologists (UK)
- Royal College of Pathologists of Australasia (Australia & Oceania)
- Sullivan Nicolaides Pathology - Leading Australian Pathology Laboratory.
- United States and Canadian Academy of Pathology
- WebPath: The Internet Pathology Laboratory for Medical Education
- Pathtalk.org - A community weblog about pathology-related topics.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Pathologypics - an interactive community-driven histology atlas
Pathology as a medical specialty
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/79/Enterobacter_cloacae_01.png/200px-Enterobacter_cloacae_01.png)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bb/Infiltrating_ductal_carcinoma_of_the_breast.jpg/200px-Infiltrating_ductal_carcinoma_of_the_breast.jpg)
Pathology (from Greek πάθος, pathos, "fate, harm"; and -λογία, -logia) is the study and diagnosis of disease through examination of organs, tissues, bodily fluids, and whole bodies (autopsies). The term also encompasses the related scientific study of disease processes, called General pathology.
Medical pathology is divided in two main branches, Anatomical pathology and Clinical pathology. Veterinary pathology is concerned with animal disease whereas Phytopathology is the study of plant diseases.
History of pathology
The history of pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age and in Western Europe during the Italian Renaissance.
Early systematic human dissections were carried out by the Ancient Greek physicians Herophilus of Chalcedon and Erasistratus of Chios in the early part of the third century BC.[1] The first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161). Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. Most early pathologists were also practicing physicians or surgeons.
Origins of pathology
Early understanding of the origins of diseases constitutes the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age[2] and in Western Europe during the Italian Renaissance.[3]
The Greek physician Hippocrates, the founder of scientific medicine, was the first to deal with the anatomy and the pathology of human spine.[4] Galen developed an interest in anatomy from his studies of Herophilus and Erasistratus.[5] The concept of studying disease through the methodical dissection and examination of diseased bodies, organs, and tissues may seem obvious today, but there are few if any recorded examples of true autopsies performed prior to the second millennium. Though the pathology of contagion was understood by Muslim physicians since the time of Avicenna (980–1037) who described it in The Canon of Medicine (c. 1020),[6] the first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161) who proved that the skin disease scabies was caused by a parasite, followed by Ibn al-Nafis (b. 1213) who used dissection to discover pulmonary circulation in 1242.[7] In the 15th century, anatomic dissection was repeatedly used by the Italian physician Antonio Benivieni (1443–1502) to determine cause of death.[3] Antonio Benivieni is also credited with having introduced necropsy to the medical field.[8] Perhaps the most famous early gross pathologist was Giovanni Morgagni (1682–1771). His magnum opus, De Sedibus et Causis Morborum per Anatomem Indagatis, published in 1761, describes the findings of over 600 partial and complete autopsies, organised anatomically and methodically correlated with the symptoms exhibited by the patients prior to their demise. Although the study of normal anatomy was already well advanced at this date, De Sedibus was one of the first treatises specifically devoted to the correlation of diseased anatomy with clinical illness.[9][10] By the late 1800s, an exhaustive body of literature had been produced on the gross anatomical findings characteristic of known diseases. The extent of gross pathology research in this period can be epitomized by the work of the Viennese pathologist (originally from Hradec Kralove in the Czech Rep.) Carl Rokitansky (1804–1878), who is said to have performed 20,000 autopsies, and supervised an additional 60,000, in his lifetime.[3][11]
Origins of microscopic pathology
Rudolf Virchow (1821–1902) is generally recognized to be the father of microscopic pathology. While the compound microscope had been invented approximately 150 years prior, Virchow was one of the first prominent physicians to emphasize the study of manifestations of disease which were visible only at the cellular level.[3][12] A student of Virchow's, Julius Cohnheim (1839–1884) combined histology techniques with experimental manipulations to study inflammation, making him one of the earliest experimental pathologists.[3] Cohnheim also pioneered the use of the frozen section procedure; a version of this technique is widely employed by modern pathologists to render diagnoses and provide other clinical information intraoperatively.[13]
Modern experimental pathology
As new research techniques, such as electron microscopy, immunohistochemistry, and molecular biology have expanded the means by which biomedical scientists can study disease, the definition and boundaries of investigative pathology have become less distinct. In the broadest sense, nearly all research which links manifestations of disease to identifiable processes in cells, tissues, or organs can be considered experimental pathology.[14]
Other Pertinent Topics
- History of medicine
- Anatomical pathology
- Surgical pathology
- List of pathologists
- United States and Canadian Academy of Pathology
References
- ^ Von Staden, H (1992). "The discovery of the body: human dissection and its cultural contexts in ancient Greece". The Yale Journal of Biology and Medicine. 65 (3): 223–41. PMC 2589595. PMID 1285450.
- ^ Toby E. Huff (2003), The Rise of Early Modern Science: Islam, China, and the West, p. 54, 246-247, 216-218. Cambridge University Press, ISBN 0-521-52994-8.
- ^ a b c d e [11] History of Pathology, at the USC School of Dentistry
- ^ Hippocrates: The Father of Spine Surgery : Spine
- ^ Greek Medicine - Galen
- ^ Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale.
- ^ Islamic medicine, Hutchinson Encyclopedia.
- ^ Rubin's Pathology, Fifth Edition. 2008. Ed. R. Rubin and D.S. Strayer
- ^ [12] A History of Medicine from the Biblioteca Centrale dell'Area Biomedica
- ^ Morgagni, GB (1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–7. PMC 1698114. PMID 18340813.
- ^ [13] Karl von Rokitansky at Whonamedit.com
- ^ [14] Rudolf Virchow at Whonamedit.com
- ^ [15] Jewish Encyclopedia entry on Julius Cohnheim
- ^ "Mission and History". Archived from the original on 2008-05-12. Retrieved 2008-04-23. Mission of the American Society for Investigative Pathology
General pathology
Template loop detected: General pathology
Pathology as a medical specialty
Template loop detected: Pathology as a medical specialty
Anatomical pathology
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![](https://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg/200px-Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg)
Anatomical pathology (Commonwealth) or anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the 20th century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovanni Battista Morgagni from Forlì.[1]
Anatomical pathology is one of two branches of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids or tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology.[2] Similar specialties exist in veterinary pathology.
Differences with clinical pathology
Anatomic pathology relates to the processing, examination, and diagnosis of surgical specimens by a physician trained in pathological diagnosis. Clinical pathology involves the laboratory analysis of tissue samples and bodily fluids; procedures may include blood sample analysis, urinalysis, stool sample analysis, and analysis of spinal fluid. Clinical pathologists may specialize in a number of areas, including blood banking, clinical chemistry, microbiology, and hematology.[3]
Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology (breast, gynecological, endocrine, gastrointestinal, genitourinary, soft tissue, head and neck, dermatopathology), neuropathology, hematopathology cytopathology, and forensic pathology. To be licensed to practice pathology, one has to complete medical school and secure a license to practice medicine. An approved residency program and certification (in the U.S., the American Board of Pathology or the American Osteopathic Board of Pathology) is usually required to obtain employment or hospital privileges.[citation needed]
Skills and procedures
The procedures used in anatomic pathology include:
- Gross examination – the examination of diseased tissues with the naked eye. This is important especially for large tissue fragments, because the disease can often be visually identified. It is also at this step that the pathologist selects areas that will be processed for histopathology. The eye can sometimes be aided with a magnifying glass or a stereo microscope, especially when examining parasitic organisms.
- Histopathology – the microscopic examination of stained tissue sections using histological techniques. The standard stains are haematoxylin and eosin, but many others exist. The use of haematoxylin and eosin-stained slides to provide specific diagnoses based on morphology is considered to be the core skill of anatomic pathology. The science of staining tissues sections is called histochemistry.
- Immunohistochemistry – the use of antibodies to detect the presence, abundance, and localization of specific proteins. This technique is critical to distinguishing between disorders with similar morphology, as well as characterizing the molecular properties of certain cancers.
- In situ hybridization – Specific DNA and RNA molecules can be identified on sections using this technique. When the probe is labeled with fluorescent dye, the technique is called FISH.
- Cytopathology – the examination of loose cells spread and stained on glass slides using cytology techniques
- Electron microscopy – the examination of tissue with an electron microscope, which allows much greater magnification, enabling the visualization of organelles within the cells. Its use has been largely supplanted by immunohistochemistry, but it is still in common use for certain tasks, including the diagnosis of kidney disease and the identification of immotile cilia syndrome.
- Tissue cytogenetics – the visualization of chromosomes to identify genetic defects such as chromosomal translocation
- Flow immunophenotyping – the determination of the immunophenotype of cells using flow cytometry techniques. It is very useful to diagnose the different types of leukemia and lymphoma.
Subspecialties
Surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists. Surgical pathology increasingly requires technologies and skills traditionally associated with clinical pathology such as molecular diagnostics.
Oral and maxillofacial pathology
In the United States, subspecialty-trained doctors of dentistry, rather than medical doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.
Cytopathology
Cytopathology is a sub-discipline of anatomical pathology concerned with the microscopic examination of whole, individual cells obtained from exfoliation or fine-needle aspirates. Cytopathologists are trained to perform fine-needle aspirates of superficially located organs, masses, or cysts and are often able to render an immediate diagnosis in the presence of the patient and consulting physician. In the case of screening tests such as the Papanicolaou smear, non-physician cytotechnologists are often employed to perform initial reviews, with only positive or uncertain cases examined by the pathologist. Cytopathology is a board-certifiable subspecialty in the U.S.
Molecular pathology
Molecular pathology is an emerging discipline within anatomical and clinical pathology that is focused on the use of nucleic acid-based techniques such as in-situ hybridization, reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialized studies of disease in tissues and cells. Molecular pathology shares some aspects of practice with both anatomic and clinical pathology, and is sometimes considered a "crossover" discipline.
Forensic pathology
Forensic pathologists receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died suddenly with no known medical condition, those who die from non-natural causes, as well as those dying as a result of homicide, or other criminally suspicious deaths. A majority of the forensic pathologists cases are due to natural causes. Often, additional tests such as toxicology, histology, and genetic testing will be used to help the pathologist determine the cause of death. Forensic pathologists will often testify in courts regarding their findings in cases of homicide and suspicious death. They also play a large role in public health, such as investigating deaths in the workplace, deaths in custody, as well as sudden and unexpected deaths in children. Forensic pathologists often have special areas of interest within their practice, such as sudden death due to cardiac pathology, deaths due to drugs, or Sudden Infant Death (SIDS), and various others.
Training and certification
Australia
- (Also New Zealand, Hong Kong, Singapore, Malaysia, and Saudi Arabia)
Anatomical Pathology is one of the specialty training programs offered by the Royal College of Pathologists of Australasia (RCPA). The RCPA. To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised undergraduate or postgraduate medical qualification and then complete a minimum of 2 years of clinical medical experience as a prerequisite to selection as a training registrar. The training program is a minimum of 5 years, served in at least two laboratories, and candidates must pass a Basic Pathological Sciences examination (usually in first year), the Part 1 examinations (not before 3rd year) and the Part 2 examinations (not before 5th year). Fellows may then continue into subspecialty training.
Canada
Anatomical Pathology (AP) is one of the specialist certificates granted by the Royal College of Physicians and Surgeons of Canada. Other certificates related to pathology include general pathology (GP), hematopathology, and neuropathology. Candidates for any of these must have completed four years of medical school and five years of residency training.
