UKRAINE MINISTRY OF HEALTHCARE
UKRAINIAN MEDICAL STOMATOLOGICAL ACADEMY
“CONCORDATED“
at pathological anatomy department
with sectional course
Protocol № 1 27.08.2020 y
Head of the department, prof. Starchenko I.I.
METHODICAL RECOMMENDATIONS
FOR 2ND LEVEL (A MASTER'S DEGREE) SPECIALIST’S INDIVIDUAL WORK
Сlassroom
Discipline
Sectional course
Module 1
Sectional courseТheme
Tasks and methods of pathological service and its place in the health care system of Ukraine. The main tasks of the postmortem bureau, centralized dissection and postmortem department. Job requirements for the pathologist and the staff of the department (office). Equipment and equipment of the pathological department (bureau).Research methods of biopsy and postoperative material. Rules for the study of biopsy, postoperative and cytological material. Delivery of objects for research to the pathological department. Processing of material obtained from various organs and pathological formations. Deadline for biopsies. Borders of biopsies. Pathologist's biopsy response form. Shelf life of histological biopsy specimens.
Course
5Faculty
Foreign student’s training department
« Medicine »
1. Relevance of the topic. The main purpose of the biopsy-sectional course is to master the method of clinical and anatomical analysis of biopsy, surgical and sectional material and the principles of formulating a diagnosis, the technique of opening and filling out pathological documentation. During the course, students get acquainted with the structure of the pathological service, which is an integral part of the health care system in ukraine.
The pathological service is aimed at improving the quality of treatment, diagnostic and preventive work and its improvement.
2. Specific goals:
• determine the tasks and methods of the pathological service and its place in the health care system of ukraine.
• determine the role of attending physicians in the knowledge of the regulations on the procedure for autopsy in medical institutions.
• analyze objects subject to histopathological examination.
• determine the objectives of the study of postoperative and biopsy material.
• correctly make a fence, labeling, temporary storage (if necessary) and delivery of material to the pathology department.
• correctly and completely fill out the referral form for histopathological examination. • estimate the time allotted for the study.
• interpret the findings to improve the treatment process.
3. Basic knowledge, skills, skills required to study the topic (interdisciplinary integration)
Полученные навыки
Human anatomy
Distinguish between the macroscopic structure of organs and
their age characteristics
Medical biology and
genetics
Using the laws of tissue reproduction to study the essence of the
processes of regeneration and tumor growth
Histology, cytology
and embryology
Determination of cells and tissues for studying pathology at the
cellular level
Medical chemistry
The study of the morphogenesis of the dystrophic process,
inflammation is carried out taking into account the knowledge of
students of the relevant sections of chemistry.
Pathological anatomy
Determine the stereotypical general pathological processes
characteristic of all diseases. Use knowledge of the morphology
and pathogenesis of certain diseases (nosological pathological
anatomy).
All clinical
departments
Use clinical diagnosis of diseases and syndromes to conduct
clinical and morphological analysis
4. Tasks for independent work during preparation for the lesson.
4.1. The list of basic terms, parameters, characteristics that the student must learn in preparation for the lesson:
Term Definition
Pathological
bureau
Structural unit of the pathological anatomical service, the main task
of which is to conduct autopsies with subsequent histological
examination of organs and tissues
IDC
International classification of diseases
Biopsy
Microscopic examination of tissue or cellular material taken from a
patient in vivo for the purpose of diagnosis, treatment, prognosis and
scientific research.
examination
Histological
examination
Examination of body tissues
Sectional material
Pieces of organs and tissues were taken during autopsy for histological examination4.2. Theoretical questions for the lesson:
1. Tasks, methods and structure of the pathological service.
2. The structure, tasks, equipment and equipment of the pathology bureau (department), centralized prosectura.
3. Regulations on the procedure for conducting autopsies in medical institutions. Categories of the deceased subject to mandatory autopsy.
4. Job requirements for the pathologist and the staff of the department (bureau). 5. Deontology in the work of a pathologist.
6. Basic documentation of the pathological department (bureau).
7. Definition of biopsy and its types. Indications for the appointment of a biopsy.
8. Regulations on the procedure for histological examination of biopsies and postoperative material.
9. Deontological aspects around the histological examination of biopsies and postoperative material.
10. The role of the archive of histological preparations in theoretical and practical medicine. 11. The purpose of the study of postoperative and biopsy material. What objects are subject to histopathological examination?
12. Rules and principles of collection, labeling, temporary storage (if necessary) and delivery of material to the pathological department (bureau).
13. Rules for filling out the form-referral for pathological examination. 14. The time allotted for the study of the material.
15. Interpretation of the data of histopathological research and its importance in the treatment process.
16. Rules for the storage and use of archival data and preparations. 4.3. Practical work that is performed in the lesson
Acquaintance with the documentation: "On the development and improvement of the pathological service in Ukraine", the Regulation on the procedure for the study of biopsy and surgical materials (pathological studies)
Task 1. A jar without labeling (without a label), which contains several poorly fixed pieces of tissue, was delivered to the pathological laboratory. The direction indicates which fabrics are
contained in the jar. What is the tactics of the head of the pathological department? 1 - take the material to work;
2 - return to clarify marketing *;
3 - inform the head of the clinical department about the violation of the rules for the delivery of material *.
Problem No. 2 A rotten vermiform appendix was delivered to the histological laboratory for examination. What should be the tactics of a dissector?
1 - take the material to work; 2 - return to clarify the marking *;
3 - report to the head physician of the institution *.
Task number 3 Histological examination of the removed part of the stomach was diagnosed with adenocarcinoma. A patient came for the results. Is it possible for him to hand out the result?
1 - yes; 2 - no *.
