Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.
Viral hepatitis and Parkinson disease
Parkinson disease is a neurodegenerative disease characterized by motor and nonmotor symptoms, with loss of dopaminergic neurons in the brain and presence of Lewy body pathology. The pathogenesis of Parkinson disease is complex, and multiple risk factors are associated with the disease, including advancing age, male gender, environmental toxins, and head trauma. Recent studies have also shown an association between hepatitis C and risk of Parkinson disease. The authors conducted a study to determine if an association exists between viral hepatitis, including B and C, and Parkinson disease. They used a linked dataset of English national hospital records to analyze a retrospective cohort of people with hepatitis B, hepatitis C, autoimmune hepatitis, chronic active hepatitis, and HIV and compared them with a control group for subsequent rates of Parkinson disease. The data showed that the standardized rate ratio of Parkinson disease following hepatitis B was significant, at 1.76, and the rate ratio of the disease following hepatitis C was also significant, at 1.51. No significant association was found between autoimmune hepatitis, chronic active hepatitis, or HIV and Parkinson disease. The authors noted that a limitation of the study is that they were unable to control for lifestyle factors, including smoking and alcohol use. The authors concluded that the study showed strong evidence of elevated rates of subsequent Parkinson disease in patients with hepatitis B and C. It is not clear whether the association is due to the consequences of infection or the mechanism of disease or if it’s the result of antiviral treatment. Additional studies may help confirm this association and enhance etiologic understanding of the pathogenesis of Parkinson disease.
Pakpoor J, Noyce A, Goldacre R, et al. Viral hepatitis and Parkinson disease. Neurology. 2017;88:1–4.
Correspondence: Dr. Michael Goldacre at michael.goldacre@dph.ox.ac.uk
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Case studies of professionalism in pathology as an educational tool
Unprofessional or unethical behaviors are the most common reasons cited for disciplinary action taken by medical licensing boards and professional organizations. The teaching of professionalism is a requirement with the new Accreditation Council for Graduate Medical Education (ACGME) milestones. To help residency and fellowship program directors recognize and mitigate unprofessional behavior, the Graduate Medical Education Committee of the College of American Pathologists held a workshop, titled Case Studies in Professionalism: an Interactive Session, at the July 2015 annual meeting of the Association of Pathology Chairs, Pathology Program Directors Section, and Undergraduate Medical Education Section. The faculty participating in the interactive workshop, as well as residents who were later surveyed using an online tool, were asked what actions they would take in specific case scenarios demonstrating unprofessional behavior. The study was unique because it compared faculty and resident responses. This implies that the study can also be used to examine potential generational or role-based differences in defining or addressing the types of behavior that are considered unprofessional. The results of the study showed that although age and professional role were factors in the recognition and proposed management of unprofessional behavior, there was some agreement across generations and levels of experience. The discrepancy in responses in certain areas may be useful in developing educational, assessment, and remediation resources for professional behavior. Scenarios that showed a discrepancy in responses were inappropriate off-hour and work requests by a faculty member and inappropriate behavior by a resident toward others. In both of these case-based scenarios, the residents suggested a more severe response than did the faculty. The authors concluded that the discrepant responses to the case scenarios may help shed light on the differences in values and beliefs across generations with regard to unprofessional behavior. The differing expectations of faculty and residents should be taken into account when teaching professionalism.
Heddle NM, Cook RJ, Liu AY, et al. Professionalism in pathology: a case-based approach as a potential educational tool. Arch Pathol Lab Med. 2017;141:213–219.
Correspondence: Ronald E. Domen at rdomen@hmc.psu.edu