United States
Anatomic Pathology (AP) is one of the two primary certifications offered by the American Board of Pathology (the other is Clinical Pathology (CP))[4] and one of three primary certifications offered by the American Osteopathic Board of Pathology.[5] To be certified in anatomic pathology, the trainee must complete four years of medical school followed by three years of residency training. Many U.S. pathologists are certified in both AP and CP, which requires a total of four years of residency. After completing residency, many pathologists enroll in further years of fellowship training to gain expertise in a subspecialty of AP or CP. Pathologists' Assistants are highly trained medical professionals with specialized training in Anatomic and Forensic pathology. To become a Pathologists' Assistant one must enter and successfully complete a NAACLS accredited program and pass the ASCP Board of Certification Exam.
Practice settings
- Academic anatomical pathology is practiced at university medical centers by pathologists who are also university faculty. As such, they often have diverse responsibilities that may include training pathology residents, teaching medical students, conducting basic, clinical, or translational research, or performing administrative duties, all in addition to the practice of diagnostic anatomical pathology. Pathologists in academic settings often sub-specialize in a particular area of anatomic pathology and may serve as consultants to other pathologists regarding cases in their specific area of expertise.
- Group practice is the most traditional private practice model. In this arrangement, a group of senior pathologists will control a partnership that employs junior pathologists and contracts independently with hospitals to provide diagnostic services, as well as attracting referral business from local clinicians who practice in the outpatient setting. The group often owns a laboratory for histology and ancillary testing of tissue, and may hold contracts to run hospital-owned labs. Many pathologists who practice in this setting are trained and certified in both anatomical pathology and clinical pathology, which allows them to supervise blood banks, clinical chemistry laboratories, and medical microbiology laboratories as well.
- Large corporate providers of anatomical pathology services, such as AmeriPath in the United States. In this model, pathologists are employees, rather than independent partners. This model has been criticized for reducing physician independence, but defenders claim that the larger size of these practices allows for economies of scale and greater specialization, as well a sufficient volume to support more specialized testing methods.
- Multispecialty groups, composed of physicians from clinical specialties as well as radiology and pathology, are another practice model. In some case, these may be large groups controlled by an HMO or other large health care organization. In others, they are in essence clinician group practices that employ pathologists to provide diagnostic services for the group. These groups may own their own laboratories, or, in some cases may make controversial arrangements with "pod labs" that allow clinician groups to lease space, with the clinician groups receiving direct insurance payments for pathology services.[6] Proposed changes to Medicare regulations may essentially eliminate these arrangements in the United States.[7]
See also
Notes and references
- ^ Morgagni, G. B. (October 1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–277. ISSN 0898-1868. PMC 1698114. PMID 18340813.
- ^ "Pathology Specialty Description". American Medical Association. Retrieved 5 October 2020.
- ^ "Clinical Pathology Overview - Health Encyclopedia - University of Rochester Medical Center". www.urmc.rochester.edu. Retrieved 2024-01-23.
- ^ "ABP Home". Archived from the original on 2007-06-30. Retrieved 2006-01-11.
- ^ "Specialties & Subspecialties". AOA. Archived from the original on 2015-08-13. Retrieved 2 October 2012.
- ^ "Out of joint?OIG takes dim view of pod lab setup - College of American Pathologists". Archived from the original on 2005-03-08. Retrieved 2007-05-20. Congress of American Pathologists Feature story - "Out of joint OIG takes dim view of pod lab setup" January 2005 (Accessed May 19, 2007)
- ^ "Archived copy" (PDF). Archived from the original (PDF) on 2007-09-28. Retrieved 2007-05-20.
{{cite web}}
: CS1 maint: archived copy as title (link) Foster, Swift, Collins, and Smith, P.C. - Health Care Alert, August 2006.
External links
- "Conversations with Pathologists", a website based on a book project by Sue Armstrong, sponsored by Genentech and The Pathological Society of Great Britain and Ireland
- PathReports.in: Make Anatomical pathology reporting paperless and save trees.
- PathMax, a collection of online Pathology resources
- MyBiopsy.org, information on more than 25 of the most common cancers and cancer-related conditions
- The Doctor's doctor, a very useful web site for patients and pathologists
- Pathologie Online, online Pathology resources (in German)
- Pathology Outlines, an online textbook of anatomic pathology
- College of American Pathologists
- American Board of Pathology
- CYTOPATHNET Online Resource Center for Cytopathology
- Histology Group of Victoria Incorporated
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- Pathtalk.org: A multiple-author weblog by and for anatomic pathologists, with illustrative cases and specialty-related discussions.
- PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist as well as Pathology Trainees.
Warning: Default sort key "Anatomical Pathology" overrides earlier default sort key "Forensic Pathology".
Clinical pathology
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Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates or extracts using the tools of chemistry, microbiology, hematology, molecular pathology, and Immunohaematology. This specialty requires a medical residency.
Clinical pathology is a term used in the US, UK, Ireland, many Commonwealth countries, Portugal, Brazil, Italy, Japan, and Peru; countries using the equivalent in the home language of "laboratory medicine" include Austria, Germany, Romania, Poland and other Eastern European countries; other terms are "clinical analysis" (Spain) and "clinical/medical biology (France, Belgium, Netherlands, North and West Africa).[1]
Licensing and subspecialities
The American Board of Pathology certifies clinical pathologists, and recognizes the following secondary specialties of clinical pathology:
- Chemical pathology, also called clinical chemistry
- Hematopathology
- Blood banking - Transfusion medicine
- Clinical microbiology
- Cytogenetics
- Molecular genetics pathology.
In some countries other sub specialities fall under certified Clinical Biologists responsibility:[2]
- Reproductive biology including Assisted reproductive technology, Sperm bank and Semen analysis
- Immunopathology
Organization
Clinical pathologists are often medical doctors. In some countries in South-America, Europe, Africa or Asia, this specialty can be practiced by non-physicians, such as Ph.D. or Pharm.D. after a variable number of years of residency.
In United States of America
Clinical pathologists work in close collaboration with clinical scientists (clinical biochemists, clinical microbiologists, etc.), medical technologists, hospital administrators, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.
Clinical pathology is one of the two major divisions of pathology, the other being anatomical pathology. Often, pathologists practice both anatomical and clinical pathology, a combination sometimes known as general pathology. Similar specialties exist in veterinary pathology.
Clinical pathology is itself divided into subspecialties, the main ones being clinical chemistry, clinical hematology/blood banking, hematopathology and clinical microbiology and emerging subspecialties such as molecular diagnostics and proteomics. Many areas of clinical pathology overlap with anatomic pathology. Both can serve as medical directors of CLIA certified laboratories. Under the CLIA law, only the US Department of Health and Human Services approved Board Certified Ph.D., DSc, or MD and DO can perform the duties of a Medical or Clinical Laboratory Director. This overlap includes immunoassays, flow cytometry, microbiology and cytogenetics and any assay done on tissue. Overlap between anatomic and clinical pathology is expanding to molecular diagnostics and proteomics as we move towards making the best use of new technologies for personalized medicine.[3]
In Europe
Recently, EFLM has chosen the name of "Specialists in Laboratory Medicine" to define all European Clinical pathologists, regardless of their training (M.D., Ph.D. or Pharm.D.).[4]
In France, Clinical Pathology is called Medical Biology ("Biologie médicale") and is practiced by both M.D.s and Pharm.D.s. The residency lasts four years. Specialists in this discipline are called "Biologiste médical" which literally translates as Clinical Biologist rather than "Clinical pathologist".[5]
Tools
Microscopes, analyzers, strips, centrifuges
Macroscopic examination
The visual examination of the taken liquid is a first main indication for the pathologist or the physician. The aspect of the liquid, in addition, conditions the analytical assumption of responsibility that follow and the validity of the end-results.
Microscopical examination
Microscopic analysis is an important activity of the pathologist and the laboratory assistant. They have many different colorings at their disposal (GRAM, MGG, Grocott, Ziehl–Neelsen, etc.). Immunofluorescence, cytochemistry, the immunocytochemistry, and FISH are also used in order make a correct diagnosis.
This stage allows the pathologist to determine the character of the liquid: "normal", tumoral, inflammatory, or even infectious. Microscopic examination can also determine the causal infectious agent – often a bacterium, mould, yeast, parasite, or (rarely) virus.
Physical Analyzers
Automated analysers, by the association of robotics and spectrophotometry, have allowed these last decades better reproducibility of the results of proportionings, in particular in medical biochemistry and hematology[clarification needed].
The companies of in vitro diagnosis henceforth try to sell chains of automats, i.e. a system allowing the automatic transfer of the tubes towards the various types of automats of the same mark. These systems can include the computer-assisted management of a serum library.
These analysers must undergo daily controls to guarantee a result just possible, one speaks about quality control. These analysers must also undergo daily, weekly and monthly maintenance.
Cultures
A big part of the examinations of clinical pathology, primarily in medical microbiology, use culture media. Those allow, for example, the description of one or several infectious agents responsible of the clinical signs.
Values known as "normal" or reference values
Detailed article: Reference range.
See also
Notes and references
- ^ "Textes Généraux, Ministère de la Santé et des Sports". Journal Officiel de la République Française. Décrets, arrêtés, circulaires (Texte 15 sur 54). 20 June 2010. Retrieved 4 December 2019. Note: This document does not cover all countries listed.
- ^ "Bulletin officiel du n°32 du 4 septembre 2003 - MENS0301444A". www.education.gouv.fr. Retrieved 2023-02-21.
- ^ Description of Pathology in USA
- ^ Zerah Simone, Murray Janet, Rita Horvath Andrea (2012). "EFLM Position Statement – Our profession now has a European name: Specialist in Laboratory Medicine". Biochemia Medica. 22 (3): 272–273. doi:10.11613/BM.2012.029. PMC 3900053. PMID 23092058.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Reglementation for French Residency in Clinical Pathology Archived 2008-02-28 at the Wayback Machine
External links
- American Association for Clinical Chemistry
- American Society for Clinical Pathology
- American Board of Pathology
- College of American Pathologists
- European Federation of Clinical Chemistry and Laboratory Medicine
Forensic pathology
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Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Duties
Forensic pathology is an application of medical jurisprudence. A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology.[1] The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below.
The forensic pathologist performs autopsies/postmortem examinations with the goal of determining the cause of death as well as the possible manner of death. The autopsy report contains conclusions made relating to the following:
- The pathological process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called the mechanism of death), such as a bullet wound to the head, exsanguination caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.)
- The manner of death, the circumstances surrounding the cause of death, which, in most jurisdictions, include the following:[2]
- Homicide
- Accidental
- Natural
- Suicide
- Undetermined
The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased. Autopsies are performed when a death occurs, when an unexpected death occurs, when someone dies while not under the care of a physician, to solve criminal cases, when a mass disaster occurs and requires the identification of the victims[3] and upon request by the family or loved ones of the deceased. Typically, autopsies can cost anywhere from $3,000 to $5,000, however the price can vary from country to country.[4]
The forensic pathologist examines and documents wounds and injuries, along with the possible causation of those injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.
Forensic pathologists collect and examine tissue specimens under the microscope (histology) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).
In mass disaster settings, forensic pathologists will work alongside Forensic Odontologists, Forensics Anthropologists as well as other forensic specialties with the goal of identifying the victims of the disaster.[3] The process of identification involves the recovery of the victims, the collection of antemortem data, the initial examination along with the collection of any postmortem evidence, and finally the comparison of the antemortem and postmortem data gathered in order to identify those victims.[3]
They serve as expert witnesses in courts of law testifying in civil or criminal law cases.
In an autopsy, the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).
Forensic physicians sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty.
In the United Kingdom, membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert. Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009, which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.
Forensic pathologists make great contributions to public health and preventative medicine by studying the dead. By using their findings during autopsies, they can use their knowledge to prevent the death of another person.[1]
Investigation of death
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Pathologists determine the cause of death through postmortem examination or autopsy. There are three stages of death investigation: examination, correlation, and interpretation. Deaths where there is an unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.
