bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hematological Parameters Throughout the First Month of Direct-Acting Antivirus (DAA) Plus Ribavirin for HCV
Authors: Shedid Mohamed , Abdelmonem Mohamed , Boraik Ayman , Elmetwalli Alaa , Hassan Dalia 
Published: September 2019

Abstract

Introduction
Hematological complications such as neutropenia, thrombocytopenia, and anemia of DAAs/ribavirin in HCV can result in suboptimal outcomes. This study was aimed to investigate the frequency of hematological variations and their impact on the response to DAA therapy. Patients were defined as having hematological abnormalities if they had the presence of either/or a combination of the following hematological parameters at least once during the first month of treatment: drop in (Hb) level, TLC, and PLT count. Pretreatment, Hb, WBC count, and PLT count were not statistically related to the treatment response. However, lower count of all parameters was associated with moderate or advanced hepatic fibrosis stages according to the METAVIR scoring (P < .001). Static analysis showed that drop in Hb, TLC, and PLT count was significantly associated with response to treatment; P < .001, .21, and .41, respectively.

Methods
Fifty-eight patients for treatment of chronic hepatitis were studied. Their hematological parameters including TLC, Hb, and platelet counts were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given DAAS/ribavirin as antiviral therapy. Data were collected over a period of 3 months.

Results
Fifty-eight patients with mean (SD) age of 54.38 (12.67) years were studied. There was a mean hemoglobin (Hb) fall of 1.5 g/dL at the first 4 weeks of antiviral therapy. Mean TLC fell to 1.03 × 10⁹/L in the first month. A similar downward trend was noted in platelet values with a mean fall of 12.3 × 10⁹/mm in the first month of the antiviral therapy. Of the cases, 41.4% developed clinically significant anemia as evidenced by hemoglobin 11 g/dL after 4 weeks of antiviral therapy; this fall was noted only in first 4 weeks of treatment.

Conclusion
Significant hematological abnormalities occurred within the first 4 weeks of antiretroviral therapy. There was significant decrease in hemoglobin level.
Effect of Vaping on the Oral Cavity
Authors: Abdelmonem Mohamed , Al-Shalchi Noor , August Kirk 
Published: September 2019

Abstract

Introduction
Smoking cigarettes can have negative effects on oral health with a greater risk of periodontal disease and caries. The use of electronic cigarette is often viewed as a safer alternative, but research shows that vaping may be just as toxic. The objective of the study is to test tooth surfaces and determine cariogenic properties after they have been exposed to sweeteners in electronic cigarette aerosols generated while vaping.

Methods/Results
E-liquids containing 20/80 propylene glycol/glycerin, 10 mg/mL nicotine, and flavors were tested on noncariogenic extracted third molars. Aerosols were formed by Universal Electronic-Cigarette Testing devices and mimicked 0, 10, and 150 puffs, respectively. Streptococcus mutans was exposed to the aerosols on the tooth enamel and was shown to have four times more microbial adhesion and decreased enamel hardness of up to 27%. Demineralization is initiated when undisturbed microbes change the oral cavity to a more acidic environment, ultimately leading to caries. The viscous property of the e-liquid allowed S mutans to adhere to pits and fissures and increased biofilm formation by twofold when compared to unflavored controls.

Conclusion
E-cigarettes may increase the risk of dental caries. The sweeteners in the e-liquid have viscous properties comparable to regular soft drinks and a high-sucrose diet. Further studies are needed to understand the possible effects of vaping on the oral cavity.
Effective Utilization of Laboratory Information System to Triage Troponin Critical Value Notification to the Emergency Department
Authors: Pomper Gregory , Hunt Matt , Van Dyke Erica , Waldron Johanna , Hiestand Brian , Wong Steven 
Published: September 2019

Abstract

Objectives
The laboratory received a request to report abnormal troponin (ab-TnI) as critical values (CVs) for ED patients. The laboratory information system (LIS) was programmed to identify only ED patients presenting with an ab-TnI. Only the first ab-TnI on presentation was critical. Unnecessary laboratory CV communications could impair overall turnaround time.