Topic content:
PURPOSE, TASKS OF THE PATHOLOGYANATOMIC SERVICE AND ITS PLACE IN THE HEALTHCARE SYSTEM
Pathological anatomy as a fundamental biomedical science is at the intersection of medical theory and practice. Pathological anatomical service is an integral part of health care, the main purpose of which is intravital and postmortem diagnosis of diseases, the study of the etiology, pathogenesis and thanatogenesis of the most common diseases, control over the quality of clinical diagnostics and the effectiveness of the treatment process, as well as improving the professional training of doctors.
The pathological service has the following tasks:
1. Carrying out, together with the attending physicians, the clinical and anatomical analysis of the autopsy results and the implementation of this through scientific control over the treatment and diagnostic work in order to eliminate defects in treatment and diagnosis.
2. Helping clinicians in clarifying the intravital diagnosis of diseases, especially malignant tumors, by histological examination of biopsies and surgical material.
3. Improving the qualifications of doctors through a joint discussion of the results of autopsies and histological studies.
4. Timely identification of acute infectious diseases.
5. Scientific development of problems of human pathology.
6. Specialization and improvement of the staff of pathologists and laboratory assistants-histologists ..
The structure of the pathological service
The head of the pathological service in the state is the chief pathologist of Ukraine. At the regional level, it is subordinated to the regional pathological anatomical bureau or centralized pathological anatomical department at the regional hospital, the department of pathological anatomy of medical universities and institutes for advanced training of doctors, pathological departments of research institutes.
In the subordination of the regional pathoanatomical service are pathological departments at district and city hospitals.
The base of the pathological anatomical service is the pathological departments (PAO) of medical institutions, the department of pathological anatomy of medical institutes, institutes for advanced training of doctors and PAO research institutes.
The main task of dissection medical and prophylactic departments is to improve medical care and lifetime diagnosis of diseases by:
1) in vivo determination of the nature of the pathological process on the operating or biopsy material;
2) detection of acutely infectious diseases on sectional, operating and biopsy material; 3) establishing a diagnosis based on the autopsy data of the deceased;
4) establishment of the cause and mechanism of death of the patient with the identification of the nature and origin of the disease;
5) professional development of doctors through joint discussion of the results of autopsies and histological studies;
6) analysis of the quality of diagnostic and therapeutic work together with clinicians through the comparison of clinical and pathological diagnoses.
The main methods of postmortem and lifetime diagnosis of diseases
The main methods of postmortem diagnosis of diseases are macroscopic (autopsy) and microscopic (necropsy), intravital - microscopic (biopsy, cytology) and experiment.
To additional methods include biological (bacteriological, virological, serology, hematology, method of tissue cultures), chemical (histochemical, immunohistochemical, atomic absorptiometry, quantitative analysis, qualitative analysis, biochemical) physics (historadiography, radiography, x-ray analysis, ultrasonic diagnosis ).
Practical activity of the pathologist at the present stage
At the present stage, the doctor has become more likely to meet with a combination of several serious diseases. He was faced with the problem of iatrogenism, i.e. painful conditions caused by therapeutic measures.
These changes in medical practice made it difficult for the pathologist to independently determine the pathogenesis of many processes, especially thanatogenesis. To solve these problems, the practice of jointly discussing the revealed morphological facts with the attending physicians is increasingly being introduced. In addition, a narrow specialization of pathologists is now
widespread. So, pathologists who work in oncological dispensaries, tuberculosis dispensaries, cardiological dispensaries, infectious diseases hospitals, etc., become narrow specialists. Often in such institutions, their work is reduced to the treatment of a narrow range of diseases.
The pathologist spends most of his working time on the intravital diagnosis of diseases. But, using such forms of biopsy as puncture, aspiration, trepanobiopsy, etc., as well as cytological, chemical and physical methods, he controls the course of the treatment process and the dynamics of the disease as a whole. Surgeons, oncologists, gastroenterologists, nephrologists, and cardiologists turn to his services in our time.
Today, the pathologist is not limited only to a statement of the pathological process, but increasingly gives a definition of its stages, forecasts. The pathologist is required to clearly
differentiate the histological affiliation of the tumor, the degree of maturity, because the nature of the medicinal measures depends on this. It is this fact that led to the widespread introduction of histochemical, electron microscopic, morphometric, immunological morphological studies. Increasingly, clinical and laboratory data are used to interpret biopsy, because it would be wrong, widely using additional methods, to assess the pathological process only by morphology data. After all, it is known that sometimes a biopsy is taken not in a typical place, and, therefore, the
morphological diagnosis may not coincide with the clinical one. In this case, clinicians participate in the discussion of the results, as interested and equal participants in the diagnostic process.
Thus, a pathologist is a "clinical pathologist", because he not only performs autopsies on the dead, but also examines intravital removed or excised pieces of organs and tissues (surgical and biopsy materials).
He is a clinician who uses anatomical, histological, histochemical and other research methods.
The pathologist helps clinicians recognize diseases and treat them correctly - helps to improve diagnosis and treatment.
The projector, which is able to interpret anatomical, histochemical, histological and other facts, contributes to an increase in the theoretical level of attending physicians.
The contact of pathologists with the attending physicians is carried out during autopsy, at clinical and anatomical conferences (СAC), meetings of the treatment and control commissions (TCC). Our state attaches great importance to the formation and improvement of the pathological service in the country, which is reflected in a number of documents of the Ministry of Health.
APPROXIMATE POSITION
about the pathological department of a healthcare institution 1. General Provisions
1.1. The pathological department (hereinafter referred to as the department) is a structural unit of a healthcare institution.
1.2. The department is guided in its activities by the Constitution of Ukraine, the laws of Ukraine, Decrees of the President of Ukraine, decrees of the Cabinet of Ministers of Ukraine, orders of the Ministry of Health of Ukraine, legislative and regulatory acts of local executive authorities and local self-government bodies, other regulatory legal acts, as well as this Regulation.
1.3. The department is accountable and supervised by the deputy chief physician of the healthcare institution, within which it functions in accordance with the distribution of responsibilities.
1.4. The department interacts with the structural subdivisions of the health care institution in which it operates, as well as with other health care institutions and scientific institutions.