Methods
Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body.[5] While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.
Terminology inconsistencies across jurisdictions
In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.
Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.
Canadian coroners
In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems[6][7]
Coroners and medical examiners in the United States
In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).
In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.
History
Forensic pathology was founded by Rudolf Virchow, a German pathologist, who developed the Virchow method which is one of the main and popular techniques still used by forensic pathologists today. The Virchow method is of doing autopsies as well as instituting cell theory which would shed light on the effects and damage of disease on the human body. Rudolf Virchow began the practice of regulated autopsies where the entire body would be inspected rather than a particular area of interest which would expose additional damage that injuries and ailments inflicted on the human body.[8] In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu, Johann Ludwig Casper and Carl Liman made great efforts to develop forensic pathology into a science based on empirics.
Ambroise Paré is also considered one of the fathers of modern forensic pathology and surgery. His inventions in the early 16th century include surgical instruments and techniques. He pioneered battlefield medicine and treatments of wounds. One technique he used was pouring boiling oil into wounds.[9]
This history of forensic pathology can be traced all the way back to the fourth century BC in Babylonia but instead of practicing on deceased human bodies, the practice of forensic pathology was strictly practiced on animals. This was said to be done only to animals since humans during this era were believed to be sacred. Later on, in forensic pathology history, forensic pathology would be practiced among those who live in Asia. Muslim doctors would discover infectious diseases and as a result, would operate on deceased bodies; one of those doctors being Ibn Zuhr. Zuhr would go on to performing autopsies on bodies in postmortem and research diseases such as leprosy, mange, and sexually transmitted diseases.
While Zuhr was busy learning about contagious diseases, Yee Siung, a Chinese government official was assembling a group of physicians who were in charge of dissecting criminal murder victims. These victims’ cause of death would be investigated alongside the actual case itself and this would be the first time pathology would be used to help solve criminal cases.[10]
Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959 after toxicology and pathology had been used to solve thousands of criminal cases worldwide for years.[11][12]
In Canada, it was formally recognized in 2003,[13][14] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.[15]
Education
In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country, however, it is common for pathologists to study at a medical school and then go on to study pathology. Many forensic pathologists practice as a histo (hospital) pathologists before moving onto forensic science. Another requirement for forensic pathologists includes having a working knowledge of specific fields of study like toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology.[16]
Australia
There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).[citation needed]
Canada
In Canada,[17] individuals must complete an undergraduate science degree, followed by a doctor of medicine degree from one of the seven medical schools in Canada. After these are completed individuals may enter the Royal College of Physicians and Surgeons (RCPSC) which requires the completion of residency training.[18] Anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the RCPSC. As of 2022, there are three schools in Canada that offer the forensic pathology training program. These schools are the University of Alberta, the University of Ottawa[19] and the University of Toronto. McMaster University ceased their training program in 2019.
Germany
Once students have acquired the "Abitur" diploma and completed all the requirements, they can study medicine at a university. Within the medical education system, there are four subdivisions individuals must partake in prior to moving into a specialization.
The first section is a two year preclinical study period where individuals are introduced to the basics. A two month work period at a hospital must be completed between each semester in order to become familiar with everyday life in a hospital. A final exam on the basics concludes this portion.
The second section is a one year clinical period to familiarize the students with the basics of clinical practice. The students complete the first part of the physician's exam at the end of this period.
The third section is another clinical period which lasts for two years, which practices non-surgical, surgical, neurological, ecological and general medicine domains. Here is where forensic medicine is first introduced. Between the first and second clinical sections, four months of medical clerkship are required, which consists of two months in a hospital and two months at any other medical institution. Students complete the second part of the physician's exam at the end of this period.
The final section is a one year practical period where students partake in three 4 month practicums: four months of internal medicine, four months of surgery and four months of clinical practical study of their choice. Students write the final part of the physician's exam before this period and have the oral part afterwards.
Once individuals have completed their medical studies, there is a minimum of six extra years of specialization training for forensic pathology. During this training individuals must complete at least three years and six months working for a legal medicine institution, focusing on clinical forensic pathology training. Then, at least one year of pathology work at a specialized institute is required partaking in autopsy technical training. As well, a minimum of 6 months working with forensic psychiatrists is also required. Finally, a single year of work in any field of medicine or legal medicine must be completed. During these work periods, it is required that these physicians write a number of opinions on their post-mortem examinations, crime scene investigations, crime scene reconstructions and insurance medical cases. There is also a minimum number of reports consisting of their own autopsies, police inquiries, histological investigation and other investigative results. Finally, the practicing physician must complete a certain number of oral court proceedings. Once all of this has been completed, an oral examination, overseen by the Chamber of Physicians (also known as the German Medical Association) is to be completed which allows individuals to officially become a forensic pathologist upon completion.[20]
India
In India, the specialty is commonly referred to as Forensic Medicine and Toxicology, or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to the award of a degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by the National Board of Examinations Archived 2021-06-03 at the Wayback Machine, leading to awarding of Diplomate of National Board (DNB).
The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader), and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this, clinical forensic examinations constitute a major part of the work and the number of cases can run up to ten thousand a year in an average institution.
The largest association of the specialty is Indian Academy of Forensic Medicine [18] (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine [19] regularly. This association has a specialist member strength of more than 1000.
Indonesia
In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years. It was first introduced through the Dutch colonial criminal justice system in the early twentieth century.
Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.
Japan
In Japan, the profession of forensic pathology is not commonly pursued compared to other medical professions such as clinicians and doctors. In Japan, there are 33 of 42 universities that have a department of pathology established on their campuses yet, even so, only 21 of the 42 universities offer residency programs pertaining to forensic pathology.[21]
To become a forensic pathologist, it requires individuals to pursue a four year undergraduate degree. After completing their undergraduate career, it is then required for individuals to attend medical school to either earn their Masters or Doctorates degree. After completing medical school, individuals are then required to have 2 years of mandatory postgraduate clinical education where they learn important clinical skills such as communication skills, common laboratory procedures such as Gram’s stain and urinalysis. When the two year mandatory clinical training is completed, another 3-4[21] years of training is needed to focus more on surgical procedures which is especially for forensic pathologists. During these last 3–4 years of training, forensic pathologists will learn more about specified human anatomy and they will also have the chance to interact with real patients as well as interacting with other forensic pathologists as well. The department of Forensic Medicine at Kyoto University in Japan has a legacy that can be traced back to 1899 when the department of forensic was first founded. The department has been active forces in promoting the significance of forensic medicine through its innovative programs, research, and analysis.
When their training is completed, forensic pathologists in Japan will then have the opportunity to receive their certificate of pathology awarded by the Japanese Society of Pathology[22]
United Kingdom
In the UK, forensic histopathology is a five-year training programme, consisting of two years of histopathology followed by three years of forensic histopathology. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC), which is a requirement to work as a consultant forensic pathologist.
Entry to forensic histopathology specialty training requires completion of the UK Foundation Programme, stages A and B of histopathology specialty training, and a pass in the FRCPath Part 1 examination in histopathology. Candidates are in year 3 of specialty training (ST3) when entering forensic histopathology and progress immediately to stage C. Completion of stages C and D (a minimum of 36 months), and a pass in the FRCPath Part 2 examination in forensic histopathology allow the candidate to apply for the Certificate of Completion of Training (CCT).[23]
Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)) or the Diploma in Medical Jurisprudence (DMJ). In England and Wales, the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.
Currently approved centers for forensic pathology training include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow, and Dundee. Not all the posts are currently actively training.
Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises. The Royal College has not yet issued their response to this matter.
United States
In the United States, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.
In the United States, all told, the education after high school is typically 13–15 years in duration (4 years of undergraduate training + 4 years of medical school + 4–5 years of residency [anatomic and clinical pathology combined] + 1–2 years of forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require the American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field.[24]
In popular culture
Pathologists often feature in crime fiction. The following television series are listed alphabetically by the character's name:
- Dr George Bullard of Causton in Midsomer Murders
- Jordan Cavanaugh M.D., is a forensic pathologist in the Massachusetts Office of the Chief Medical Examiner, in the series Crossing Jordan
- Dr Ravi Chakrabarti, Medical Examiner with the King County Medical Examiner's Office, in the series iZombie
- Dr Max Debryn, Home Office forensic pathologist in detective series Endeavour and Inspector Morse
- Dr Laura Hobson, pathologist and eventual love interest of D.I. Robbie Lewis in later episodes of Inspector Morse and in Lewis
- Dr. Maura Isles, Chief Medical Examiner of the Commonwealth of Massachusetts, in the series Rizzoli & Isles
- Isabelle Lightwood, said to be the best forensic pathologist in New York the TV series, Shadowhunters
- Dr. Donald "Ducky" Mallard, the Chief Medical Examiner for the NCIS Major Case Response Team in NCIS
- Sven Nyberg, Ystad police department's forensic pathologist in the Swedish and British TV series Wallander
- Dr. James "Jimmy" Palmer, former Medical Examiner Assistant and now Chief Medical Examiner (after Dr. Mallard's retirement) in NCIS
- Dr Marco Pasquano, Vigàta's local forensic pathologist in the Italian series, Inspector Montalbano
- Dr R. Quincy, Chief medical examiner for Los Angeles County in the US TV series Quincy, M.E.
- Dr Samantha Ryan, forensic pathologist, the primary character (Series 1 - 8) in the British crime drama series Silent Witness
- Dr Nikki Alexander, forensic pathologist (since Series 8) and the primary character since Series 24 in the British crime drama series Silent Witness
- Dr. Camille Saroyan, head of the Forensic Division of the Jeffersonian in Bones
- Ambrose Spellman, coroner for the Spellman Sisters' Mortuary and main character in the Netflix supernatural horror series Chilling Adventures of Sabrina
- Dr Misumi Mikoto, a forensic pathologist at the fictional Unnatural Death Investigation Laboratory (UDI Lab) in Tokyo, is the protagonist of the Japanese drama Unnatural (2018)
See also
References
- ^ a b "What is a Forensic Pathologist?". University of New Mexico Health Sciences. Retrieved 4 October 2020.
- ^ DiMaio, Dominick (28 June 2001). Forensic Pathology (2nd ed.). Florida: CRC Press LLC. pp. 3–6. ISBN 0-8493-0072-X.
- ^ a b c Schuliar, Yves; Knudsen, Peter Juel Thiis (2012-06-01). "Role of forensic pathologists in mass disasters". Forensic Science, Medicine, and Pathology. 8 (2): 164–173. doi:10.1007/s12024-011-9300-3. ISSN 1556-2891. PMID 22160735. S2CID 40971570.
- ^ "Post Mortem - Autopsy 101". FRONTLINE. Retrieved 2022-03-05.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-03-03.
- ^ The Coroner System. USW. http://www.usw.ca/program/content/3179.php Archived 2009-11-13 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ Coroners' law resource. King's College London. http://www.kcl.ac.uk/depsta/law/research/coroners/canada.html Archived 2009-02-03 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ "Rudolf Virchow | Biography, Discovery, & Facts | Britannica". www.britannica.com. Retrieved 2022-03-03.
- ^ "Ambroise Paré - Advances in medical knowledge – WJEC - GCSE History Revision - WJEC". BBC Bitesize. Retrieved 2022-03-05.
- ^ Choo, Tae M.; Choi, Young-Shik (2012). "Historical Development of Forensic Pathology in the United States". Korean Journal of Legal Medicine. 36 (1): 15–21. doi:10.7580/KoreanJLegMed.2012.36.1.15.
- ^ Eckert WG (1988). "The forensic pathology specialty certifications". The American Journal of Forensic Medicine and Pathology. 9 (1): 85–9. doi:10.1097/00000433-198803000-00023. PMID 3354533.