Methods
Mean troponin, ab-TnI test volumes, and ab-TnI from ED patients with suspected acute coronary syndrome were determined. The LIS team constructed a best practice alert in the Beaker module (EPIC, Verona, WI). The ab-TnI CV build filtered patients based on ab-TnI values and ED location. Based on pilot data, the build was adjusted to limit ab-TnI alerts to only the first ab-TnI result. The amended build logic was to trigger the alert if an ED location TnI was abnormal. At trigger, if the lowest TnI result in the last 24 hours is ≤0.040, the return “true.” If true, then no TnI >0.040 in the last 24 hours, call the ED because they currently have a result >0.040. If the answer is “false,” then do not call the ED. If the patient had no TnI in the last 24 hours, then the alert would be triggered as well. The system was piloted after education to the ED and laboratory teams.

Results
The mean TnI per day was 150; the mean ab-TnI was 63 (42%), of which 1.1 ab-TnI originated from the ED. After pilot go-live, the actual number of ab-TnI/day was 14.3. The alert logic was amended to limit the trigger to the first ab-TnI result, reducing the CV volume to 9.6/day.

Conclusion
The LIS can be leveraged to develop a clinically valuable and operationally manageable critical value alert system. Clinical and laboratory teams must be open to amending the process as needed to achieve success.
Blood Culture Contamination in the Clinical Microbiology Laboratory of a Teaching Hospital
Authors: Xu Kemin , Gilani Sarwat , Wang Hank , Fallon John 
Published: September 2019

Abstract

Objectives
Blood culture is one of the most important tests performed in clinical microbiology laboratories. However, blood culture contamination remains a problematic cause of diagnostic errors for laboratory diagnosis and patient management. This aim of this study was to determine blood culture contamination rates and tendency at Westchester Medical Center (WMC), a tertiary teaching hospital in suburban New York City.

Methods
All blood culture tests at WMC received from January 2017 to December 2018, as well as some historical data from 2007 to 2014, were retrospectively retrieved. Blood culture contamination rates were determined according to the laboratory’s predefined criteria.

Results
From 2007 to 2014, a total of 209,750 blood cultures were performed with an average contamination rate of 1.6% (ranging from 0.4% to 3.5% monthly). The total numbers of blood cultures performed in 2017 and 2018 were 27,863 and 28,047, respectively. The overall positive rate of blood culture was 6.8% in 2017 and 7.6% in 2018. The contamination rate of blood culture was 0.6% in 2017 and 0.9% in 2018 with very few variations among different months of the year, which was significantly lower than that of the national benchmark (~2.5%) on blood culture contamination. The majority of contaminants were Staphylococcus epidermidis, accounting for 87% of source contamination, followed by Corynebacterium species (5.5%), Bacillus species and Micrococcus species (3.5% each), and Propionibacterium species (0.5%).

Conclusion
Adherence to current guideline on appropriate blood collection techniques and monthly monitoring and timely feedback to phlebotomists should be continued to keep a low contamination rate for blood culture, which is not only from the perspective of individual patient care but also from the standpoint of hospital epidemiology and public health.
Role of Plasma miRNA-501 Expression Profile as a Marker of Hepatocellular Carcinoma (HCC) Progression With Hepatitis C Virus Infection
Authors: Shedid Mohamed , Abdelmonem Mohamed , Boraik Ayman , Elmetwalli Alaa , Esmael Ahmed 
Published: September 2019

Abstract

Introduction
HCV is a health problem that confronts many countries in the world. Those patients will develop complications like cirrhosis and HCC, which is one of the most common cancers in the world, especially in Egypt, and considered the third leading cause of death worldwide. The prognosis of HCC is still dismal due to the late diagnosis. miRNAs are small, short noncoding RNAs, which have roles in the diagnosis of HCC. In our study, we focus on biological aspects of miRNAs. We report that miR-501 is strongly expressed and observed in the process of HCC development. miR-501 regulation is important as an oncofetal relevant to the diagnosis of HCC.

Method
This study was conducted on 100 adult patients; 25 patients were positive for anti-HCV and 25 patients were negative for HCV and enrolled as a control group. Patients were categorized into three groups: fibrosis (n = 25), CHC (n = 25), and HCC (n = 25) related to HCV evident by CT abdomen. All patients and controls were subjected to full clinical assessment and laboratory investigation. Blood (8 mL) was withdrawn from subjects, and 3 mL was collected in EDTA tubes for processing total RNA extraction and miRNA. The remaining 5 mL was left for determination of biochemical parameters. miRN-501 expression levels were determined by RT-PCR.