1.5. The pathology department cannot be reorganized or liquidated with the aim of creating a pathology office.
1.6. The property of the pathology departments cannot be withdrawn or alienated from the health care institutions in which they operate, as well as transferred to the operational management of the pathology office.
1.7. In the absence of a pathological department within a health care institution, for the purpose of conducting pathological studies of quality control of the medical and diagnostic work of the institution, agreements on cooperation are concluded with other health care institutions, which include pathological departments or a pathological office.
1.8. The premises of the pathological department can be leased to institutions and organizations in accordance with the current legislation of Ukraine, if this does not affect the performance of the functions assigned to the department.
1.9. The working hours of the pathological department, performing autopsies of the dead and urgent biopsy examinations, the procedure for issuing medical certificates of death and corpses, the communication of research results is determined by the management of the health care institution that includes the department.
2. Structure of the department
2.1. The structure and staffing of the department is determined by the staffing table of the health care institution in which it operates.
3. The task of the department
The main tasks of the department are:
3.1. Intravital diagnosis of diseases and pathological processes using morphological studies of biopsy specimens, surgical material and placenta.
3.2. Dynamic control over the effectiveness of treatment by repeated intravital morphological studies.
3.3. Accounting for the results of the final (postmortem) diagnosis of diseases and pathological processes based on the materials of pathological autopsies, taking into account the causes and mechanisms of death.
3.4. Examination of the quality of diagnosis and treatment based on clinical and morphological comparisons.
3.5. Analysis of the structure of morbidity and causes of death of the population based on the results of the analysis of pathological studies.
3.6. Providing reliable information of territorial health authorities on the structure of morbidity and causes of death of the population based on the results of pathological studies.
3.7. Provision of materials for pathological studies for the training of doctors and junior specialists with medical education.
3.8. Promoting the development of clinical thinking of doctors of various specialties on the basis of clinical and anatomical comparisons (including at clinical and anatomical conferences, commissions for the study of lethal outcomes, etc.).
3.9. Analysis of the quality of the medical and diagnostic work of the health care institution within which it operates or with which a contractual relationship has been concluded for
conducting pathological studies by comparing clinical and pathological data and diagnoses.
3.10. Consideration of cases of differences in clinical and pathological data and diagnoses at pathological conferences.
3.11. Providing advice to doctors of other specialties on issues of intravital diagnostics and treatment of diseases.
3.12. Introduction of new forms and methods of intravital diagnostics and treatment of diseases. 3.13. Participation in scientific research on the diagnosis and treatment of diseases.
3.14. Determining the needs of the healthcare institution, which includes the department, in medical products, medical equipment and consumables for intravital diagnosis and treatment of diseases. 3.15. Organizational and methodological support for the training of advanced training for doctors of other specialties, junior specialists with medical education on issues of intravital diagnosis and treatment of diseases.
3.16. Compliance with the requirements of antimonopoly legislation and the requirements of current legislation in the field of providing services within the competence of the pathological department. 4. Functions of the department
Branch in accordance with the tasks assigned to it:
4.1. Ensures, within its competence, the observance of the right of citizens to health protection. 4.2. Studies, analyzes and predicts indicators of the health status of the population and participates in the development of measures aimed at improving the lifetime diagnosis and treatment of diseases. 4.3. Provides information on inquiries from central and local executive authorities and local governments, enterprises, institutions, organizations and citizens on issues that are within the competence of the department.
4.4. Conducts business correspondence with leading freelance specialists of the Ministry of Health of the Autonomous Republic of Crimea, health departments of regional, Kiev and Sevastopol city state administrations, enterprises, institutions and organizations, healthcare institutions, regardless of the form of ownership and level of subordination on issues that are within the authority of the department.
4.5. Promotes the organization of advanced training for specialists of the health care institution, in which it operates, for the intravital diagnosis and treatment of diseases.
4.6. Performs other functions arising from the tasks assigned to the department. 5. Branch rights
The department, in accordance with the tasks assigned to it, has the right:
5.1. Receive, in accordance with the procedure established by the current legislation, information from healthcare institutions, executive authorities, local authorities, enterprises, institutions, organizations, public associations, the necessary statistical and operational data, reports on issues within the competence of the department and necessary for the implementation of those assigned to it tasks.
5.2. Submit for consideration by the management of the health care institution within which it functions, proposals on:
5.2.1. Distinction of the department specialists.
5.2.2. Improving the work of the department and the institution in which it functions.
5.3. Use the appropriate material and technical means necessary to perform the tasks within the competence of the department.
5.4. Convene, in the prescribed manner, meetings on issues within the competence of the Department.
6. Management of the Branch
6.1. The department is headed by the head, who is appointed and dismissed in accordance with the current legislation by order of the healthcare institution, which includes the department.
6.2. The head of the department is appointed as a pathologist with I or the highest qualification category and at least 7 years of practical work experience in the specialty.
6.3. The head of the department is subordinate to the deputy chief physician of the healthcare institution, which includes the department, in accordance with the distribution of responsibilities. 6.4. Head of the department:
- manages the department, bears personal responsibility for the quality of pathological studies, intravital diagnostics of diseases;
- carries out its activities within the granted powers in accordance with the Regulations on the department, coordinates its activities with the relevant structural units of the healthcare institution, which includes the department;
- plans and organizes the activities of the department, distributes responsibilities among employees, analyzes the results of work;
- submits, in accordance with the current legislation, proposals to the management of the health care institution in which the department operates, upon appointment to positions, dismissal and
relocation of department employees, incentives, imposition of penalties and other issues of official activities;
- takes the necessary measures to improve the organization of the department's work; - ensures that the employees of the department comply with the internal labor regulations; - takes the necessary measures to improve the qualifications of the department employees
POSITION
about pathoanatomical bureau 1. General Provisions
1.1. The Bureau is a health care institution, subordinate to the regional health authority, the main scientific and practical institution in the region on issues of intravital diagnostics and treatment of diseases, the establishment of scientifically based causes and mechanisms of death.