- ^ "History of Forensic Pathology". 17 December 2011. Retrieved 2022-03-05.
- ^ Lett D (July 2007). "National standards for forensic pathology training slow to develop". CMAJ. 177 (3): 240–1. doi:10.1503/cmaj.070881. PMC 1930175. PMID 17664437.
- ^ Royal College of Physicians and Surgeons of Canada. Information by Specialty or Subspecialty. Available at: http://rcpsc.medical.org/information/index.php?specialty=417&submit=Select.[dead link] Accessed on: 15 July 2008.
- ^ "2 new pathologists to restart Ottawa forensic unit". CBC News. 11 January 2008.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-02-16.
- ^ Residency Training Programs. Dalhousie University. URL: http://pathology.medicine.dal.ca/anatomical.html. Accessed on: 7 June 2007.
- ^ "Forensic Science in Canada - PDF Free Download". docplayer.net. Retrieved 2022-03-30.
- ^ University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. Retrieved 2022-03-28.
- ^ Bockholdt, Britta; Rothschild, Marcus A.; Ehrlich, Edwin; Maxeiner, Helmut; Schneider, Volkmar (2001-06-01). "Medical studies and training duration for forensic pathologists in Germany". Legal Medicine. 3 (2): 104–108. doi:10.1016/S1344-6223(01)00017-7. ISSN 1344-6223. PMID 12935530.
- ^ a b Nonomura, A; Minato, H; Koike, M (April 2002). "[Postgraduate medical training in anatomical pathology in Japanese national universities]". Rinsho Byori. 50 (4): 347–352. PMID 12014012.
- ^ Kumasaka, K (April 2002). "[Postgraduates' training as laboratory physicians/clinical pathologists in Japan--board certification of JSLM as a mandatory requirement for chairpersons of laboratory medicine]". Rinsho Byori. 50 (4): 353–357. PMID 12014013.
- ^ Pathologists, The Royal College of. "Forensic Histopathology". www.rcpath.org. Archived from the original on 2021-07-09. Retrieved 2021-07-09.
- ^ "Top 10 Things to Look For in Finding a Qualified Forensic Pathologist Expert Witness". Archived from the original on 2012-03-08. Retrieved 2011-11-07.
Sources
- Bartos, Leah, "No Forensic Background? No Problem", ProPublica, April 17, 2012.
- Payne-James, Jason (ed.; et al.) (2005). Encyclopedia of Forensic & Legal Medicine. Amsterdam; Boston: Elsevier Academic Press. ISBN 0-12-547970-0. OCLC 60834620.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Payne-James, Jason; Busuttil, Anthony; Smock, William S. (eds.) (2003). Forensic Medicine: Clinical and Pathological Aspects. London; San Francisco: Greenwich Medical Media. ISBN 1-84110-026-9. OCLC 51678652.
{{cite book}}
:|first3=
has generic name (help) - Saukko, Pekka J.; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). London: Edward Arnold (Publishers). ISBN 0-340-76044-3. OCLC 56440239.
- Spitz, Werner U.; Spitz, Daniel J. (eds.) (2006). Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation (4th ed.). Springfield, Ill.: Charles C. Thomas Publisher. ISBN 0-398-07544-1. OCLC 56614481.
{{cite book}}
:|first2=
has generic name (help) - The Real CSI, PBS Frontline documentary, April 17, 2012
- Syukriani, Yoni Fuadah; Novita, Nita; Sunjaya, Deni K. (1 August 2018). "Development of forensic medicine in post reform Indonesia". Journal of Forensic and Legal Medicine. 58: 56–63. doi:10.1016/j.jflm.2018.05.001. PMID 29751222. S2CID 21709263.
- https://www.med.kyoto-u.ac.jp/en/organization-staff/research/doctoral_course/r-011/ Archived 2022-03-03 at the Wayback Machine
- University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. https://med.uottawa.ca/pathology/education/postgraduate-medical-education/forensic-pathology-residency-training-program Retrieved 2022-03-28.
External links
- National Association of Medical Examiners (NAME)
- American Academy of Forensic Sciences
- Forensic Science Society
- British Association in Forensic Medicine
- British Association for Human Identification
- British Academy of Forensic Science
- Forensic Medicine for Medical Students - a website providing educational resources in forensic medicine
- Faculty of Forensic & Legal Medicine of the Royal College of Physicians
- Royal College of Pathologists of Australasia
- Forensic Oral Pathology Journal - FOPJ
- Punjab Academy of Forensic Medicine & Toxicology Archived 2021-02-11 at the Wayback Machine
- 2011 books for forensic pathology.
- Indian Congress of Forensic Medicine and Toxicology
- Forensic Medicine Online Master's Degree at the University of Florida- the first fully online advanced degree program in forensic medicine in the United States
- A career in forensic pathology Archived 2021-02-06 at the Wayback Machine - educational website on career pathways for forensic pathology in the UK and USA
- So, you want to be a forensic scientist? - Simon Fraser University.
- When I grow up: becoming a pathologist by G. William Moore, MD, PhD. - netautopsy.org.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Forensic Pathology Resource
- Royal College of Pathologists of Australasia - Follow the "Careers and Training" Link, & go to "Disciplines and Career Brochures", or go to this page directly
- Royal College of Pathologists UK
- Forensic Pathology by David Webb, University of Huddersfield
- Forensic Pathology Pathway in Residency and fellowship - USMLE Forums
Warning: Default sort key "Forensic Pathology" overrides earlier default sort key "Anatomical Pathology".
Veterinary pathology
Veterinary pathologists are veterinarians who specialize in the diagnosis of diseases through the examination of animal tissue and body fluids.[1] Like medical pathology, veterinary pathology is divided into two branches, anatomical pathology and clinical pathology. Other than the diagnosis of disease in food-producing animals, companion animals, zoo animals and wildlife, veterinary pathologists also have an important role in drug discovery and safety as well as scientific research.[1]
Veterinary anatomical pathology
Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is concerned with the diagnosis of disease based on the gross examination, microscopic, and molecular examination of organs, tissues, and whole bodies (necropsy). Veterinary pathology also takes into account the structure and function of the body and how particular cells were injured.[2][page needed] The Indian, European, Japanese, and American Colleges of Veterinary Pathologists certify veterinary pathologists through a certifying exam after completing a residency program. After completing the residency and the exam, a certificate will be given out to display specialization in veterinary pathology.[3] The American College of Veterinary Pathologist certification exam consists of four parts, - gross pathology, microscopic pathology, veterinary pathology, and general pathology. Only the general pathology section is shared between the anatomic and clinical pathology examinations.[4] Veterinary pathologists are employed in several different positions, including diagnostics, teaching, research, and the pharmaceutical industry.[5]
Veterinary clinical pathology
Clinical pathology is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood, urine or cavitary effusions, or tissue aspirates using the tools of chemistry, microbiology, hematology, and molecular pathology.[6] Clinical pathology labs offer many services including hematology, hemostasis, urinalysis, cytology, and clinical biochemistry tests. [6] Many clinical pathology tests can be done "in" or "out" of house, meaning that the test can be done in that particular clinic or sent to a further specialized outside laboratory. Many patients have the desire to do "in-house" tests because it is usually cheaper.[7] Ultimately, veterinary pathology consists of most of the behind-the-scenes laboratory work that studies virus, infections, bacteria, and much more. Without veterinary pathologists, illness would spread throughout many species of animals much quicker than in the present day.[8]
See also
References
- ^ a b "What is veterinary pathology?". American College of Veterinary Pathology. Archived from the original on October 24, 2013. Retrieved October 3, 2013.
- ^ Cheville, Norman F. (2001). Introduction to Veterinary Pathology (2nd ed.). Wiley. ISBN 978-0-813-82488-8.
- ^ "Veterinary Pathology (ACVP) FAQs". AKVNA. Retrieved 2024-03-07.
- ^ "American College of Veterinary Pathologists" (PDF). 2024 Phase 1 Certifying Examination Candidate Handbook. March 7, 2024.
- ^ "What is Veterinary Pathology? - American College of Veterinary Pathologists". www.acvp.org. Retrieved 2024-03-07.
- ^ a b "Clinical Pathology". The College of Veterinary Medicine at Michigan State University. Retrieved 2024-03-07.
- ^ "Overview of Diagnostic Procedures for the Private Practice Laboratory - Clinical Pathology and Procedures". MSD Veterinary Manual. Retrieved 2024-03-07.
- ^ Papajeski, Barbie (February 2022). "Specialty Spotlight" (PDF). VTS in Clinical Pathology.
External links
- American College of Veterinary Pathologists
- European College of Veterinary Clinical Pathology
- European College of Veterinary Pathologists
Plant pathology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/a/ad/Black_rot_lifecycle.tif/lossy-page1-390px-Black_rot_lifecycle.tif.jpg)
Plant pathology or phytopathology is the scientific study of plant diseases caused by pathogens (infectious organisms) and environmental conditions (physiological factors).[1] Plant pathology involves the study of pathogen identification, disease etiology, disease cycles, economic impact, plant disease epidemiology, plant disease resistance, how plant diseases affect humans and animals, pathosystem genetics, and management of plant diseases.
Plant pathogenicity
Plant pathogens, organisms that cause infectious plant diseases, include fungi, oomycetes, bacteria, viruses, viroids, virus-like organisms, phytoplasmas, protozoa, nematodes and parasitic plants.[2] In most plant pathosystems, virulence depends on hydrolases and enzymes that degrade the cell wall. The vast majority of these act on pectins (for example, pectinesterase, pectate lyase, and pectinases). For microbes, the cell wall polysaccharides are both a food source and a barrier to be overcome. Many pathogens grow opportunistically when the host breaks down its own cell walls, most often during fruit ripening.[3] Unlike human and animal pathology, plant pathology usually focuses on a single causal organism; however, some plant diseases have been shown to be interactions between multiple pathogens.[4]
To colonize a plant, pathogens have specific pathogenicity factors, of five main types: uses of cell wall–degrading enzymes, toxins, effector proteins, phytohormones, and exopolysaccharides.
- Cell wall-degrading enzymes: These are used to break down the plant cell wall in order to release the nutrients inside and include esterases, glycosyl hydrolases, lyases and oxidoreductases.[5]
- Toxins: These can be non-host-specific, which damage all plants, or host-specific, which cause damage only on a host plant.
- Effector proteins: These can be secreted by pathogens such as bacteria, fungi, and oomycetes[6][7] into the extracellular environment or directly into the host cell, often via the Type three secretion system. Some effectors are known to suppress host defense processes. This can include reducing the plant's internal signaling mechanisms or reduction of phytochemicals production.[8]
- Phytohormones are chemicals used by plants for signaling; pathogens can produce these to modify plant growth to their own advantage.
- Exopolysaccharides are mostly small chains of sugars that help pathogens to adhere to a plant's surface, enabling them to begin the process of infection.