Results
The data revealed a significant increase in levels of AST, ALT, ALP, and CBC in both HCC and CHC groups compared to controls. The results of miRNA expression showed that miR-501 was higher in the HCC group than non-HCC group at P1.1.

Conclusion
miR-501 can be used as a noninvasive biomarker for early diagnosis of HCC among patients with HCV on account of its affectability for HCC.
Mentorship Strengthens HIV-1 Viral Load Laboratory Quality and Testing in Mozambique
Authors: Basu Debby , Nhabomba Augusto , Assane Mariamo , Adamo Noorbebi , Benzane Octavia , Pinto Isabel , Macave Admiro , Landgraf Kenneth 
Published: September 2019

Abstract

Objectives
In response to the urgent need for high-quality HIV viral load (VL) testing scale-up to reach the UNAIDS goal of 90% of HIV+ patients on ART treatment and 90% of these patients reaching viral suppression worldwide, the American Society for Clinical Pathology (ASCP) has directed a VL mentorship program across six provinces in Mozambique.

Methods
Through this program, three in-country consultants with advanced molecular biology and quality management system skills have mentored nine molecular biology laboratories conducting VL testing (four new laboratories, five established laboratories) through both in-person and remote mentorship methods. Using external audit evaluations conducted by CDC and Ministry of Health using the CDC VL Scorecard (scored 1-5), mentors have directed targeted interventions to address laboratory needs including (but not limited to) the following: biosafety, document control, quality control, corrective actions, assay troubleshooting, and codevelopment of key technical and quality-based SOPs and job aids with local laboratory management. In-person mentorship visits also focus on skills building of laboratory staff and management.

Results
Excluding two new laboratories with only baseline assessments available, the majority of mentored laboratories (six of seven; 85%) showed improvement at follow-up audits compared to baseline assessment scores, with only one laboratory showing a one-level backslide between sequential audits. Potential reasons for this backslide include more limited in-person mentorship during the time period or interevaluator scoring variability.

Conclusion
These data suggest that mentorship focused on test methodology and quality management is an effective way to promote laboratory quality while scaling up services; however, additional efforts, including integration of methods for improved remote mentorship to in-laboratory mentors and management, are needed in order to sustain high laboratory quality in the absence of an external mentor.
Advocacy Journal Club: Teaching Residents and Faculty About Policy and the Importance of Pathology Societies
Authors: Talmon Geoffrey , Wolf Alejandro , Molani Mariam , Martin Kimberly , Jacobs Jeff , Waibel Liz 
Published: September 2019

Abstract

Objectives
To describe the Advocacy Journal Club, a novel method to expose pathology residents, fellows, and faculty to critical regulatory and policy issues that affect the practice of laboratory medicine and the importance of involvement in advocacy initiatives.

Methods
Six voluntary conferences were held for UNMC faculty, local pathologists, and residents during a 1-year period. Each featured a unique, 50-minute interactive discussion led by a faculty member on a topic related to systems-based practice, public health, and/or legislative reform in health care. The six topics included Stark Law, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Laboratory Developed Tests, Executive Branch Influence on Health Care, Local Coverage Determinants, and Protecting Access to Medicare Act of 2014 (PAMA). In addition, all participants completed an 8- to 10-question pre- and posttest. After the completion, a survey to assess the quality and efficacy of the series was administered.

Results
Between 5 and 11 residents attended each session. Both residents and faculty demonstrated a marked increase in their posttest scores. In the final survey, 92% stated they gained an understanding of how policy affects their local laboratory and 100% a better appreciation of how involvement in pathology organizations’ advocacy efforts impacts the laws, rules, and regulations that affect laboratory medicine. Most (92.3%) reported that topics of the Advocacy Journal Club are important to pathology training and 100% reported that the format was effective.

Conclusion
The journal club format is an effective method to teach both residents and faculty about health policy and other issues impacting laboratory medicine and the critical role that participation in the advocacy efforts of pathology societies plays in affecting the future of the specialty.
Pathologists’ Participation and Performance in the Medicare Physician Quality Reporting System
Authors: Ge Li , Liu Xinliang 
Published: September 2019

Abstract

Objectives
Public reporting of quality metrics has become increasingly important for pathologists to demonstrate excellence of care and to secure value-based payments from both public and private payers. This study evaluated the participation and performance of pathologists in the Medicare Physician Quality Reporting System (PQRS).