1.2. The Bureau carries out its activities at the expense of funds coming from the budget of the Autonomous Republic of Crimea, regional, Kiev and Sevastopol city budgets, charity, patronage, sponsorship, income from core activities.
1.3. The Bureau in its activities is guided by the Constitution of Ukraine, the laws of Ukraine, Decrees of the President of Ukraine, decrees of the Cabinet of Ministers of Ukraine, orders of the Ministry of Health of Ukraine, legislative and regulatory acts of local executive authorities and local self-government bodies, orders of the Ministry of Health of the Autonomous Republic of Crimea, health departments of regional, Kiev and Sevastopol city state administrations, other regulatory legal acts, as well as this Regulation.
1.4. The bureau is created on the proposal of the regional health management body, agreed with the Ministry of Health of Ukraine.
1.5. An autopsy bureau cannot be created by:
reorganization, liquidation of pathological departments of health care institutions, the structural units of which they are,
seizure, alienation of property of pathological departments,
transfer of the property of the pathology departments to the operational management of the pathology office.
1.6. In the absence of pathological anatomical bureaus in the region, its functions are assumed by the pathological department of the regional (republican Autonomous Republic of Crimea, city in Kiev and Sevastopol) hospitals.
2. Legal status of the Bureau
2.1. The Bureau is a legal entity, has a separate property assigned to it, an independent balance sheet, accounts in the State Treasury, bank institutions, seals, stamps, letterheads with their own details and other attributes and symbols.
2.2. The Bureau acquires the rights and obligations of a legal entity from the date of its state registration.
2.3. The Bureau is responsible for the obligations arising from the exercise of its powers within the funds provided to it in accordance with the current legislation. The Bureau is not responsible for the obligations of the regional health authority.
2.4. The Bureau has the right to conclude transactions on its own behalf, acquire personal property and personal non-property rights, bear obligations, be a plaintiff and a defendant, a third party in judicial institutions in accordance with applicable law.
2.5. The Bureau carries out operational, statistical and accounting records of the activities of the institution, submits financial and statistical reports to the relevant authorities within the time limits established by the current legislation.
The head of the bureau and the chief accountant of the institution are personally responsible for compliance with the procedure for maintaining and reliability of accounting and statistical reporting. 2.6. The Bureau has the right to lease property to other enterprises, institutions and organizations in accordance with the current legislation of Ukraine, if this does not affect the performance of the functions assigned to it.
3. The purpose and scope of the Bureau
3.1. The Bureau was created with the aim of implementing the state policy in the field of health care, which provides for the implementation of activities in the region aimed at:
ensuring the improvement of intravital diagnosis and treatment of diseases; examination of the quality of diagnosis and treatment based on clinical and morphological comparisons;
development and implementation of modern methods of intravital diagnosis and treatment of diseases;provision of reliable data from state statistics of causes of death;reduction of morbidity, disability and mortality of the population.
3.2. The bureau's activities are:
Development, coordination of implementation and control over the implementation of regulations on the issues of intravital diagnostics and treatment of diseases;
Determination of problematic issues of the pathoanatomical service of the region and ways of solving them;
Development and implementation of new forms and methods of intravital diagnosis and treatment of diseases;
Participation in the development and elaboration of projects of national programs and activities on issues of intravital diagnosis and treatment of diseases;
Information and analytical support of healthcare institutions and healthcare authorities in the region on issues of intravital diagnosis and treatment of diseases;
Information support for the implementation of national and regional programs on the issues of intravital diagnostics and treatment of diseases, taking into account the principles of evidence-based medicine;
Introduction of a unified modern system for collecting, processing, analyzing, storing and transmitting information in healthcare institutions, regardless of the form of ownership and level of subordination on issues of intravital diagnostics and treatment of diseases;
Preparation and publication of methodological developments, collections, reference books and analytical reviews on issues of intravital diagnosis and treatment of diseases in the relevant administrative territory;
Elaboration of responses to inquiries from central and local executive authorities and local self-government bodies, enterprises, institutions, organizations and citizens, judicial authorities on issues of intravital diagnostics and treatment of diseases;
Organizational and methodological support for the training of advanced training for doctors of pathologists and doctors of other specialties, junior specialists with medical education on issues of intravital diagnosis and treatment of diseases;
Holding scientific and practical conferences, seminars, reviews, competitions, exhibitions and other events aimed at improving the pathological service in the region;
Assistance to the participation of health care institutions in the region in the implementation of international projects and international grants for lifetime diagnostics and treatment of diseases;
Organization of postmortem conferences at the regional level in accordance with the procedure established by the ministry of health;
General management of the activities of the region's pathologists;
Studying the needs of the pathological service of the region in medical personnel, equipment and submitting proposals to the regional health department and the ministry of health of ukraine on personnel and material and technical support of the service;
adoption of organizational measures to improve the quality of intravital diagnostics and treatment of diseases;
ensuring control over the implementation of the current legislation on informing about cases of acutely contagious infectious diseases, including especially dangerous ones; organization of a museum of macroscopic and microscopic preparations, a library of educational and methodological medical literature and, if technical capabilities are available, a video library, etc. to improve the qualifications of medical personnel of the pathological service of the region;compliance with the requirements of antimonopoly legislation and the requirements of the current legislation in the field of providing services within the competence of the pathological anatomical bureau.
3.3. In the absence of pathological departments as part of healthcare institutions in the corresponding administrative territory, their functions can be assumed by the pathological office on the basis of cooperation agreements with these institutions, namely:
intravital diagnosis of diseases and pathological processes using morphological studies of biopsies, surgical material and placenta;examination of the quality of diagnosis and treatment based on clinical and morphological comparisons;analysis of the quality of medical and diagnostic work of healthcare institutions with which a contractual relationship has been concluded to conduct pathological studies by comparing clinical and pathological data and diagnoses;
consideration of cases of differences in clinical and pathological data and diagnoses at pathological conferences, etc.
