bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploration and Practice of Electronic, Networked and Intelligent Methods for Basic Medical Science Education to Develop Pathology Interest
Authors: Zhu M Y 
Published: November 2022

Abstract

Introduction/Objective
In response to the sudden COVID-19 pandemic, the Chinese government has restricted student visas for international students as part of an emergency "zero COVID" plan. As a result of these border closures, most international students enrolled in Chinese medical universities have not returned to campus for more than 2.5 years and have continued their medical education online. Basic medical science study has continued relatively smoothly compared to clinical apprenticeships, which focus more on clinical traineeship and practice. How to turn the crisis caused by the pandemic into an opportunity to improve the level of basic medical science education and level of pathology interest in our school is the topic explored in this paper.

Methods/Case Report
The methods proposed in this study include the intelligence of artificial intelligence technology and adaptive teaching tools for teaching students in accordance with their aptitude, interactive microscopic slides and gross pathology recognition methods based on computer graphics technology, and Internet-based group learning and large group discussions. All the advantages of traditional classroom teaching are therefore included and some overcome the shortcomings of traditional classroom teaching.

Results (if a Case Study enter NA)
Grades in 2019-2020 school year basic medical science courses were obtained. In this school year, the first semester was traditional education on campus and the second semester was online using the method described in this paper. Second semester grades were 17.2% higher than the first. USMLE Step 1 performance was another measured outcome because it focuses on basic science and pathology. A good outcome on this exam was obtained and the teaching method proposed in this paper is verified.

Conclusion
The author is preparing to expand the sample size to further verify, improve, and perfect the method proposed in this paper, so as to promote the depth and breadth of basic medical education and continuing success from education into success in pathology careers.
Tumor-to-Tumor Metastasis in the Central Nervous System: A 21-Year Single-Institutional Experience
Authors: Galev G , Prayson R 
Published: November 2022

Abstract

Introduction/Objective
Tumor-to-tumor metastasis (TTM) has two distinct morphologic appearances. In strict terms, it is a phenomenon where one tumor (donor tumor) metastasizes to another tumor (recipient tumor). Another pattern of TTM is collision tumor, where two tumors occur in immediate proximity with infiltration at the border between the two. TTM is a rare event, particularly in the central nervous system (CNS). Herein, we present a series of cases from our institution encountered in the past 21 years.

Methods/Case Report
The institutional archives were searched for CNS tumors that bear metastatic deposits or are collision tumors. The hematoxylin and eosin and any available immunohistochemical slides were reviewed. Relevant demographic and clinical data were obtained from patient medical records.

Results (if a Case Study enter NA)
Four cases were identified. The findings are summarized in the Table. The median age at presentation was 67 years (range, 60-74 years). Three patients were male. All metastases were carcinomas. Three cases were TTM in strict terms and one was a collision tumor. All TTM cases were an unexpected finding with no prior clinical or radiological suspicion for primary or metastatic neoplasm. In the collision tumor case, the metastatic tumor was an expected finding and the primary CNS tumor was an incidental one.

Conclusion
TTM in the CNS is a rare but important entity to recognize, as it often represents the presentation of an unknown primary malignancy. Further workup should aim at identifying the primary source of the malignancy, which warrants clinicopathologic correlation.
Performance Evaluation ofB. burgdorferi Serology Test Using Zeus Modified Two-Tier Testing (MTTT) Against Standard Two-Tier Testing (STTT) by Immunoblot Method
Authors: Karki S 
Published: November 2022

Abstract

Introduction/Objective
Lyme disease (LD) is a multisystem infection caused by tick-transmitted spirochete Borrelia burgdorferi. Serologic testing of LD is the primary diagnostic approach, and two-tiered testing is required to optimize specificity. The FDA cleared a variation of standard two-tiered testing (STTT) known as modified two-tier testing (MTTT) replacing the second tier immunoblot testing with a second enzyme immunoassay either ELISA or chemiluminescence format that can detect IgM and IgG simultaneously (MTTT-1) or separately (MTTT-2). The objective of this study is to evaluate the MTTT-2 assay performance against the predicate immunoblot method.