Physiological plant disorders
Some abiotic disorders can be confused with pathogen-induced disorders. Abiotic causes include natural processes such as drought, frost, snow and hail; flooding and poor drainage; nutrient deficiency; deposition of mineral salts such as sodium chloride and gypsum; windburn and breakage by storms; and wildfires. [9]
Epidemiology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Plant_Disease_Triangle.svg/220px-Plant_Disease_Triangle.svg.png)
Epidemiology is the study of factors affecting the outbreak and spread of infectious diseases.[10]
A disease triangle describes the basic factors required for plant diseases. These are the host plant, the pathogen, and the environment. Any one of these can be modified to control a disease.[11]
Disease resistance
Plant disease resistance is the ability of a plant to prevent and terminate infections from plant pathogens. Structures that help plants prevent pathogens from entering are the cuticular layer, cell walls and stomata guard cells. Once pathogens have overcome these barriers, plant receptors initiate signaling pathways to create molecules to compete against the foreign molecules. These pathways are influenced and triggered by genes within the host plant and can manipulated by genetic breeding to create resistant varieties.[12]
Management
Detection
Ancient methods of leaf examination and breaking open plant material by hand are now augmented by newer technologies. These include molecular pathology assays such as polymerase chain reaction (PCR), RT-PCR and loop-mediated isothermal amplification (LAMP).[13] Although PCR can detect multiple molecular targets in a single solution there are limits.[13] Bertolini et al 2001, Ito et al 2002 and Ragozzino et al 2004 developed PCR methods for multiplexing six or seven plant pathogen molecular products and Persson et al 2005 for multiplexing four with RT-PCR.[13] More extensive molecular diagnosis requires PCR arrays.[13] The primary detection method used worldwide is enzyme linked immunosorbent assay.[14]
Biological
Crop rotation is a traditional and sometimes effective means of preventing a parasitic population from becoming well-established. For example, protection against infection by Agrobacterium tumefaciens, which causes gall diseases in many plants, by dipping cuttings in suspensions of Agrobacterium radiobacter before inserting them in the ground to take root.[15]
History
Plant pathology has developed from antiquity, starting with Theophrastus in the ancient era, but scientific study began in the Early Modern period with the invention of the microscope, and developed in the 19th century.[16]
See also
- American Phytopathological Society
- Australasian Plant Pathology Society
- British Society for Plant Pathology
- Forest pathology
- Gene-for-gene relationship
- Global Plant Clinic
- Glossary of phytopathology
- Horsfall-Barratt scale
- List of phytopathology journals
- Microbial inoculant
- Phytopharmacology
- Plant disease forecasting
- Stunting
Notes
References
- ^ Agrios GN (1972). Plant Pathology (3rd ed.). Academic Press.
- ^ Nazarov PA, Baleev DN, Ivanova MI, Sokolova LM, Karakozova MV (2020-10-27). "Infectious Plant Diseases: Etiology, Current Status, Problems and Prospects in Plant Protection". Acta Naturae. 12 (3): 46–59. doi:10.32607/actanaturae.11026. PMC 7604890. PMID 33173596.
- ^ Cantu D, Vicente AR, Labavitch JM, Bennett AB, Powell AL (November 2008). "Strangers in the matrix: plant cell walls and pathogen susceptibility". Trends in Plant Science. 13 (11). Cell Press: 610–617. doi:10.1016/j.tplants.2008.09.002. hdl:11336/148749. PMID 18824396. (ARV ORCID: 0000-0003-1289-9554).
- ^ Lamichhane JR, Venturi V (2015). "Synergisms between microbial pathogens in plant disease complexes: a growing trend". Frontiers in Plant Science. 6 (385): 385. doi:10.3389/fpls.2015.00385. PMC 4445244. PMID 26074945.
- ^ Giovannoni M, Gramegna G, Benedetti M, Mattei B (2020). "Industrial Use of Cell Wall Degrading Enzymes: The Fine Line Between Production Strategy and Economic Feasibility". Frontiers in Bioengineering and Biotechnology. 8: 356. doi:10.3389/fbioe.2020.00356. PMC 7200985. PMID 32411686.
- ^ Davis N (September 9, 2009). "Genome of Irish potato famine pathogen decoded". Haas et al. Broad Institute of MIT and Harvard. Retrieved 24 July 2012.
- ^ "1st large-scale map of a plant's protein network addresses evolution, disease process". Dana-Farber Cancer Institute. July 29, 2011. Archived from the original on 12 May 2012. Retrieved 24 July 2012.
- ^ Ma, Winbo (March 28, 2011). "How do plants fight disease? Breakthrough research by UC Riverside plant pathologist offers a clue". UC Riverside.
- ^ Schutzki, R.E.; Cregg, B. (2007). "Abiotic plant disorders: Symptoms, signs and solutions. A diagnostic guide to problem solving" (PDF). Michigan State University Department of Horticulture. Michigan State University. Archived from the original (PDF) on 24 September 2015. Retrieved 10 April 2015.
- ^ "American Phytopathological Society". American Phytopathological Society. Retrieved 2019-03-26.
- ^ "Disease Triangle". Oregon State University. 25 April 2014. Retrieved 31 December 2023.
- ^ Andersen EJ, Ali S, Byamukama E, Yen Y, Nepal MP (July 2018). "Disease Resistance Mechanisms in Plants". Genes. 9 (7): 339. doi:10.3390/genes9070339. PMC 6071103. PMID 29973557.
- ^ a b c d Mumford R, Boonham N, Tomlinson J, Barker I (2006-07-13). "Advances in molecular phytodiagnostics - new solutions for old problems". European Journal of Plant Pathology. 116 (1). European Foundation for Plant Pathology (Springer): 1–19. Bibcode:2006EJPP..116....1M. doi:10.1007/s10658-006-9037-0. PMC 7087944. PMID 32214677.
- ^ Current and emerging trends in techniques for plant pathogen detection Frontiers in Plant Science
- ^ Ryder MH, Jones DA (1991-10-01). "Biological Control of Crown Gall Using Using Agrobacterium Strains K84 and K1026". Functional Plant Biology. 18 (5): 571–579. doi:10.1071/pp9910571.
- ^ Aisnworth GC (1981). Introduction to the History of Plant Pathology. Cambridge University Press. ISBN 978-0-521-23032-2.
External links
- International Society for Plant Pathology
- Australasian Plant Pathology Society
- American Phytopathological Society
- British Society for Plant Pathology
- Erwin Frink Smith Papers Index to papers of Smith (1854–1927) who was considered the "father of bacterial plant pathology" and worked for the United States Department of Agriculture for over 40 years.
- Plant Health Progress, Online journal of applied plant pathology
- Pacific Northwest Fungi, online mycology journal with papers on fungal plant pathogens
- Rothamsted Plant Pathology and Microbiology Department
- New Mexico State University Department of Entomology Plant Pathology and Weed Science
- Pathogen Host Interactions Database (PHI-base)
- Grape Virology
- Opportunity in Plant Pathology
- Facebook page for Asian Association of Societies for Plant Pathology
See also
References
External links
- Association of Clinical Biochemistry (UK)
- American Society for Investigative Pathology
- American Society of Cytopathology
- British Neuropathological Society
- Case Records of the Massachusetts General Hospital - Clinicopathological Conference
- College of American Pathologists
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- HistoPathology Atlas
- humpath.com (Atlas in Human Pathology)
- Immunohistochemistry protocols and troubleshooting
- Traditional Chinese medicine Pathology
- Mybiopsy.org
- Neuropathology blog
- Pathological Society of Great Britain and Ireland
- Royal College of Pathologists (UK)
- Royal College of Pathologists of Australasia (Australia & Oceania)
- Sullivan Nicolaides Pathology - Leading Australian Pathology Laboratory.
- United States and Canadian Academy of Pathology
- WebPath: The Internet Pathology Laboratory for Medical Education
- Pathtalk.org - A community weblog about pathology-related topics.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Pathologypics - an interactive community-driven histology atlas
Anatomical pathology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/71/Breast_invasive_scirrhous_carcinoma_histopathology_%281%29.jpg/200px-Breast_invasive_scirrhous_carcinoma_histopathology_%281%29.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Streptococcus_pneumoniae_meningitis%2C_gross_pathology_33_lores.jpg/200px-Streptococcus_pneumoniae_meningitis%2C_gross_pathology_33_lores.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/e/eb/End-stage_interstitial_lung_disease_%28honeycomb_lung%29.jpg/200px-End-stage_interstitial_lung_disease_%28honeycomb_lung%29.jpg)
![](https://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg/200px-Villous_adenoma_of_the_sigmoid_colon%2C_gross_pathology.jpg)
Anatomical pathology (Commonwealth) or anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the 20th century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovanni Battista Morgagni from Forlì.[1]
Anatomical pathology is one of two branches of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids or tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology.[2] Similar specialties exist in veterinary pathology.
Differences with clinical pathology
Anatomic pathology relates to the processing, examination, and diagnosis of surgical specimens by a physician trained in pathological diagnosis. Clinical pathology involves the laboratory analysis of tissue samples and bodily fluids; procedures may include blood sample analysis, urinalysis, stool sample analysis, and analysis of spinal fluid. Clinical pathologists may specialize in a number of areas, including blood banking, clinical chemistry, microbiology, and hematology.[3]
Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology (breast, gynecological, endocrine, gastrointestinal, genitourinary, soft tissue, head and neck, dermatopathology), neuropathology, hematopathology cytopathology, and forensic pathology. To be licensed to practice pathology, one has to complete medical school and secure a license to practice medicine. An approved residency program and certification (in the U.S., the American Board of Pathology or the American Osteopathic Board of Pathology) is usually required to obtain employment or hospital privileges.[citation needed]
Skills and procedures
The procedures used in anatomic pathology include:
- Gross examination – the examination of diseased tissues with the naked eye. This is important especially for large tissue fragments, because the disease can often be visually identified. It is also at this step that the pathologist selects areas that will be processed for histopathology. The eye can sometimes be aided with a magnifying glass or a stereo microscope, especially when examining parasitic organisms.
- Histopathology – the microscopic examination of stained tissue sections using histological techniques. The standard stains are haematoxylin and eosin, but many others exist. The use of haematoxylin and eosin-stained slides to provide specific diagnoses based on morphology is considered to be the core skill of anatomic pathology. The science of staining tissues sections is called histochemistry.
- Immunohistochemistry – the use of antibodies to detect the presence, abundance, and localization of specific proteins. This technique is critical to distinguishing between disorders with similar morphology, as well as characterizing the molecular properties of certain cancers.
- In situ hybridization – Specific DNA and RNA molecules can be identified on sections using this technique. When the probe is labeled with fluorescent dye, the technique is called FISH.
- Cytopathology – the examination of loose cells spread and stained on glass slides using cytology techniques
- Electron microscopy – the examination of tissue with an electron microscope, which allows much greater magnification, enabling the visualization of organelles within the cells. Its use has been largely supplanted by immunohistochemistry, but it is still in common use for certain tasks, including the diagnosis of kidney disease and the identification of immotile cilia syndrome.
- Tissue cytogenetics – the visualization of chromosomes to identify genetic defects such as chromosomal translocation
- Flow immunophenotyping – the determination of the immunophenotype of cells using flow cytometry techniques. It is very useful to diagnose the different types of leukemia and lymphoma.
Subspecialties
Surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists. Surgical pathology increasingly requires technologies and skills traditionally associated with clinical pathology such as molecular diagnostics.
Oral and maxillofacial pathology
In the United States, subspecialty-trained doctors of dentistry, rather than medical doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.
Cytopathology
Cytopathology is a sub-discipline of anatomical pathology concerned with the microscopic examination of whole, individual cells obtained from exfoliation or fine-needle aspirates. Cytopathologists are trained to perform fine-needle aspirates of superficially located organs, masses, or cysts and are often able to render an immediate diagnosis in the presence of the patient and consulting physician. In the case of screening tests such as the Papanicolaou smear, non-physician cytotechnologists are often employed to perform initial reviews, with only positive or uncertain cases examined by the pathologist. Cytopathology is a board-certifiable subspecialty in the U.S.
Molecular pathology
Molecular pathology is an emerging discipline within anatomical and clinical pathology that is focused on the use of nucleic acid-based techniques such as in-situ hybridization, reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialized studies of disease in tissues and cells. Molecular pathology shares some aspects of practice with both anatomic and clinical pathology, and is sometimes considered a "crossover" discipline.