3.4. The Bureau can be a clinical base of higher medical educational institutions and institutions of postgraduate education.
3.5. The property of the bureau is biopsy, surgical histological material taken from organs and tissues of patients, as well as autopsy material, which are stored in the archives of the bureau.
The specified material can be issued for consultation and other purposes only with the permission of the head of the bureau.
The storage periods for the raw archive, blocks and finished histological preparations are determined in accordance with the procedure established by the Ministry of Health.
3.6. The bureaus are related to institutions with hazardous health and especially difficult working conditions.
4. Office structure
4.1. The Bureau includes the following structural divisions:department of general pathology with a histological laboratory;department of pediatric pathology with a histological laboratory;department of infectious pathology with histological and viral-bacteriological laboratories;department of biopsy research with an electron microscopy laboratory;organizational and advisory department;administrative part;department of immunomorphological diagnostics.
In the absence of the possibility of organizing these divisions, general departments can be organized.
5. Property of the Bureau
5.1. The Bureau is a budgetary, non-profit institution that independently carries out financial and economic activities.
5.2. The property of the bureau consists of fixed assets and working capital, as well as other values, the value of which is reflected in the bureau's independent balance sheet.
5.3. The property of the bureau is assigned to it on the basis of the right of operational management. The Bureau owns, uses and disposes of the specified property in accordance with the current legislation of Ukraine.
5.4. The sources of formation of the bureau's property are: property transferred by the founder;
funds and property acquired as a result of their activities;
funds from the budget of the Autonomous Republic of Crimea, regional and city (Kiev, Sevastopol) budgets received in accordance with the bureau's estimates;
funds and property that come free of charge or in the form of financial assistance; other sources not prohibited by the current legislation of Ukraine.
5.5. The funds of the special fund are used exclusively for the implementation of the statutory activities of the Bureau in accordance with the approved estimate.
5.6. The relations of the bureau with legal entities and individuals in all spheres of scientific and economic activity are carried out on the basis of business contracts in accordance with the current legislation of Ukraine.
6. Office management
6.1. The bureau is headed by a chief, who is appointed and dismissed by the founder on the proposal of the regional health management body, agreed with the Ministry of Health.
6.2. The head of the bureau is a pathologist with I or the highest qualification category and work experience in the specialty for at least 7 years.
6.3. The structure and staffing of the bureau is determined by the chief of the bureau and approved by the regional health authority.
6.4. The head of the bureau manages the activities of the bureau and is responsible for the implementation of the tasks assigned to the institution.
6.5. The head of the Bureau independently decides on the issues of the Bureau's activities in accordance with the regulations.
6.6. Head Office: is responsible for the formation and implementation of the financial plan and development plan of the bureau, the results of the bureau's activities;appoints and dismisses deputies, chief accountant, heads of structural divisions;acts without a power of attorney on behalf of the bureau, represents it in all enterprises, institutions and organizations;concludes contracts, including labor contracts, with certain categories of workers, can apply the contractual recruitment system;issues powers of attorney, opens settlement and other accounts in banking institutions;within the limits of its competence, issues orders and other acts, gives instructions that are binding on all divisions and employees of the bureau;in accordance with labor legislation, accepts and dismisses employees, applies incentives and imposes penalties;applies state tariff rates, official salaries in accordance with the current legislation;approves regulations on structural divisions and job descriptions of bureau employees;receives information from state statistical bodies that can be used in the performance of the tasks assigned to the bureau;develops and ensures the implementation of current and future plans of the bureau;ensures the selection, placement, professional development and education of personnel, improvement of working and rest conditions of the office employees; provides material and technical supply, equipping with modern equipment, timely carrying out of current and overhaul of fixed assets in a timely manner;provides financial planning, including planning of current activities, the formation and use of material incentives in accordance with the approved estimate of funds for economic and social development;ensures the maintenance and provision of approved medical records and operational information;issues powers of attorney on behalf of the bureau;uses the property of the office;
распоряжается средствами бюро в пределах, предусмотренных действующим законод ateliery of Ukraine;
checks the activities of structural divisions of the bureau and takes action in case of deficiencies; solves other issues within the competence.
6.7. The remuneration of the head of the Bureau is determined in accordance with the regulations on the working conditions of employees of health care institutions.
7. Labor collective of the bureau
7.1. The labor collective of the bureau includes citizens hired in accordance with the current legislation and participating in the activities of the bureau on the basis of a collective agreement concluded to regulate production, labor and socio-economic relations of the bureau's employees. 7.2. The powers of the labor collective of the Bureau are implemented by the general meeting through their elected bodies.
To represent the interests of the labor collective at the general meeting, the labor collective may choose bodies of collective self-government, to which the head of the bureau cannot be elected. Elections are held by secret ballot for a period of 2-3 years at least 2/3 of the votes.
Members of an elected body cannot be dismissed from work or transferred to other positions at the initiative of the administration without the consent of the corresponding elected body of the collective.
7.3. The right to conclude a collective agreement on behalf of the founder is granted to the head of the bureau, and on behalf of the labor collective - to the body authorized by him.
7.4. Bureau employees are subject to social insurance in the manner prescribed by the current legislation of Ukraine.
7.5. Each employee of the bureau is obliged to comply with the provisions of the bureau, labor and production discipline, comply with the internal labor regulations, normative acts of Ukraine, local regulations, honestly and conscientiously treat the performance of their functional duties.
8. Termination of the Bureau
8.1. The office is terminated on the basis of:
decisions of the founder or authorized body on the proposal of the regional health management body, agreed with the Ministry of Health of Ukraine;
decisions of the court, economic court.
8.2. The termination of the bureau's activities occurs through its reorganization or liquidation.
The reorganization of a bureau entails the transfer of the rights and obligations belonging to the bureau to its successors.