Methods
This study conducted a retrospective review of the Physician Compare data files from 2016. Specifically, pathologists enrolled in the Physician Compare Initiative were identified and merged with quality data using uniquely assigned National Provider Identifiers. Descriptive statistics and multiple logistic regression were performed using Stata (version 12.1) statistical software (StataCorp, College Station, TX).

Results
Among the 11,637 pathologists identified in the Physician Compare Initiative, 8,408 pathologists (73.3%) participated in the PQRS. Regression analysis indicated that female gender, foreign medical graduate (FMG), and a larger number of employees in the affiliated organization were associated with a lower likelihood of participating in the PQRS. To protect patient privacy, the Centers for Medicare and Medicaid Services (CMS) only released the quality metrics of 353 pathologists, which were computed based on 20 or more Medicare beneficiaries. The three most commonly reported quality metrics included PQRS#249 Barrett’s Esophagus, PQRS#395 Lung Cancer Reporting (Biopsy/Cytology Specimens), and PQRS#397 Melanoma Reporting. The mean performance rates for the three most common metrics were 98.8% (SD 8.3%), 96.8% (SD 11.9%), and 97.4% (SD 6.9%), respectively.

Conclusion
A majority of pathologists participated in the Medicare PQRS program in 2016. The performance rates of public available quality metrics remained at high levels with significant variations in some metrics. Future research should examine the quality performance of pathologists as they transition from the PQRS to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.
The Utility of Immunohistochemistry in Diagnosing Liver Adenocarcinoma in Patients With Pancreatic Mass
Authors: Katerji Roula , Whitney-Miller Christa 
Published: September 2019

Abstract

Objectives
Biopsies of liver lesions frequently have two goals: confirm malignancy and determine the site of origin. We frequently encounter liver biopsies in patients with pancreatic mass (PM). Given the lack of a specific marker for pancreatic adenocarcinoma, a broad panel of immunohistochemical (IHC) stains is frequently done. In this study, we evaluated the usefulness of IHC staining in the setting of a liver biopsy in the presence of PM.

Methods
Between 2011 and 2017, 85 cases of liver biopsies or segmental resections with a diagnosis of adenocarcinoma in the presence of PM were retrieved from our archives. Clinical history of other malignancies, any other lesions detected by imaging studies, CA19-9 levels, and reevaluation of the available H&E and IHC slides were performed.

Results
The patients were divided into four groups: 74.1% with isolated PM on imaging and no previous history of any malignancy, 12.9% with PM on imaging with previous history-proven adenocarcinoma of the pancreas, 7.0% with PM in association with another lesion shown by imaging studies in other organs, and 5 (5.8%) PM on imaging in association with previous history of cancer somewhere else other than pancreas. At least two IHC stains were performed for each case. CK7 was ordered in all the cases and was positive in 100%; CK20 was positive in 35.8%. Interestingly, TTF-1 was positive in only one case, in the absence of discrete lung mass; the patient was treated for pancreatic adenocarcinoma.

Conclusion
We suggest that in the presence of PM, with liver metastasis of adenocarcinoma morphology on H&E, the metastasis is from the pancreas or upper gastrointestinal primarily and no need for further stains. Although performing IHC is useful sometimes, it should be ordered wisely; this practice will lower costs and result in higher quality care, with more effective use of the lab resources and personnel.
A Network Model of Communication and Test Utilization: A Laboratory Ambassador Program
Authors: Hutson LeAnne 
Published: September 2019