Methods/Case Report
Positive and negative quality controls (QC) were used to perform within and between day precision. 96 serum specimens were screened using ZEUS ELISA Borrelia VlsE1/pepC10 IgG/IgM Test System followed by method comparison using ZEUS B. burgdorferi IgG and IgM, separate test systems (ZEUS scientific, Branchburg, NJ) with the predicate MarDX Lyme Western Blot kit on Biotech Trinblot analyzer (Trinity Biotech USA, Jamestown, NY). Interference study was performed using 17 serum samples: 4 HIV positive, 5 ANA positive with high titer, 2 EBV IgG positive, 1 CMV IgG positive, 2 EBV & CMV IgG positive, and 3 reactive syphilis samples. Patient clinical chart was reviewed on results that disagreed.

Results (if a Case Study enter NA)
Within and between day precision studies were acceptable. Method comparison between MTTT-2 vs. immunoblot demonstrated 73% agreement (70/96). The remaining 26 samples showed disagreement either by IgM or IgG alone, or both. Upon clinical chart review, 8/26 samples that disagreed were likely true positive and 3/26 samples were likely false positive by MTTT-2 assay; the remaining 15/26 samples either cannot be confirmed due to lack of clinical history or inappropriately ordered as routine test. No cross-reactivity was observed on the MTTT-2 assay.

Conclusion
Our study demonstrated MTTT-2 assay is equivalent or slightly better than the predicate immunoblot method, if ordered appropriately when clinically indicated.
Clinical Lab Decision Support System for Quality Test Ordering and Utilization with Increase Reimbursement
Authors: Shrestha R , Hamill T , Beqaj S S 
Published: November 2022

Abstract

Introduction/Objective
It is estimated that at least 20% of the 5 billion lab orders submitted annually are inappropriate. Use of an appropriate laboratory test utilization management system (TUMS) can significantly overcome this. Laboratory Decision System (LDS) is the only automated TUMS to assist providers understand, select, order, and optimally utilize tests for disease diagnosis and management. This algorithm-based LDS rates and scores potential tests for any given disease and assigns an interpretable numeric score based on clinical relevance, medical necessity, and indication. Importantly, every orders using LDS will also have right CPT and ICD-10 codes assigned to meet the medical necessity and improve reimbursement. Therefore, in this study, we evaluated the performance of LDS as a testing utilization management system and its ability to improve the reimbursement.

Methods/Case Report
A total of 96,170 lab orders were analyzed from a reference laboratory. Of these, 814 tests were accompanied by an invalid ICD10 code and 44,671 tests or were accompanied by ICD10 that are described by Medicare as “never covered” because of inability to meet medical necessity. A total of 160,449 tests were subject to an Medicare policy review from which 112,400 tests met coverage criteria and 48,049 tests did not. These orders were then reevaluated using LDS, which can be accessed from app.medicaldatabase.com/site/api/cpoe or interfaced with EMR to determine if the system would have improved test selection and reimbursement.

Results (if a Case Study enter NA)
Of the original test order sample, 91.5% had an associated LDS score. Of these scored tests, 47.80% met coverage and 43.73% failed to meet coverage, according to the LDS Ranking System. Importantly, LDS provided recommendations for alternative diagnostic ICD10 codes or tests which could have aided physicians in choosing a more appropriate test or submitting a different ICD10 diagnostic code to meet medical necessity. 96.4% with an alternative ICD10 code or test with a score above 5, meeting medical necessity. 80.5% were recommended by the LDS system which would meet Medicare policies.

