739. A Two-Center Assessment of Histopathologic Diagnostic Performance for Fungal Organism Identification

Abstract Background Accurate detection and identification of invasive fungal pathogens relies on concordance of several complementary laboratory techniques, including fungal culture, serology, and histopathologic identification. Histopathologic stains such as the Gomori methenamine silver stain (GMS) are used to highlight fungal cell wall in tissue specimens. We sought to determine the diagnostic performance of histopathology fungal stains as compared to fungal culture for diagnosis of invasive fungal tissue infection at tertiary medical centers with dissimilar patient populations. Methods We performed a retrospective review of all surgical pathology specimens with reported GMS results and concurrent fungal culture at Keck Medical Center (Keck) and Los Angeles County + USC Medical Center (LAC). Ratios of GMS diagnostic performance were compared using chi-squared analyses, with fungal culture as the gold standard for detection. Results Of 1347 LAC surgical pathology specimens stained with GMS to evaluate for fungal infection, 229 (17.0%) had concurrent tissue specimens submitted for fungal culture. Of 1546 Keck GMS-stained surgical pathology specimens, 358 (23.2%) had concurrent tissue for fungal culture. GMS stain performance at LAC showed a sensitivity of 53.7% (95% CI: 37.4-69.3%) and specificity of 90.4% (95% CI: 85.2-94.2%). At Keck, GMS showed a sensitivity of 64.1% (95% CI: 52.4-74.7%), specificity of 88.9% (95% CI: 84.7-92.4%), without significant difference in performance between sites, (p=0.27) and (p=0.62), respectively. Among filamentous fungi, GMS false negative frequency at LAC was 5.3% (10/190) and 4.0% (11/277) at Keck, without significant difference (p=0.51). A subset of pathology reports suggested the fungus genus based on histologic morphology. Of 10 LAC pathology specimens with fungal genus specified, 2 (20.0%) reports gave the incorrect genus and 8/18 (44.4%) reports at Keck gave incorrect genus as per concurrent culture isolate result. Table 1. Diagnostic performance of GMS histopathology stain on surgical pathology specimens compared to tissue fungal culture at LAC and Keck Medical Centers from July 2015 through December 2018. Conclusion GMS stain had low-to-moderate sensitivity when compared to fungal tissue culture. Increased submission of concurrent tissue for fungal culture is likely to improve detection. When genus level identification was attempted, fungal forms were incorrectly identified in about one-third of histopathology specimens. Disclosures All Authors: No reported disclosures

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The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

The American Surgeon ◽

10.1177/000313481307901113 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1134-1139 ◽

Cited By ~ 4

Author(s):

Kenji Inaba ◽

Adam Hauch ◽

Bernardino C. Branco ◽

Stephen Cohn ◽

Pedro G. R. Teixeira ◽

...

Keyword(s):

Los Angeles ◽

Trauma Center ◽

Medical Center ◽

Trauma Patients ◽

University Of Southern California ◽

Academic Level ◽

Significant Difference ◽

Level I ◽

The Impact ◽

Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

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Comparison of Fungal Culture Versus Surgical Pathology Examination in the Detection of Histoplasma in Surgically Excised Pulmonary Granulomas

Archives of Pathology & Laboratory Medicine ◽

10.5858/2007-131-780-cofcvs ◽

2007 ◽

Vol 131 (5) ◽

pp. 780-783

Author(s):

Jamie A. Weydert ◽

Timothy L. Van Natta ◽

Barry R. DeYoung

Keyword(s):