Forensic pathology
Forensic pathologists receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died suddenly with no known medical condition, those who die from non-natural causes, as well as those dying as a result of homicide, or other criminally suspicious deaths. A majority of the forensic pathologists cases are due to natural causes. Often, additional tests such as toxicology, histology, and genetic testing will be used to help the pathologist determine the cause of death. Forensic pathologists will often testify in courts regarding their findings in cases of homicide and suspicious death. They also play a large role in public health, such as investigating deaths in the workplace, deaths in custody, as well as sudden and unexpected deaths in children. Forensic pathologists often have special areas of interest within their practice, such as sudden death due to cardiac pathology, deaths due to drugs, or Sudden Infant Death (SIDS), and various others.
Training and certification
Australia
- (Also New Zealand, Hong Kong, Singapore, Malaysia, and Saudi Arabia)
Anatomical Pathology is one of the specialty training programs offered by the Royal College of Pathologists of Australasia (RCPA). The RCPA. To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised undergraduate or postgraduate medical qualification and then complete a minimum of 2 years of clinical medical experience as a prerequisite to selection as a training registrar. The training program is a minimum of 5 years, served in at least two laboratories, and candidates must pass a Basic Pathological Sciences examination (usually in first year), the Part 1 examinations (not before 3rd year) and the Part 2 examinations (not before 5th year). Fellows may then continue into subspecialty training.
Canada
Anatomical Pathology (AP) is one of the specialist certificates granted by the Royal College of Physicians and Surgeons of Canada. Other certificates related to pathology include general pathology (GP), hematopathology, and neuropathology. Candidates for any of these must have completed four years of medical school and five years of residency training.
United States
Anatomic Pathology (AP) is one of the two primary certifications offered by the American Board of Pathology (the other is Clinical Pathology (CP))[4] and one of three primary certifications offered by the American Osteopathic Board of Pathology.[5] To be certified in anatomic pathology, the trainee must complete four years of medical school followed by three years of residency training. Many U.S. pathologists are certified in both AP and CP, which requires a total of four years of residency. After completing residency, many pathologists enroll in further years of fellowship training to gain expertise in a subspecialty of AP or CP. Pathologists' Assistants are highly trained medical professionals with specialized training in Anatomic and Forensic pathology. To become a Pathologists' Assistant one must enter and successfully complete a NAACLS accredited program and pass the ASCP Board of Certification Exam.
Practice settings
- Academic anatomical pathology is practiced at university medical centers by pathologists who are also university faculty. As such, they often have diverse responsibilities that may include training pathology residents, teaching medical students, conducting basic, clinical, or translational research, or performing administrative duties, all in addition to the practice of diagnostic anatomical pathology. Pathologists in academic settings often sub-specialize in a particular area of anatomic pathology and may serve as consultants to other pathologists regarding cases in their specific area of expertise.
- Group practice is the most traditional private practice model. In this arrangement, a group of senior pathologists will control a partnership that employs junior pathologists and contracts independently with hospitals to provide diagnostic services, as well as attracting referral business from local clinicians who practice in the outpatient setting. The group often owns a laboratory for histology and ancillary testing of tissue, and may hold contracts to run hospital-owned labs. Many pathologists who practice in this setting are trained and certified in both anatomical pathology and clinical pathology, which allows them to supervise blood banks, clinical chemistry laboratories, and medical microbiology laboratories as well.
- Large corporate providers of anatomical pathology services, such as AmeriPath in the United States. In this model, pathologists are employees, rather than independent partners. This model has been criticized for reducing physician independence, but defenders claim that the larger size of these practices allows for economies of scale and greater specialization, as well a sufficient volume to support more specialized testing methods.
- Multispecialty groups, composed of physicians from clinical specialties as well as radiology and pathology, are another practice model. In some case, these may be large groups controlled by an HMO or other large health care organization. In others, they are in essence clinician group practices that employ pathologists to provide diagnostic services for the group. These groups may own their own laboratories, or, in some cases may make controversial arrangements with "pod labs" that allow clinician groups to lease space, with the clinician groups receiving direct insurance payments for pathology services.[6] Proposed changes to Medicare regulations may essentially eliminate these arrangements in the United States.[7]
See also
Notes and references
- ^ Morgagni, G. B. (October 1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682-1771)". Medical Library and Historical Journal. 1 (4): 270–277. ISSN 0898-1868. PMC 1698114. PMID 18340813.
- ^ "Pathology Specialty Description". American Medical Association. Retrieved 5 October 2020.
- ^ "Clinical Pathology Overview - Health Encyclopedia - University of Rochester Medical Center". www.urmc.rochester.edu. Retrieved 2024-01-23.
- ^ "ABP Home". Archived from the original on 2007-06-30. Retrieved 2006-01-11.
- ^ "Specialties & Subspecialties". AOA. Archived from the original on 2015-08-13. Retrieved 2 October 2012.
- ^ "Out of joint?OIG takes dim view of pod lab setup - College of American Pathologists". Archived from the original on 2005-03-08. Retrieved 2007-05-20. Congress of American Pathologists Feature story - "Out of joint OIG takes dim view of pod lab setup" January 2005 (Accessed May 19, 2007)
- ^ "Archived copy" (PDF). Archived from the original (PDF) on 2007-09-28. Retrieved 2007-05-20.
{{cite web}}
: CS1 maint: archived copy as title (link) Foster, Swift, Collins, and Smith, P.C. - Health Care Alert, August 2006.
External links
- "Conversations with Pathologists", a website based on a book project by Sue Armstrong, sponsored by Genentech and The Pathological Society of Great Britain and Ireland
- PathReports.in: Make Anatomical pathology reporting paperless and save trees.
- PathMax, a collection of online Pathology resources
- MyBiopsy.org, information on more than 25 of the most common cancers and cancer-related conditions
- The Doctor's doctor, a very useful web site for patients and pathologists
- Pathologie Online, online Pathology resources (in German)
- Pathology Outlines, an online textbook of anatomic pathology
- College of American Pathologists
- American Board of Pathology
- CYTOPATHNET Online Resource Center for Cytopathology
- Histology Group of Victoria Incorporated
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- Pathtalk.org: A multiple-author weblog by and for anatomic pathologists, with illustrative cases and specialty-related discussions.
- PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist as well as Pathology Trainees.
Warning: Default sort key "Anatomical Pathology" overrides earlier default sort key "Forensic Pathology".
Clinical pathology
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Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates or extracts using the tools of chemistry, microbiology, hematology, molecular pathology, and Immunohaematology. This specialty requires a medical residency.
Clinical pathology is a term used in the US, UK, Ireland, many Commonwealth countries, Portugal, Brazil, Italy, Japan, and Peru; countries using the equivalent in the home language of "laboratory medicine" include Austria, Germany, Romania, Poland and other Eastern European countries; other terms are "clinical analysis" (Spain) and "clinical/medical biology (France, Belgium, Netherlands, North and West Africa).[1]
Licensing and subspecialities
The American Board of Pathology certifies clinical pathologists, and recognizes the following secondary specialties of clinical pathology:
- Chemical pathology, also called clinical chemistry
- Hematopathology
- Blood banking - Transfusion medicine
- Clinical microbiology
- Cytogenetics
- Molecular genetics pathology.
In some countries other sub specialities fall under certified Clinical Biologists responsibility:[2]
- Reproductive biology including Assisted reproductive technology, Sperm bank and Semen analysis
- Immunopathology
Organization
Clinical pathologists are often medical doctors. In some countries in South-America, Europe, Africa or Asia, this specialty can be practiced by non-physicians, such as Ph.D. or Pharm.D. after a variable number of years of residency.
In United States of America
Clinical pathologists work in close collaboration with clinical scientists (clinical biochemists, clinical microbiologists, etc.), medical technologists, hospital administrators, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.
Clinical pathology is one of the two major divisions of pathology, the other being anatomical pathology. Often, pathologists practice both anatomical and clinical pathology, a combination sometimes known as general pathology. Similar specialties exist in veterinary pathology.
Clinical pathology is itself divided into subspecialties, the main ones being clinical chemistry, clinical hematology/blood banking, hematopathology and clinical microbiology and emerging subspecialties such as molecular diagnostics and proteomics. Many areas of clinical pathology overlap with anatomic pathology. Both can serve as medical directors of CLIA certified laboratories. Under the CLIA law, only the US Department of Health and Human Services approved Board Certified Ph.D., DSc, or MD and DO can perform the duties of a Medical or Clinical Laboratory Director. This overlap includes immunoassays, flow cytometry, microbiology and cytogenetics and any assay done on tissue. Overlap between anatomic and clinical pathology is expanding to molecular diagnostics and proteomics as we move towards making the best use of new technologies for personalized medicine.[3]
In Europe
Recently, EFLM has chosen the name of "Specialists in Laboratory Medicine" to define all European Clinical pathologists, regardless of their training (M.D., Ph.D. or Pharm.D.).[4]
In France, Clinical Pathology is called Medical Biology ("Biologie médicale") and is practiced by both M.D.s and Pharm.D.s. The residency lasts four years. Specialists in this discipline are called "Biologiste médical" which literally translates as Clinical Biologist rather than "Clinical pathologist".[5]
Tools
Microscopes, analyzers, strips, centrifuges
Macroscopic examination
The visual examination of the taken liquid is a first main indication for the pathologist or the physician. The aspect of the liquid, in addition, conditions the analytical assumption of responsibility that follow and the validity of the end-results.
Microscopical examination
Microscopic analysis is an important activity of the pathologist and the laboratory assistant. They have many different colorings at their disposal (GRAM, MGG, Grocott, Ziehl–Neelsen, etc.). Immunofluorescence, cytochemistry, the immunocytochemistry, and FISH are also used in order make a correct diagnosis.
This stage allows the pathologist to determine the character of the liquid: "normal", tumoral, inflammatory, or even infectious. Microscopic examination can also determine the causal infectious agent – often a bacterium, mould, yeast, parasite, or (rarely) virus.
Physical Analyzers
Automated analysers, by the association of robotics and spectrophotometry, have allowed these last decades better reproducibility of the results of proportionings, in particular in medical biochemistry and hematology[clarification needed].
The companies of in vitro diagnosis henceforth try to sell chains of automats, i.e. a system allowing the automatic transfer of the tubes towards the various types of automats of the same mark. These systems can include the computer-assisted management of a serum library.
These analysers must undergo daily controls to guarantee a result just possible, one speaks about quality control. These analysers must also undergo daily, weekly and monthly maintenance.
Cultures
A big part of the examinations of clinical pathology, primarily in medical microbiology, use culture media. Those allow, for example, the description of one or several infectious agents responsible of the clinical signs.
Values known as "normal" or reference values
Detailed article: Reference range.
See also
Notes and references
- ^ "Textes Généraux, Ministère de la Santé et des Sports". Journal Officiel de la République Française. Décrets, arrêtés, circulaires (Texte 15 sur 54). 20 June 2010. Retrieved 4 December 2019. Note: This document does not cover all countries listed.
- ^ "Bulletin officiel du n°32 du 4 septembre 2003 - MENS0301444A". www.education.gouv.fr. Retrieved 2023-02-21.
- ^ Description of Pathology in USA
- ^ Zerah Simone, Murray Janet, Rita Horvath Andrea (2012). "EFLM Position Statement – Our profession now has a European name: Specialist in Laboratory Medicine". Biochemia Medica. 22 (3): 272–273. doi:10.11613/BM.2012.029. PMC 3900053. PMID 23092058.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Reglementation for French Residency in Clinical Pathology Archived 2008-02-28 at the Wayback Machine
External links
- American Association for Clinical Chemistry
- American Society for Clinical Pathology
- American Board of Pathology
- College of American Pathologists
- European Federation of Clinical Chemistry and Laboratory Medicine
Forensic pathology
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Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Duties
Forensic pathology is an application of medical jurisprudence. A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology.[1] The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below.