Conclusion
Use of such algorithm-based testing selection and ordering database that rates and scores potential tests for any given disease based on clinical relevance, medical necessity, and testing indication, would eventually help providers to select and order right test and reduce miss-utilization of tests.
Association Between Daily Sample Collection Time and Results of Testosterone Testing in Adult Males
Authors: Windham A K , Brimhall B , Nguyen K 
Published: November 2022

Abstract

Introduction/Objective
Serum testosterone levels in men have diurnal fluctuation with levels peaking between 7 AM and 10 AM, reaching an early evening nadir around 7 PM. For evaluation of male hypogonadism, fasting total testosterone levels should be measured in the early morning (8 to 10 AM). Testosterone measurements made beyond peak times may yield misleading results. We aim to investigate specimen collection times and compare with testosterone levels.

Methods/Case Report
We examined specimen collection times for testosterone testing (n=3075) for adult males (age &gt;16 years) over a four-year period (July 2016-June 2020). Collection times were grouped into 2-hour intervals and test interpretations were grouped as either “low” or “high/normal”. Collection times were categorized as either morning (between 6 AM and 12 PM) or non-peak times (between 12 PM and 6 AM) A chi-square analysis was performed to investigate the possible relationship between low testosterone levels and specimen collection time.

Results (if a Case Study enter NA)
Approximately two-thirds of testosterone test samples were collected outside the recommended timeframe of 8-10 AM and accounted for 70% of low testosterone levels. The chi-square test showed that there is a significant (p=0.005) overall relationship between specimen collection times and testosterone levels. A correspondence plot of chi-square residuals showed a positive relationship between low testosterone levels collected at non-peak times. Conversely, there was a negative relationship between low testosterone levels collected in the morning.

Conclusion
Low testosterone levels measured on specimens collected outside of peak morning hours may be difficult to interpret and may lead to additional unnecessary repeat testing or treatment.
Diagnostic Testing for Gastrointestinal Surgery Patients at Academic and Non-Academic Health Systems
Authors: Zhou Y , Windham A K , Whitted M , Brimhall B , Podichetty A , Clark K 
Published: November 2022

Abstract

Introduction/Objective
Comparisons of surgical inpatient clinical laboratory test and radiology imaging utilization between multiple academic and non-academic health systems are very uncommon.

Methods/Case Report
Using the Vizient Clinical Data Base®, with permission from Vizient, Inc. (All rights reserved.), we compared clinical laboratory and imaging utilization over 3 years (2019-2021) for adult patients hospitalized for major GI surgical procedures at mid-size (250-450 hospital beds) academic (N=12; 8,706 hospitalizations) and non- academic (N=18; 7,930 hospitalizations) hospitals across the US. We used Medicare Severity Diagnosis Related Groups (MSDRG), employed by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for major small and large bowel procedures (MSDRG triplet 329-331). Using single MSDRGs, we stratified patients by comorbid conditions and complications into high, moderate, and low severity groups. We compared the mean number of laboratory tests (CPT codes 80000-89999), and imaging studies (CPT codes 70000- 79999) per hospitalization and per hospital day. We measured aggregate Clinical Resource Intensity Weight (RIW) per hospitalization to quantify diagnostic resource consumption for each encounter. The RIW is based on the CMS Ambulatory Payment Classification weights.

Results (if a Case Study enter NA)
Academic hospitals had significantly (p&lt;.01) higher mean laboratory tests per encounter (65.6 vs. 43.0 tests, 52.6% higher) and per hospital day (7.6 vs. 5.1 tests, 49.0% higher). Laboratory RIW was also higher at academic hospitals per hospitalization (12.8 vs. 10.3, 24.3% higher) and per hospital day (1.7 vs. 1.5, 13.3% higher). Mean imaging studies were also higher at academic centers per case (3.5 vs. 3.1 studies, 12.9% higher) and per day (0.37 vs. 0.33, 12.1% higher), but lacked statistical significance. Imaging RIW was not significantly different between academic and non-academic hospitals either by encounter (6.5 vs.6.2, 4.8% higher) or per day (0.697 vs. 0.700, 0.4% lower). Analysis of utilization after stratification by severity revealed similar patterns with larger differences at higher severity levels.