8.3. For the liquidation of the bureau, the body that made such a decision creates a liquidation commission, which draws up a liquidation balance sheet.
In this case, the powers of the head of the bureau are suspended.
8.4. The liquidation commission publishes in the official press, at the location of the bureau, a publication on its liquidation, on the procedure and terms for filing claims by creditors.
Along with the publication, the liquidation commission carries out work to collect accounts receivable and identify claims of creditors with a written notification of each of them about the liquidation of the bureau.
The liquidation commission evaluates the property of the institution, settles accounts with creditors, draws up a liquidation balance sheet and submits it to the body that appointed the liquidation commission.
8.5. Claims unsatisfied due to the lack of property, not recognized by the liquidation commission, if their applicants, within a month after receiving a message on full or partial rejection of the claim, do not apply to the court with a corresponding claim, as well as claims, which were denied to the creditor by a court decision, are considered extinguished ...
8.6. The liquidation of the bureau is considered completed, and the activity of the bureau is terminated from the moment of making an entry on entry into the unified state register of enterprises, institutions, organizations.
EQUIPMENT AND EQUIPMENT OF PATHOLOGY ANATOMICAL OFFICE (DEPARTMENT)
Pathology bureaus (departments) provide: 1) dissector's office
2) laboratory 3) section hall 4) funeral hall
5) auxiliary premises (basement for storing archival materials, toilet, shower room, dressing room, etc.)
A sectional area of 30 m2 should have sufficient natural light. The floor has a slight slope towards the center, where the sewer is located and is covered with tiles. The sectional table is installed with its head end to the window above the sewer drain. Table height 90 cm, length 200 cm, width 85 cm, the leg end is installed below the main one by no more than 0.5 cm.The table cover is made of waterproof material (marble, marble chips, glass, duralumin, stainless steel, plastic, etc. )
and should be smooth and easy to clean. There should be a hole at the edge of the lid, covered with a mesh; a sewer pipe is connected from below to the hole. In addition, the edge should be supplied with water flowing through the hose as needed. The height of the side of the lid is 3-5 cm. During the autopsy, a dissecting table is installed above the shins of the corpse, on which organs isolated from the corpse are examined. The height of the table should not exceed 25 cm, the size of the lid should be 25 × 15 cm. There should be 10-12 holes in the center and at the edges for liquid drainage.
In the sectional room there should be a first-aid kit, where alcohol, iodine, cotton wool, bandages, ammonia are stored; and a cabinet for reagents (Lugol's district, 10% sulfuric acid, etc.), sterile test tubes and pipettes, Petri dishes, glass slides and alcohol lamps.
The sectional room should contain disinfecting liquids (3-5% lysol solution, chloramine B, etc.).
The dissector's clothing: a medical gown, a waterproof apron, a medical cap, armbands, rubber gloves, boots.
The autopsy kit is stored in a cabinet in the breakout room. The sectional set must meet the elementary requirements of the dissector and is used both in stationary pathological departments and during autopsy visits.
METHODS FOR BIOPSY RESEARCH OF MATERIAL
Biopsy (Greek bios - life, opsis - vision) is a microscopic examination of tissue and cellular material obtained from a patient for the purpose of diagnosis, treatment, prognosis and scientific research.
The term "biopsy" was introduced in 1879 by E. Beigne. For the first time a biopsy was applied in 1864 by Duchamp de Boulogne, and in 1865 he proposed a “histological punch” - a prototype of the modern trephine.
Biopsy material is formally divided into diagnostic and operational. Types of biopsies:
1. Excisional - removal of the entire investigated formation or organ during surgery.
2. Incisional - removal of a part of the formation or organ during surgery, but always on the border between the damaged and unchanged tissue.
3. Puncture - collection of fragments or a column of tissue of the studied formation as a result of puncture with a needle or special trocars with a certain diameter of the lumen (lymph nodes, bone marrow, parenchymal organs).
4. Trepanobiopsy is a method of intravital bone tissue removal (mainly spongy tissue) for examining the bone marrow.
5. Forceps - obtaining material (a piece of tissue) using special devices - forceps, for example, during endoscopic examinations.
6. Curettage - obtaining material by scraping (uterus or maxillary cavity, etc.). 7. Aspiration - aspiration of the contents of an organ or body cavity using a syringe. 8. Guided catheterization.
9. Biopsy by massage and pressure. 10. Biopsy by washing the organ cavities.
11. Biopsy by flushing from surgical wounds and ulcers. 12. Biopsy by smear.
13. Smear-prints. 14. Endoscopic.
15. Accidental, unexpected biopsy.
All diagnostic biopsies, all organs and tissues removed during surgical interventions, as well as afterbirth, scrapings during abortions, carried out outside this medical institution and the medical institutions attached to it, are subject to pathohistological examination.
Pathohistological studies are carried out in order to clarify and confirm the clinical diagnosis, to establish a diagnosis in clinically unclear cases, to determine the initial stages of the disease, to
recognize inflammatory, hyperplastic and tumor processes of different form and origin. The study of biopsy and surgical materials makes it possible to judge the radical nature of the operation, the dynamics of the pathological process, the changes that have arisen in tissues or neoplasms under the influence of treatment, etc.
Objects to be examined are delivered immediately to the pathology bureau (department) to ensure timely conclusions. It is forbidden to accumulate biopsy-operating material (including scrapings) in operating rooms. The surgical material must be carefully marked: the name, initials of the patient, the number of the medical history, the label is glued to the jar with the object to be examined. When several objects from different patients are placed in one dish, each of them is individually tied in gauze with an attached tag made of thick waterproof paper, on which the patient's surname and his initials should be written in pencil. An object unsuitable for research, delivered from the clinical department (dried out, decayed, frozen), is not accepted, which is immediately reported to the head of the department. For each material, a special referral form for research is filled out, which is delivered to the pathology bureau (department). All columns of the form must be completed by the clinician so that the pathologist who will conduct the research has a sufficient amount of clinical information when assessing the identified morphological changes. In addition to the clinical picture of the disease, the form must also contain brief data on the history and treatment (the total number of cytostatic and hormonal drugs administered, the nature of radiation therapy, etc.) and a macroscopic description of the drug.
