Tumor Molecular Gene Profiling of Pancreatic Adenocarcinoma and Compliance with the Latest NCCN Guideline: A Regional Veteran Affairs Medical Center Experience

2021 ◽  
Vol 10 (5) ◽  
pp. S67
Author(s):  
Jeffrey Petersen ◽  
Darshana Jhala
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Medical Center ◽  
Gene Profiling ◽  
Veteran Affairs

scholarly journals Identifiable Mutations in Pancreatic Adenocarcinoma in the Veteran Population: Molecular Testing Guidelines by NCCN 2020

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
J M Petersen ◽  
D Jhala
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Medical Center ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Gene Profiling ◽  
Molecular Testing ◽  
Nccn Guidelines ◽  
Cdkn2a Mutation ◽  
Frequent Mutations ◽  
Locally Advanced Pancreatic Adenocarcinoma

Abstract Introduction/Objective In 2019 and 2020, the National Comprehensive Cancer Network (NCCN) advanced a recommendation that all patients with metastatic, recurrent, or locally advanced pancreatic adenocarcinoma should undergo tumor gene profiling (TGP). Prior to these recommendations, TGP in targeted patients have demonstrated a high frequency of KRAS (>90%), TP53 (60-70%), CDKN2A (>50%), SMAD4, TGF- βR1, and TGF- βR2 mutations or alterations. Even less frequent mutations such as the homologous recombination repair (HRR) genes impact treatment by predicting tumor response to platinum-based therapies. However, the literature is sparse for the frequency of these mutations in patients with pancreatic adenocarcinoma undergoing generalized testing as part of the standard of care per NCCN guidance, particularly for veterans. Methods/Case Report For a quality assurance study, a retrospective review was performed to identify patients with pancreatic adenocarcinoma at a tertiary medical center serving veterans from January 2019 to February 2021 with TGP performed as part of their care. All of the TGP had been sent to Foundation Medicine (Cambridge MA), and the identifiable tumor mutations from the test reports were recorded to document the frequency of KRAS, TP53, CDKN2A, SMAD4, TGF- βR1, TGF- βR2 and HRR mutations or alterations. Results (if a Case Study enter NA) There were a total of 11 patients with pancreatic adenocarcinoma who had a tumor specimen for TGP during the study period. All 11 patient tumors had KRAS mutation. 10 out of 11 had a mutation or alteration in TP53. 8 of 11 patients had a CDKN2A mutation or alteration. 7 of 11 patients had a mutation or alteration of SMAD4 though none had TGF- βR1 or TGF- βR2. 2 of 11 patients had HRR mutations (1 with FANCA and 1 with ATM). Conclusion Tumor mutations on generalized gene profiling per NCCN guidelines continue to identify important mutations in pancreatic adenocarcinoma for veteran patients.

Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in southeastern USA

Infection ◽  
2010 ◽  
Vol 38 (4) ◽  
pp. 297-300 ◽  
Author(s):  
S. Naggie ◽  
J. Frederick ◽  
B. C. Pien ◽  
B. A. Miller ◽  
D. T. Provenzale ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Medical Center ◽  
Southeastern Usa ◽  
Veteran Affairs

Oligonucleotide-Directed Microarray Gene Profiling of Pancreatic Adenocarcinoma

2004 ◽  
pp. 175-188
Author(s):  
David E. Misek ◽  
Rork Kuick ◽  
Samir M. Hanash ◽  
Craig D. Logsdon
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Gene Profiling ◽  
Microarray Gene

Legionella Test Reporting at a Regional Veteran Affairs Medical Center

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S139-S139
Author(s):  
J M Petersen ◽  
D Jhala
Keyword(s):  
Quality Assurance ◽  
Medical Center ◽  
Disease Incidence ◽  
The United States ◽  
Health Care Facilities ◽  
Quality Assurance Program ◽  
Regulatory Requirement ◽  
Veteran Affairs ◽  
Antigen Tests ◽  
Prompt Action

Abstract Introduction/Objective The appropriate reporting and monitoring of legionella antigen and culture test volumes and results is a veteran affairs quality assurance regulatory requirement. Legionnaires disease incidence has been noted to be increasing in the United States, and it has also been documented that health care facilities are especially high- risk settings for the transmission of Legionella bacteria from the building water systems to the occupants. However, studies of Legionella test epidemiology for non-veteran hospitals is sparse in the literature. To provide perspective, here we report the total legionella antigen and culture tests from quarter 1 2016 to quarter 4 2019 to provide a regional perspective. Methods Quality assurance data on both the total number of Legionella antigen and culture tests and the recorded number of positive cases were reviewed from quarter 1 2016 to quarter 4 2019 and tabulated. This data is collected routinely as per veteran affairs regulatory directives. Results There were a total of 1613 legionella antigen tests and 1287 legionella cultures. None of the Legionella cultures were positive during the study period. Nonetheless, there were 3 positive urinary antigen tests for a total calculated percentage of 0.00002%. Conclusion The presence of positive Legionella antigen tests at a regional veteran affairs medical center indicates that a robust quality assurance program is tremendous benefit to monitoring Legionella at a major medical institution in order to prompt action to prevent hospital-based spread.

scholarly journals Gonorrhea and Chlamydia Specimen Positivity Rate by Polymerase Chain Reaction at a Regional Veteran Affairs Medical Center

2020 ◽  
Author(s):  
Jeffrey M Petersen ◽  
Sahil Patel ◽  
Sharvari Dalal ◽  
Darshana Jhala
Keyword(s):  
Polymerase Chain Reaction ◽  
Quality Assurance ◽  
Medical Center ◽  
Reference Points ◽  
Statistical Analyses ◽  
Major Public Health Problem ◽  
Chain Reaction ◽  
Test Volume ◽  
Veteran Affairs ◽  
Polymerase Chain

Abstract Objective Sexually transmitted infections because of Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) remain a major public health problem. Although the literature describes the population-based epidemiology of CT/NG, it does not appear to contain reference points for the statistical analyses of specimen positivity rates by nucleic acid testing (NAT) with polymerase chain reaction (PCR) that would be collected by a laboratory following best laboratory and regulatory practice. For facilities that diagnose NG and CT by a real-time PCR assay, an understanding of the expected specimen positivity rate of gonorrhea and chlamydia would be helpful for monitoring the assay for quality assurance. Therefore, on behalf of the Michael J. Crescenz Veteran Affairs Medical Center (VAMC), we present this novel quality assurance study on its CT/NG specimen positivity rates conducted by NAT with PCR. Methods Quality assurance/improvement quarterly data from April 1, 2012 to September 30, 2019 were reviewed to obtain both the test volume of PCR for CT/NG and the number of positive test results at the VAMC to collate and perform statistical analyses. Testing had been performed using the Abbott m2000 RealTime System (Abbott Park, IL). Results A total of 22,709 PCR tests for CT/NG had been performed on the veteran population; of these, 502 tests were positive for NG and 744 were positive for CT. Quarterly percentage rates ranged from 1.67% to 5.30% for CT and from 1.00% to 3.25% for NG, with average rates of 3.35% and 2.22% for CT and NG, respectively. Conclusion The establishment of an expected rate of specimen positivity of CT/NG by NAT with PCR at the VAMC is a significant novel reference point in the quality assurance (QA) literature and provides a benchmark that aids tremendously in QA for the microbiology/molecular laboratory.

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