The forensic pathologist performs autopsies/postmortem examinations with the goal of determining the cause of death as well as the possible manner of death. The autopsy report contains conclusions made relating to the following:
- The pathological process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called the mechanism of death), such as a bullet wound to the head, exsanguination caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.)
- The manner of death, the circumstances surrounding the cause of death, which, in most jurisdictions, include the following:[2]
- Homicide
- Accidental
- Natural
- Suicide
- Undetermined
The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased. Autopsies are performed when a death occurs, when an unexpected death occurs, when someone dies while not under the care of a physician, to solve criminal cases, when a mass disaster occurs and requires the identification of the victims[3] and upon request by the family or loved ones of the deceased. Typically, autopsies can cost anywhere from $3,000 to $5,000, however the price can vary from country to country.[4]
The forensic pathologist examines and documents wounds and injuries, along with the possible causation of those injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.
Forensic pathologists collect and examine tissue specimens under the microscope (histology) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).
In mass disaster settings, forensic pathologists will work alongside Forensic Odontologists, Forensics Anthropologists as well as other forensic specialties with the goal of identifying the victims of the disaster.[3] The process of identification involves the recovery of the victims, the collection of antemortem data, the initial examination along with the collection of any postmortem evidence, and finally the comparison of the antemortem and postmortem data gathered in order to identify those victims.[3]
They serve as expert witnesses in courts of law testifying in civil or criminal law cases.
In an autopsy, the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).
Forensic physicians sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty.
In the United Kingdom, membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert. Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009, which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.
Forensic pathologists make great contributions to public health and preventative medicine by studying the dead. By using their findings during autopsies, they can use their knowledge to prevent the death of another person.[1]
Investigation of death
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Pathologists determine the cause of death through postmortem examination or autopsy. There are three stages of death investigation: examination, correlation, and interpretation. Deaths where there is an unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.
Methods
Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body.[5] While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.
Terminology inconsistencies across jurisdictions
In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.
Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.
Canadian coroners
In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems[6][7]
Coroners and medical examiners in the United States
In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).
In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.
History
Forensic pathology was founded by Rudolf Virchow, a German pathologist, who developed the Virchow method which is one of the main and popular techniques still used by forensic pathologists today. The Virchow method is of doing autopsies as well as instituting cell theory which would shed light on the effects and damage of disease on the human body. Rudolf Virchow began the practice of regulated autopsies where the entire body would be inspected rather than a particular area of interest which would expose additional damage that injuries and ailments inflicted on the human body.[8] In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu, Johann Ludwig Casper and Carl Liman made great efforts to develop forensic pathology into a science based on empirics.
Ambroise Paré is also considered one of the fathers of modern forensic pathology and surgery. His inventions in the early 16th century include surgical instruments and techniques. He pioneered battlefield medicine and treatments of wounds. One technique he used was pouring boiling oil into wounds.[9]
This history of forensic pathology can be traced all the way back to the fourth century BC in Babylonia but instead of practicing on deceased human bodies, the practice of forensic pathology was strictly practiced on animals. This was said to be done only to animals since humans during this era were believed to be sacred. Later on, in forensic pathology history, forensic pathology would be practiced among those who live in Asia. Muslim doctors would discover infectious diseases and as a result, would operate on deceased bodies; one of those doctors being Ibn Zuhr. Zuhr would go on to performing autopsies on bodies in postmortem and research diseases such as leprosy, mange, and sexually transmitted diseases.
While Zuhr was busy learning about contagious diseases, Yee Siung, a Chinese government official was assembling a group of physicians who were in charge of dissecting criminal murder victims. These victims’ cause of death would be investigated alongside the actual case itself and this would be the first time pathology would be used to help solve criminal cases.[10]
Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959 after toxicology and pathology had been used to solve thousands of criminal cases worldwide for years.[11][12]
In Canada, it was formally recognized in 2003,[13][14] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.[15]
Education
In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country, however, it is common for pathologists to study at a medical school and then go on to study pathology. Many forensic pathologists practice as a histo (hospital) pathologists before moving onto forensic science. Another requirement for forensic pathologists includes having a working knowledge of specific fields of study like toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology.[16]
Australia
There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).[citation needed]
Canada
In Canada,[17] individuals must complete an undergraduate science degree, followed by a doctor of medicine degree from one of the seven medical schools in Canada. After these are completed individuals may enter the Royal College of Physicians and Surgeons (RCPSC) which requires the completion of residency training.[18] Anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the RCPSC. As of 2022, there are three schools in Canada that offer the forensic pathology training program. These schools are the University of Alberta, the University of Ottawa[19] and the University of Toronto. McMaster University ceased their training program in 2019.
Germany
Once students have acquired the "Abitur" diploma and completed all the requirements, they can study medicine at a university. Within the medical education system, there are four subdivisions individuals must partake in prior to moving into a specialization.
The first section is a two year preclinical study period where individuals are introduced to the basics. A two month work period at a hospital must be completed between each semester in order to become familiar with everyday life in a hospital. A final exam on the basics concludes this portion.
The second section is a one year clinical period to familiarize the students with the basics of clinical practice. The students complete the first part of the physician's exam at the end of this period.
The third section is another clinical period which lasts for two years, which practices non-surgical, surgical, neurological, ecological and general medicine domains. Here is where forensic medicine is first introduced. Between the first and second clinical sections, four months of medical clerkship are required, which consists of two months in a hospital and two months at any other medical institution. Students complete the second part of the physician's exam at the end of this period.
The final section is a one year practical period where students partake in three 4 month practicums: four months of internal medicine, four months of surgery and four months of clinical practical study of their choice. Students write the final part of the physician's exam before this period and have the oral part afterwards.
Once individuals have completed their medical studies, there is a minimum of six extra years of specialization training for forensic pathology. During this training individuals must complete at least three years and six months working for a legal medicine institution, focusing on clinical forensic pathology training. Then, at least one year of pathology work at a specialized institute is required partaking in autopsy technical training. As well, a minimum of 6 months working with forensic psychiatrists is also required. Finally, a single year of work in any field of medicine or legal medicine must be completed. During these work periods, it is required that these physicians write a number of opinions on their post-mortem examinations, crime scene investigations, crime scene reconstructions and insurance medical cases. There is also a minimum number of reports consisting of their own autopsies, police inquiries, histological investigation and other investigative results. Finally, the practicing physician must complete a certain number of oral court proceedings. Once all of this has been completed, an oral examination, overseen by the Chamber of Physicians (also known as the German Medical Association) is to be completed which allows individuals to officially become a forensic pathologist upon completion.[20]
India
In India, the specialty is commonly referred to as Forensic Medicine and Toxicology, or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to the award of a degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by the National Board of Examinations Archived 2021-06-03 at the Wayback Machine, leading to awarding of Diplomate of National Board (DNB).
The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader), and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this, clinical forensic examinations constitute a major part of the work and the number of cases can run up to ten thousand a year in an average institution.
The largest association of the specialty is Indian Academy of Forensic Medicine [20] (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine [21] regularly. This association has a specialist member strength of more than 1000.
Indonesia
In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years. It was first introduced through the Dutch colonial criminal justice system in the early twentieth century.
Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.
Japan
In Japan, the profession of forensic pathology is not commonly pursued compared to other medical professions such as clinicians and doctors. In Japan, there are 33 of 42 universities that have a department of pathology established on their campuses yet, even so, only 21 of the 42 universities offer residency programs pertaining to forensic pathology.[21]
To become a forensic pathologist, it requires individuals to pursue a four year undergraduate degree. After completing their undergraduate career, it is then required for individuals to attend medical school to either earn their Masters or Doctorates degree. After completing medical school, individuals are then required to have 2 years of mandatory postgraduate clinical education where they learn important clinical skills such as communication skills, common laboratory procedures such as Gram’s stain and urinalysis. When the two year mandatory clinical training is completed, another 3-4[21] years of training is needed to focus more on surgical procedures which is especially for forensic pathologists. During these last 3–4 years of training, forensic pathologists will learn more about specified human anatomy and they will also have the chance to interact with real patients as well as interacting with other forensic pathologists as well. The department of Forensic Medicine at Kyoto University in Japan has a legacy that can be traced back to 1899 when the department of forensic was first founded. The department has been active forces in promoting the significance of forensic medicine through its innovative programs, research, and analysis.
When their training is completed, forensic pathologists in Japan will then have the opportunity to receive their certificate of pathology awarded by the Japanese Society of Pathology[22]
United Kingdom
In the UK, forensic histopathology is a five-year training programme, consisting of two years of histopathology followed by three years of forensic histopathology. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC), which is a requirement to work as a consultant forensic pathologist.
Entry to forensic histopathology specialty training requires completion of the UK Foundation Programme, stages A and B of histopathology specialty training, and a pass in the FRCPath Part 1 examination in histopathology. Candidates are in year 3 of specialty training (ST3) when entering forensic histopathology and progress immediately to stage C. Completion of stages C and D (a minimum of 36 months), and a pass in the FRCPath Part 2 examination in forensic histopathology allow the candidate to apply for the Certificate of Completion of Training (CCT).[23]
Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)) or the Diploma in Medical Jurisprudence (DMJ). In England and Wales, the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.
Currently approved centers for forensic pathology training include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow, and Dundee. Not all the posts are currently actively training.
Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises. The Royal College has not yet issued their response to this matter.
United States
In the United States, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.
In the United States, all told, the education after high school is typically 13–15 years in duration (4 years of undergraduate training + 4 years of medical school + 4–5 years of residency [anatomic and clinical pathology combined] + 1–2 years of forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require the American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field.[24]
In popular culture
Pathologists often feature in crime fiction. The following television series are listed alphabetically by the character's name:
- Dr George Bullard of Causton in Midsomer Murders
- Jordan Cavanaugh M.D., is a forensic pathologist in the Massachusetts Office of the Chief Medical Examiner, in the series Crossing Jordan
- Dr Ravi Chakrabarti, Medical Examiner with the King County Medical Examiner's Office, in the series iZombie
- Dr Max Debryn, Home Office forensic pathologist in detective series Endeavour and Inspector Morse
- Dr Laura Hobson, pathologist and eventual love interest of D.I. Robbie Lewis in later episodes of Inspector Morse and in Lewis
- Dr. Maura Isles, Chief Medical Examiner of the Commonwealth of Massachusetts, in the series Rizzoli & Isles
- Isabelle Lightwood, said to be the best forensic pathologist in New York the TV series, Shadowhunters
- Dr. Donald "Ducky" Mallard, the Chief Medical Examiner for the NCIS Major Case Response Team in NCIS
- Sven Nyberg, Ystad police department's forensic pathologist in the Swedish and British TV series Wallander
- Dr. James "Jimmy" Palmer, former Medical Examiner Assistant and now Chief Medical Examiner (after Dr. Mallard's retirement) in NCIS
- Dr Marco Pasquano, Vigàta's local forensic pathologist in the Italian series, Inspector Montalbano
- Dr R. Quincy, Chief medical examiner for Los Angeles County in the US TV series Quincy, M.E.
- Dr Samantha Ryan, forensic pathologist, the primary character (Series 1 - 8) in the British crime drama series Silent Witness
- Dr Nikki Alexander, forensic pathologist (since Series 8) and the primary character since Series 24 in the British crime drama series Silent Witness
- Dr. Camille Saroyan, head of the Forensic Division of the Jeffersonian in Bones
- Ambrose Spellman, coroner for the Spellman Sisters' Mortuary and main character in the Netflix supernatural horror series Chilling Adventures of Sabrina
- Dr Misumi Mikoto, a forensic pathologist at the fictional Unnatural Death Investigation Laboratory (UDI Lab) in Tokyo, is the protagonist of the Japanese drama Unnatural (2018)
See also
References
- ^ a b "What is a Forensic Pathologist?". University of New Mexico Health Sciences. Retrieved 4 October 2020.