Abstract
Clinical laboratories often have the problem of poor communication between the lab and other health care professions, mainly nursing. This miscommunication can negatively influence employee satisfaction and patient care, requiring specimen recollections when quality is jeopardized. In an effort to improve specimen quality and build relationships between professionals, Parkland Hospital has worked to focus attention on laboratory/nursing communication by implementing the Laboratory Ambassador Program. The initial implementation of the Ambassador Program began in 2008 but ended in 2012 due to staffing issues. Afterward, the clinical laboratory noticed a marked increase in specimen recollections due to the specimen quality. They also found that both the nursing and laboratory staff missed the interactions between each other. As a result, the Ambassador Program restarted in 2018, targeting eight nursing units. A small team of laboratory professionals was assigned to each nursing unit and provided educational and reference material on specimen collections. The Ambassador Program at Parkland Hospital has proven to improve patient care by lessening specimen recollections by nearly 30%, and it has built critical relationships between nursing and the clinical laboratory staff. By working together with nursing, the laboratorians can now see the bigger picture of health care outside of the lab, and nursing now understands the complexities of laboratory testing and resulting.
Test Utilization of Serum Protein Electrophoresis and Immunofixation Electrophoresis
Authors: Katerji Roula , Paczos Tamera , Liu Li 
Published: September 2019

Abstract

Objectives
Serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) are commonly used to screen and monitor monoclonal gammopathies. Currently, there are no consensus guidelines on optimal testing frequency leading to overutilization. Here we examined the testing frequencies of SPE and IFE in our institution to provide an evidence-based perspective on efficient test utilization.

Methods
We retrospectively reviewed all SPE and IFE tests performed in 2018. Ordering patterns and testing frequencies were analyzed. In cases with more than monthly repeats, electronic medical records were reviewed to follow the result changes over time.

Results
There were 10,054 SPE and 4,248 IFE orders in 2018. The 4,248 IFE cases represented 2,439 patients, among whom 104 patients (4.3%) had IFE repeated more frequently than every 2 months and 50 patients (2%) more frequently than monthly. The 10,054 SPE cases represented 5,472 patients; 127 patients (2.3%) had SPE performed more than 12 times. Rare cases (0.1%) had SPE and IFE repeated every 1 to 2 weeks. Most IFE tests were ordered together with SPE (89% of all IFE orders), among which 28% of cases had normal SPE findings. Among the cases with more than monthly SPE and IFE tests, IFE results showed meaningful interpretation changes in a minimum period of 2 to 3 months; 35% cases had no IFE interpretation changes throughout the year. In contrast, during active treatment period of multiple myeloma, SPE detected paraprotein level change weekly.

Conclusion
IFE is overutilized and monthly monitoring does not add value even during active treatment of multiple myeloma. Our results support the need for the development of testing frequency guidelines to avoid overutilization and provide more cost-effective patient care.
Review of Free Prostate-Specific Antigen Assay Utilization at Danbury Hospital
Authors: Nguyen Quoc , Sena Salvador 
Published: September 2019

Abstract

Introduction
Measuring the concentration of free fraction of prostate-specific antigen (fPSA) present in serum in addition to the total PSA (tPSA) concentration has been shown to enhance specificity over tPSA alone in evaluating male patients with mild-moderate elevations of tPSA in the diagnostic “gray zone” (4.0-10.0 ng/mL) and negative findings on digital rectal exam. The clinical utility of fPSA has not been demonstrated outside the tPSA gray zone, as the probability of prostate cancer is very low at tPSA <4.0 and very high at tPSA >10.0. However, many clinicians order tPSA and fPSA concurrently without first knowing the results of the tPSA. This study was to review orders for fPSA and provide suggestions for improving utilization.

Methods
Paired test results for concurrently ordered tPSA and fPSA tests during the time periods of January to February 2018 and January to February 2019 (before and after laboratory information system upgrade) were extracted for quality assurance purposes. No patient identifiers were included. Data were sorted and the percentage of “appropriate” fPSA orders was calculated for each time period.

Results
The number of concurrent total and fPSA tests ordered was 174 for January-February 2018 and 232 for January-February 2019. The number of tPSA within the 4.0 to 10.0 ng/mL range was 78 for January-February 2018 and 148 for January-February 2019. The percentage of “appropriate” fPSA test orders (tPSA 4.0-10.0 ng/mL) was 44.8% for January-February 2018 and 63.8% for January-February 2019.

Conclusion
A high percentage of inappropriate fPSA orders was found during both time periods. Inappropriate fPSA testing is not only unnecessary and wasteful but can lead to diagnostic errors. Options for driving improved utilization include automatic canceling of fPSA orders when tPSA is not within the diagnostic gray zone and offering fPSA as a “reflex” test that is performed only when tPSA is within the diagnostic gray zone.