If the referral form is filled in carelessly and there is no necessary data in it, the head of the department of the pathoanatomical bureau informs the head of the clinical department from where the material was delivered; in case of repeated cases, reports to the chief physician (director of the institute), his deputy for medical work.
It is strictly forbidden to divide biopsy and operational material into parts and transfer it to different pathological laboratories. In such cases, morphological changes characteristic of the given process (cancer, tuberculosis, etc.) may appear in only one part of the object, and, accordingly, the results will be different. This can confuse the treating physician and harm the patient.
The doctor who ordered the study is responsible for delivery. The material is delivered to the pathology bureau (department) by employees of the medical department. If, for certain reasons, it is impossible to send the material immediately after the operation, then the surgeon who performed the operation ensures its correct
1st variant of registration: the registration book is started for each calendar year, has the following columns: No. in order (the numbering of the studies starts anew every year), the numbers correspond to the number of pieces cut from the object; date of receipt and date of examination of the material, last name, first name and patronymic of the patient, age, medical history number, object of study, approximate clinical diagnosis, necessary clinical information about the patient, histological description of the drug and clinical diagnosis, receipt for the conclusion.
2nd registration option: passport data are entered into a blank form, which also indicates the corresponding study number. The results of macroscopic and microscopic studies are made by copy. A copy of the conclusion is sent to the medical institution, and the original form received with the material is stitched and left in the laboratory.
Thus, the laboratory stores all the clinical information about the patient, which ensures clear documentation and the ability to summarize the results of biopsy work. It is advisable to fill in all the columns of the form in the pathological department using a typographic method.
Macroscopic examination of the material, the choice of methods for its processing, methods of research and the necessary types of staining is carried out, respectively, by a pathologist. It is prohibited to entrust this work to a laboratory assistant.
Each study (block, piece) is assigned a sequential number, which is written on the tag, which is placed in a container with the studied material, on the block when embedded in paraffin or
celloidin, and is stamped on histological preparations. The last two digits of the calendar year of the study are put under the number of the study on the slides with a fraction.
The examination of the delivered tissue pieces must be completed within the following terms: a) for urgent biopsies no later than 20-25 minutes. from the moment of receiving the material;
b) for diagnostic biopsies and surgical material within 4-5 days.
The processing time for bone tissue and biopsies that require additional staining methods or consultation of highly qualified specialists may be extended.
Copies of forms with the results of histological examination are sent to clinical departments (against receipt) and must be placed in the medical history.
It is recommended to keep archival histological preparations and registration books for the entire period of existence of the pathological bureau (department). Depending on local conditions, histological preparations of appendixes, hernial sacs, tonsils, scrapings from the uterine cavity after an incomplete abortion are stored for one year, after the expiration of the period they can be
destroyed. Histological preparations of benign and malignant tumors, tumor-like processes, with suspected tumor growth and specific inflammation are stored permanently. Celloidin blocks are stored in jars in 70% alcohol solution, which must be labeled with the indicated numbers and year of research. For long-term storage of the material, embedded in celloidin, the latter is removed from the blocks, strung on a thread along with tags indicating the number and year of research, and placed in a 70% alcohol solution. Paraffin blocks with the appropriate markings are stored under conditions that delay drying (plastic bags, waxing of the cut surface).
Macro preparations or pieces of them are stored in 10% formalin solution for a year, after which they are destroyed. Pieces of brain tumors, soft tissue malignant tumors and rare tumors are recommended to be stored in 10% formalin solution for the entire lifetime of the laboratory, if conditions exist.
Histological preparations, if necessary, an archival micropreparation can be issued to the patient, his relatives or medical personnel for consultation in another medical institution upon the availability of an official written request from this institution. The corresponding request is included in the histological examinations registration book (in accordance with the drug number), and is crossed out upon return of the drugs. The medical institution to which the drugs were issued is obliged to return them to the pathology bureau (department).
Self-test materials A. Tasks for self-control
Conduct clinical and morphological analysis of the biopsy. Task number 1
Patient E., 45 years old, normal menstrual cycle, suffers from chronic salpingitis, infertility. An objective examination found a diffuse breast lump. Under the nipple of the left breast, there is a focal seal 5x2 cm.
Puncture biopsy results: fibrocystic adenomatosis. The patient refused the operation. After 3 months, she again consulted a doctor about enlarged lymph nodes in the left supraclavicular region.
Results of histological examination of the lymph node: proliferation of atypical glandular structures with pathological mitoses in epithelial cells.
Task number 2
Patient N., 48 years old, one normal delivery, 6 abortions. For 7 years he has been suffering from Trichomonas colpitis and cervical erosion. Biopsy studies have not previously been performed.
The results of cytological examination: a smear from the posterior fornix of the vagina contains superficial cells of stratified epithelium, a large number of leukocytes.
Results of histological examination of cervical biopsy: squamous non-keratinizing epithelium with pathological mitoses, atypical cells, infiltrating growth.
Task number 3
Patient K., 24 years old, 5 months after childbirth felt bad, notes a deterioration in health, an increase in temperature to 38 ° C, a cough with bloody sputum. She coughed up a piece of loose crimson cloth. Clinical diagnosis: bilateral focal pneumonia.
The results of histological examination of sputum: a large number of cytotrophoblast cells with numerous atypical mitoses, lack of growth boundaries, absence of vessels, syncytia of polygonal shapes and sizes.
Task number 4
Patient F., 34 years old, has a history of chronic tonsillitis, for the last two months she has observed an increase in cervical lymph nodes, general weakness, low-grade fever. Clinical diagnosis: chronic tonsillitis, nonspecific lymphadenitis.