Conclusion
Mean diagnostic tests per hospitalization are greater at academic hospitals. These differences persist after adjustment for hospital length of stay and severity level. Laboratory test RIW is higher at academic hospitals. However, differences are not significant for imaging RIW.
The Value of Virtual Meetings during COVID-19 Pandemic in Healthcare Settings
Authors: Sughayer M A , Dabbagh T Z , Souan L , Alsughayer A 
Published: November 2022

Abstract

Introduction/Objective
The coronavirus pandemic led to an unprecedented rise in using virtual meeting technology in the healthcare sector for conferences, business meetings, and continuous medical education. This study aims to understand the practices and individual preferences and to highlight the benefits and challenges of virtual meetings compared to in-person ones.

Methods/Case Report
This cross-sectional study was disseminated via email as an online survey, using SurveyMonkey (Momentive Inc. San Mateo, California, USA) and targeted healthcare providers at the King Hussein Cancer Center-Amman, Jordan.

Results (if a Case Study enter NA)
A total of 342 healthcare providers took part in this questionnaire. 82.5% of respondents reported participating in virtual meetings; of those, only 33.5% preferred virtual over in-person meetings (PrV). Whether virtual meetings were equivalent to in-person ones, 33.2% of all participants (71.4% of the PrV) said virtual meetings were equivalent to in-person meetings in terms of participants’ attention (p&lt;0.001). Additionally 54.8% of all participants believed their gain level was less in virtual meetings compared to the conventional in-person ones; this percentage differs significantly between the participant's group who preferred in-person (PrP) over virtual meetings and the PV group who believed otherwise (75.0% vs 13.2%, p&lt;0.001). Nonetheless, when respondents were asked about their meeting preferences in the event of a pandemic, 49.5% of all healthcare providers preferred virtual over in-person meetings (91.3% of the PrV group p&lt;0.001). Almost half the participants (54.3%) reported that they tend to temporarily leave virtual meetings before it is over, yet, this percentage rockets to 70.0% if the meeting is over 2 hours long. On the other hand 43.3% of respondents admitted to leaving the meeting physically while keeping themselves logged in on their mobile/computer. An interesting result of the survey was that 58.3% of all respondents preferred to attend virtual meetings during working hours (85.7% of the PrV group, p&lt;0.001). Finally, when asked about performing other tasks while in a virtual meeting, the vast majority (82.6%) of respondents confirmed either answering the phone, reading/sending emails, or checking a social media outlet at least once, which contributes to a lack of adequate concentration.

Conclusion
Healthcare providers still prefer and attach more value and benifit to in-person interactions
Primary Hepatic Carcinosarcoma: A Rare Diagnosis With Unique Morphology
Authors: Asghar I A , Qu H , Ishtiaq H , Palmateer B 
Published: November 2022

Abstract

Introduction/Objective
The terminology and pathogenesis of primary hepatic carcinosarcoma remain controversial, as they are less than 1% of all hepatic cancers. The diagnostic challenges include interpreting their distinct morphology, immunohistochemical staining and excluding the differential diagnosis.

Methods/Case Report
Our case is of a 72-year-old man with history of smoking and occasional alcohol use. There was no history of viral hepatitis. He came with the complaint of abdominal pain and found to have 20 cm confluent mass in the left lobe of liver on imaging studies. Needle core biopsy was performed on the liver mass and showed biphasic malignant neoplasm with geographic necrosis. The tumor displayed two distinct patterns of growth. Portions of tumor exhibit vesicular nuclei with prominent nucleoli and abundant granular cytoplasm forming sheets and pseudoglandular structures. There were also separate well-demarcated foci of undifferentiated malignant epithelioid to spindle cells with abundant mitosis and apoptosis. The areas of hepatocellular differentiation were positive for Hep- Par-1, arginase and cytokeratin cam 5.2 and weak staining for glypican-3. They were negative for vimentin and smooth muscle actin. In contrast, the undifferentiated component is negative for Hep-Par-1, arginase, cytokeratin cam 5.2 and positive for vimentin (but not smooth muscle actin). The morphology and immunohistochemical staining pattern were consistent with a hepatic carcinosarcoma with undifferentiated sarcomatous component. The patient was put on palliative care due to the advanced nature of his disease.