- ^ DiMaio, Dominick (28 June 2001). Forensic Pathology (2nd ed.). Florida: CRC Press LLC. pp. 3–6. ISBN 0-8493-0072-X.
- ^ a b c Schuliar, Yves; Knudsen, Peter Juel Thiis (2012-06-01). "Role of forensic pathologists in mass disasters". Forensic Science, Medicine, and Pathology. 8 (2): 164–173. doi:10.1007/s12024-011-9300-3. ISSN 1556-2891. PMID 22160735. S2CID 40971570.
- ^ "Post Mortem - Autopsy 101". FRONTLINE. Retrieved 2022-03-05.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-03-03.
- ^ The Coroner System. USW. http://www.usw.ca/program/content/3179.php Archived 2009-11-13 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ Coroners' law resource. King's College London. http://www.kcl.ac.uk/depsta/law/research/coroners/canada.html Archived 2009-02-03 at the Wayback Machine. Accessed on: 7 June 2007.
- ^ "Rudolf Virchow | Biography, Discovery, & Facts | Britannica". www.britannica.com. Retrieved 2022-03-03.
- ^ "Ambroise Paré - Advances in medical knowledge – WJEC - GCSE History Revision - WJEC". BBC Bitesize. Retrieved 2022-03-05.
- ^ Choo, Tae M.; Choi, Young-Shik (2012). "Historical Development of Forensic Pathology in the United States". Korean Journal of Legal Medicine. 36 (1): 15–21. doi:10.7580/KoreanJLegMed.2012.36.1.15.
- ^ Eckert WG (1988). "The forensic pathology specialty certifications". The American Journal of Forensic Medicine and Pathology. 9 (1): 85–9. doi:10.1097/00000433-198803000-00023. PMID 3354533.
- ^ "History of Forensic Pathology". 17 December 2011. Retrieved 2022-03-05.
- ^ Lett D (July 2007). "National standards for forensic pathology training slow to develop". CMAJ. 177 (3): 240–1. doi:10.1503/cmaj.070881. PMC 1930175. PMID 17664437.
- ^ Royal College of Physicians and Surgeons of Canada. Information by Specialty or Subspecialty. Available at: http://rcpsc.medical.org/information/index.php?specialty=417&submit=Select.[dead link] Accessed on: 15 July 2008.
- ^ "2 new pathologists to restart Ottawa forensic unit". CBC News. 11 January 2008.
- ^ "What is a Forensic Pathologist?". hsc.unm.edu. Retrieved 2022-02-16.
- ^ Residency Training Programs. Dalhousie University. URL: http://pathology.medicine.dal.ca/anatomical.html. Accessed on: 7 June 2007.
- ^ "Forensic Science in Canada - PDF Free Download". docplayer.net. Retrieved 2022-03-30.
- ^ University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. Retrieved 2022-03-28.
- ^ Bockholdt, Britta; Rothschild, Marcus A.; Ehrlich, Edwin; Maxeiner, Helmut; Schneider, Volkmar (2001-06-01). "Medical studies and training duration for forensic pathologists in Germany". Legal Medicine. 3 (2): 104–108. doi:10.1016/S1344-6223(01)00017-7. ISSN 1344-6223. PMID 12935530.
- ^ a b Nonomura, A; Minato, H; Koike, M (April 2002). "[Postgraduate medical training in anatomical pathology in Japanese national universities]". Rinsho Byori. 50 (4): 347–352. PMID 12014012.
- ^ Kumasaka, K (April 2002). "[Postgraduates' training as laboratory physicians/clinical pathologists in Japan--board certification of JSLM as a mandatory requirement for chairpersons of laboratory medicine]". Rinsho Byori. 50 (4): 353–357. PMID 12014013.
- ^ Pathologists, The Royal College of. "Forensic Histopathology". www.rcpath.org. Archived from the original on 2021-07-09. Retrieved 2021-07-09.
- ^ "Top 10 Things to Look For in Finding a Qualified Forensic Pathologist Expert Witness". Archived from the original on 2012-03-08. Retrieved 2011-11-07.
Sources
- Bartos, Leah, "No Forensic Background? No Problem", ProPublica, April 17, 2012.
- Payne-James, Jason (ed.; et al.) (2005). Encyclopedia of Forensic & Legal Medicine. Amsterdam; Boston: Elsevier Academic Press. ISBN 0-12-547970-0. OCLC 60834620.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - Payne-James, Jason; Busuttil, Anthony; Smock, William S. (eds.) (2003). Forensic Medicine: Clinical and Pathological Aspects. London; San Francisco: Greenwich Medical Media. ISBN 1-84110-026-9. OCLC 51678652.
{{cite book}}
:|first3=
has generic name (help) - Saukko, Pekka J.; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). London: Edward Arnold (Publishers). ISBN 0-340-76044-3. OCLC 56440239.
- Spitz, Werner U.; Spitz, Daniel J. (eds.) (2006). Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation (4th ed.). Springfield, Ill.: Charles C. Thomas Publisher. ISBN 0-398-07544-1. OCLC 56614481.
{{cite book}}
:|first2=
has generic name (help) - The Real CSI, PBS Frontline documentary, April 17, 2012
- Syukriani, Yoni Fuadah; Novita, Nita; Sunjaya, Deni K. (1 August 2018). "Development of forensic medicine in post reform Indonesia". Journal of Forensic and Legal Medicine. 58: 56–63. doi:10.1016/j.jflm.2018.05.001. PMID 29751222. S2CID 21709263.
- https://www.med.kyoto-u.ac.jp/en/organization-staff/research/doctoral_course/r-011/ Archived 2022-03-03 at the Wayback Machine
- University of Ottawa. "Department of Pathology and Laboratory Medicine". med.uottawa.ca. https://med.uottawa.ca/pathology/education/postgraduate-medical-education/forensic-pathology-residency-training-program Retrieved 2022-03-28.
External links
- National Association of Medical Examiners (NAME)
- American Academy of Forensic Sciences
- Forensic Science Society
- British Association in Forensic Medicine
- British Association for Human Identification
- British Academy of Forensic Science
- Forensic Medicine for Medical Students - a website providing educational resources in forensic medicine
- Faculty of Forensic & Legal Medicine of the Royal College of Physicians
- Royal College of Pathologists of Australasia
- Forensic Oral Pathology Journal - FOPJ
- Punjab Academy of Forensic Medicine & Toxicology Archived 2021-02-11 at the Wayback Machine
- 2011 books for forensic pathology.
- Indian Congress of Forensic Medicine and Toxicology
- Forensic Medicine Online Master's Degree at the University of Florida- the first fully online advanced degree program in forensic medicine in the United States
- A career in forensic pathology Archived 2021-02-06 at the Wayback Machine - educational website on career pathways for forensic pathology in the UK and USA
- So, you want to be a forensic scientist? - Simon Fraser University.
- When I grow up: becoming a pathologist by G. William Moore, MD, PhD. - netautopsy.org.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Forensic Pathology Resource
- Royal College of Pathologists of Australasia - Follow the "Careers and Training" Link, & go to "Disciplines and Career Brochures", or go to this page directly
- Royal College of Pathologists UK
- Forensic Pathology by David Webb, University of Huddersfield
- Forensic Pathology Pathway in Residency and fellowship - USMLE Forums
Warning: Default sort key "Forensic Pathology" overrides earlier default sort key "Anatomical Pathology".
Veterinary pathology
Veterinary pathologists are veterinarians who specialize in the diagnosis of diseases through the examination of animal tissue and body fluids.[1] Like medical pathology, veterinary pathology is divided into two branches, anatomical pathology and clinical pathology. Other than the diagnosis of disease in food-producing animals, companion animals, zoo animals and wildlife, veterinary pathologists also have an important role in drug discovery and safety as well as scientific research.[1]
Veterinary anatomical pathology
Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is concerned with the diagnosis of disease based on the gross examination, microscopic, and molecular examination of organs, tissues, and whole bodies (necropsy). Veterinary pathology also takes into account the structure and function of the body and how particular cells were injured.[2][page needed] The Indian, European, Japanese, and American Colleges of Veterinary Pathologists certify veterinary pathologists through a certifying exam after completing a residency program. After completing the residency and the exam, a certificate will be given out to display specialization in veterinary pathology.[3] The American College of Veterinary Pathologist certification exam consists of four parts, - gross pathology, microscopic pathology, veterinary pathology, and general pathology. Only the general pathology section is shared between the anatomic and clinical pathology examinations.[4] Veterinary pathologists are employed in several different positions, including diagnostics, teaching, research, and the pharmaceutical industry.[5]
Veterinary clinical pathology
Clinical pathology is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood, urine or cavitary effusions, or tissue aspirates using the tools of chemistry, microbiology, hematology, and molecular pathology.[6] Clinical pathology labs offer many services including hematology, hemostasis, urinalysis, cytology, and clinical biochemistry tests. [6] Many clinical pathology tests can be done "in" or "out" of house, meaning that the test can be done in that particular clinic or sent to a further specialized outside laboratory. Many patients have the desire to do "in-house" tests because it is usually cheaper.[7] Ultimately, veterinary pathology consists of most of the behind-the-scenes laboratory work that studies virus, infections, bacteria, and much more. Without veterinary pathologists, illness would spread throughout many species of animals much quicker than in the present day.[8]
See also
References
- ^ a b "What is veterinary pathology?". American College of Veterinary Pathology. Archived from the original on October 24, 2013. Retrieved October 3, 2013.
- ^ Cheville, Norman F. (2001). Introduction to Veterinary Pathology (2nd ed.). Wiley. ISBN 978-0-813-82488-8.
- ^ "Veterinary Pathology (ACVP) FAQs". AKVNA. Retrieved 2024-03-07.
- ^ "American College of Veterinary Pathologists" (PDF). 2024 Phase 1 Certifying Examination Candidate Handbook. March 7, 2024.
- ^ "What is Veterinary Pathology? - American College of Veterinary Pathologists". www.acvp.org. Retrieved 2024-03-07.
- ^ a b "Clinical Pathology". The College of Veterinary Medicine at Michigan State University. Retrieved 2024-03-07.
- ^ "Overview of Diagnostic Procedures for the Private Practice Laboratory - Clinical Pathology and Procedures". MSD Veterinary Manual. Retrieved 2024-03-07.
- ^ Papajeski, Barbie (February 2022). "Specialty Spotlight" (PDF). VTS in Clinical Pathology.
External links
- American College of Veterinary Pathologists
- European College of Veterinary Clinical Pathology
- European College of Veterinary Pathologists
Plant pathology
See also
References
External links
- Association of Clinical Biochemistry (UK)
- American Society for Investigative Pathology
- American Society of Cytopathology
- British Neuropathological Society
- Case Records of the Massachusetts General Hospital - Clinicopathological Conference
- College of American Pathologists
- Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
- HistoPathology Atlas
- humpath.com (Atlas in Human Pathology)
- Immunohistochemistry protocols and troubleshooting
- Traditional Chinese medicine Pathology
- Mybiopsy.org
- Neuropathology blog
- Pathological Society of Great Britain and Ireland
- Royal College of Pathologists (UK)
- Royal College of Pathologists of Australasia (Australia & Oceania)
- Sullivan Nicolaides Pathology - Leading Australian Pathology Laboratory.
- United States and Canadian Academy of Pathology
- WebPath: The Internet Pathology Laboratory for Medical Education
- Pathtalk.org - A community weblog about pathology-related topics.
- What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.
- Pathologypics - an interactive community-driven histology atlas
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