The results of histological examination: the pattern of the lymph nodes is indistinct, the proliferation of young lymphoblasts, large and small Hodgkin's cells, large multinucleated cells of Berezovsky-Sternberg, focal sclerosis and hyalinosis.
Task number 5
Patient D., 33 years old, in the right mammary gland during examination was suspected of fibrocystic dysplasia of the mammary gland. A puncture biopsy was performed to clarify the diagnosis.
The results of histological examination: the growth of light atypical glandular large cells with numerous pathological mitoses, intraductal growth without clear boundaries was found in the mammary gland.
Task number 6
Patient V., 58 years old, suffers from gastric ulcer. It is known that the ulcer is located in the pyloric region of the stomach. During the last two months, the patient has significantly lost weight, vomiting is constantly worried, and recently there have been convulsions. The skin is dry, gray. Clinical diagnosis: chronic gastric ulcer with malignancy. During the operation, a piece of tissue was taken from the bottom of the ulcer for histological examination.
The results of histological examination: diffuse growth of fibrous tissue at the bottom of the ulcer and the surrounding areas of the stomach wall.
Task number 7
Patient C., 48 years old, consulted a gynecologist with complaints of uterine bleeding, which is not associated with menstruation. To clarify the clinical diagnosis and method of treatment, scraping from the uterine cavity was carried out, the material was sent for histological examination.
The results of histological examination: proliferation of endometrial glands, changes in their shape and size, areas of proliferation of epithelial cells, active stromal reaction. In places, the glands are tortuous, forming cysts.
Task number 8
Patient G., 46 years old, has been suffering from gastric ulcer for 12 years. Recently, pains in the stomach area are very disturbing, weight loss notes. Clinical diagnosis: chronic stomach ulcer in the acute stage.
The results of histological examination: at the bottom of the ulcer - areas of fibrinoid necrosis, zonal cell infiltration; at the edges of the ulcer in the mucous membrane, there is a proliferation of atypical glandular epithelium with numerous pathological mitoses.
Task number 9
Patient V., 32 years old, during a routine examination, a gynecologist discovered signs of cervical erosion. The material was sent to the histological laboratory.
The results of histological examination: in the vaginal part of the cervix, the growth of the glandular epithelium was revealed, no defects on the mucosal surface were found.
Task number 10
Patient A., 52 years old, 4 years old suffers from a violation of the ovarian-menstrual cycle. A year ago, I palpated a tumor in my left breast. In a clinical study, the tumor is dense, tuberous, its dimensions are 3 × 8 cm, and it has grown tightly with the surrounding tissues. Over the past 2 months, she notes a small amount of hemorrhagic fluid from the nipple of the breast.
Clinical diagnosis: fibrocystic breast disease.
B. Tasks for self-control
Structural logic diagrams
"The structure of the pathoanatomical service"
City Health Department
Chief Urban Pathologist
Regional Department of Health
Head of the Regional Department of
Health Protection
Regional pathoanatomical bureau
Chief regional pathologist
Therapist
Pathological departments of district and
city hospitals
City Pathological Bureau
Pathological departments and laboratories
of scientific research institutes, departments of
pathological anatomy of universities
Registration of an inpatient
card
Medical and preventive
institution
Ministry of Health of Ukraine
Chief pathologist of Ukraine
Chief physician
Delivery of the deceased with
an inpatient card and an attached
"Types of biopsy"
Autopsy protocol execution
Pathologist
Opening
Registration of a medical
death certificate
Autopsy protocol execution
Autopsy protocol execution
PLANNED
URGENT,
DURING THE
OPERATION
puncture B ON E MARR OW PAR E N C HYM AT IC OR GA NS END OCR IN E GL A ND S IMMU NE O R GA NS incisional OPEN S KI N, N ECK DR . aspiration C YTO LOG ICAL S TUD Y HO LLO W ORG AN S endoscopic trepanation B ON EBIOPSY
RESEARCH OF OPERATIONAL AND BIOPSY MATERIAL objects to be investigated material fence OBJECTIVES OF CARRYING OUT ИССЛЕДОВАНИ Я Clarification and confirmation of the diagnosis
all diagnostic
biopsies
referral for research Methods Determination of the initial stages of diseases Clarification and confirmation of diagnosis All organs and tissuesremoved during surgery Required data Abortion scrapings Differential diagnosis of inflammatory, hyperplastic and tumor processes Assessment of the radicality of the operation, the dynamics of the process, etc. Traces Responsible person Delivery to the pathologist - IC department Temporary storage Marking Determination of the initial stages of diseases
Time required for research
Interpretation of received data
Use of archival materials The healing process
Recommended literature:
1. A.K. Zagorulko. Short lectures on pathology (pathological anatomy). - 2. Simferopol: 2 ed. CSMU, 2002- P. 77-82.
3. Ramzi S. Kotran, Vinay Kumar, Stanley S. Robbins. Robbins Pathologic Basis of Disease, W.B. Saunders Company, USA, 1994 - P. 241-301, 1099.
4. Anderson’s Pathology // Edited by Jonh M. Kissane. The C.V. Mosby 5. Company. - Toronto - Philadelphia, 1990. - P. 566-610.
6. Thomas C. Macropathology. - B.C. Decker Inc. - Toronto - Philadelphia, 1990.-355 p. 7. Thomas C. Histopathology. - B.C. Decker Inc. - Toronto - Philadelphia, 198 9.- 386 p
Mohan H. Textbook of pathology 6 edition / H. Mohan. – India, New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. - 2010. – 933 p.
8. Mohan H. Textbook of pathology 6 edition / H. Mohan. – India, New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. - 2010. – 933 p.
9. Kumar V. Robbins Basic Pathology. 9th Edition /Vinay Kumar, Abul Abbas, Jon Aster. – Elsevier. – 2015. – 952 p.
Informational resources:
1.
Testing center - database of licensed test tasks "krok-1"
2. http://library.med.utah.edu/WebPath/webpath.html 3. http://www.webpathology.com/