Results (if a Case Study enter NA)
NA.

Conclusion
Despite the advancements in diagnostic techniques and treatment modalities, hepatic carcinosarcoma still is a rare occurrence with very dismal prognosis.
The SARS-CoV-2 Pandemic and Its Impact on the Incidence of Parasitic Gastrointestinal Illnesses in Pediatric and Adult Populations
Authors: Parsons D , Lavik J 
Published: November 2022

Abstract

Introduction/Objective
The initial months of the SARS-CoV-2 pandemic entailed unprecedented changes to the way lives are lived worldwide, resulting in new means of social and economic engagement. For instance, stay-at-home orders led to youths (and staff) attending school virtually. Likewise, entire sectors of the workforce were blocked from their offices and jobs went online. The aim of these public health policies was to reduce the transmission of SARS- CoV-2; however, less attention has been given to how these policies have impacted the spread of other communicable illnesses. As such, we hypothesized that stay-at-home orders, in conjunction with increased hygiene surveillance and other public health guidelines, altered the transmission cycles of communicable gastrointestinal parasites. We anticipated that when plotted against time, a decrease in positive cases would occur concomitantly with known periods of lockdown; similarly, an increase in positive cases would follow efforts to re-open society.

Methods/Case Report
To probe this hypothesis, the laboratory information system was queried for positive and negative cases of Giardia and Cryptosporidium identified within the Indiana University Health System based on the Surve-Vue Signature™ Crypto/Giardia assay (Fisher Healthcare, Waltham, MA).

Results (if a Case Study enter NA)
Results were categorized by patient age: 0 to 18-years-old and 19-110-years-old. Initial review of the pediatric data set reflected that pandemic-related public health measures did not meaningfully alter the incidence of positive test results for these two parasites, though notable observations suggested patterns buried more deeply within the data.

Conclusion
The findings of this study have broad implications regarding the perceived and actual communicability of Giardia and Cryptosporidium (as well as other gastrointestinal parasites) in both normal and pandemic-times.
The Changing Epidemiology of the Respiratory Syncytial Virus in Light of the COVID-19 Pandemic
Authors: Irfan A , Lankachandra K 
Published: November 2022

Abstract

Introduction/Objective
The epidemiology of a virus can be based on its evolving virulence, environmental and societal factors. Here we analyze the impact of the COVID-19 pandemic on the Respiratory Syncytial Virus (RSV).

Methods/Case Report
A 5-year retrospective study performed at Truman Medical Center, Kansas City, Missouri, analyzed 390 RSV positive cases by Lab PCR (polymerase chain reaction) for adult and pediatric patients, between the months of July- December, 2017-2021. Cases were divided into two groups - pre-pandemic and pandemic. Data was collected for both groups and categorized by age, gender, admission rate, summer months (July-September), winter months (October-December) and COVID-vaccination-status. A chi-square analysis was used to compare the above categorized data between both groups.

Results (if a Case Study enter NA)
Out of 390 cases, the annual incidence of RSV, pre-pandemic averaged at 71. This number fell drastically to 9 cases in 2020 followed by an overwhelming 168 cases in 2021. The incidence of cases in 2021 was higher in the summer months compared to pre-pandemic days, p&lt;.00001. Additionally, the incidence of cases in children &lt;5 years was greater during 2021, p=0.0014. Of note, no individuals &lt;20 years of age, reported positive in 2020. Of the population eligible for the COVID19 vaccine, 24% of those who tested positive had also been vaccinated. There was no significant difference reported with regards to other age groups, gender or admission rates.

Conclusion
Adequate social distancing and non-pharmaceutical interventions (masks, handwashing etc.) can explain the sharp decline in cases in 2020. RSV appears to have evolved to a more virulent strain ever since, resulting in more infections during the summer months, especially targeting children under the age of 5.