Clinical Microbiology ◽

False Negative ◽

Pulmonary Nodules ◽

Geographic Area ◽

Surgical Pathology ◽

Clinical Microbiology Laboratory ◽

Fungal Culture ◽

Microbiology Laboratory ◽

Direct Smear ◽

Pulmonary Granulomas

Abstract Context.—Granulomatous pulmonary nodules are common in areas endemic for Histoplasma infection, and may require surgical excision to exclude neoplasia. Surgeons may elect to routinely send material directly to the clinical microbiology laboratory for fungal and mycobacterial cultures. Objective.—To determine if tissue from surgically excised pulmonary granulomatous nodules removed from patients in a geographic area endemic for Histoplasma infection should be routinely submitted for fungal culture. Design.—Retrospective review and comparison of surgical pathology histochemical findings and clinical microbiology results of 30 surgical (wedge) lung excisions that demonstrated granulomatous nodule at the time of frozen section. Results.—Twenty cases demonstrated fungal organisms consistent with Histoplasma species via histochemical fungal stains. Of these 20 cases, 17 were tested in the microbiology laboratory using direct smear examination and fungal culture; Histoplasma was detected in 1 case (1/17). Eight cases revealed no organisms by surgical pathology. Of these, 6 were tested in the microbiology laboratory, and all 6 were negative by culture and direct smear (0/6). The remaining 2 cases demonstrated organisms other than Histoplasma by surgical pathology examination. Conclusions.—Surgical pathology examination of granulomatous pulmonary nodules detected Histoplasma organisms with greater sensitivity than culture and direct smear. There were no false-negative surgical pathology diagnoses when compared with microbiological results. These findings suggest that it is not necessary to routinely send material from solitary pulmonary granulomas for fungal culture when the material is removed from immunocompetent patients in a geographic area endemic for histoplasmosis.

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The diagnostic performance of TB-IGRA on HIV infected patients with active tuberculosis is associated with CD4+ T-cell counts

10.21203/rs.2.16261/v1 ◽

2019 ◽

Author(s):

Mengyan Wang ◽

Tongtong Chen ◽

Xiaotian Dong ◽

Zhongdong Zhang ◽

Jinchuan Shi ◽

...

Keyword(s):

T Cell ◽

Diagnostic Performance ◽

False Negative ◽

Active Tuberculosis ◽

Cd4 T Cell ◽

Interferon Gamma Release Assay ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Significant Difference ◽

Cd4 Cell

Abstract Objective: To investigate the factors associated with the diagnostic performance of interferon-gamma release assay (IGRA) in HIV infected patients with active tuberculosis (TB). Methods: We retrospectively analyzed the data of HIV infected patients with active tuberculosis patients from 2016-2019 who conformed with the inclusion criteria and the exclusion criteria. All patients included were performed with TB-IGRA. For evaluating the diagnostic performance of TB-IGRA, patients were divided into positive TB-IGRA and negative TB-IGRA groups. And all statistical analysis was performed using SPSS Results: Performed by logistic regression analysis, we found that CD4 cell counts is independent risk factor for false negative of TB-IGRA(P<0.001). Additionally, false negative of TB-IGRA were 68.75%, 24.29% and 14.63%, respectively, in the three groups whose CD4+ T cell counts were <20/μL, 20-100/μL and >100/μL, with the highest frequency in subjects with CD4+ T cell counts <20/μL(P<0.001). And false negative of TB-IGRA were 68.75%, 27.77%, 20.58% and 14.63%, respectively, in the four groups <20/μL (n = 32), 20-50/μL (n = 36) ,51-100/μL (n = 34) and >100/μL (n = 82). The group of CD4+ T cell counts <20/μL had the highest false negative (P<0.001). There was no significant difference in the groups of 20-50/μL, 51-100/μL and >100/μL (P=0.483, P=0.623, respectively). Conclusion: The low level of CD4+ T-cell counts increase false negative TB-IGRA in HIV infected patients with active tuberculosis. These data suggest IGRA assays may have unreliable diagnostic performance results among patients with advanced HIV especially CD4+ T cell counts were <20/μL.

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An Academic Medical Center’s Learners’ Perceptions of Health Disparities

PRiMER ◽

10.22454/primer.2018.867250 ◽

2018 ◽

Vol 2 ◽

Author(s):

Joyce E. Balls-Berry ◽

Eddie Greene ◽

Jennifer McCormick ◽

Onelis Quirindongo-Cedeno ◽

Karen Weavers ◽

...

Keyword(s):

Health Disparities ◽

Health Care Providers ◽

Medical Center ◽

Academic Medical Center ◽

Care Providers ◽

Unequal Treatment ◽

Medical Centers ◽

Academic Medical ◽

Significant Difference ◽

Patient Groups

Introduction: Lack of health equity ultimately leads to unequal treatment of diverse patients and contributes to the growing disparities seen in national health. Academic medical centers should consider providing health care providers and biomedical researchers training on how to identify and address health disparities. Methods: The authors led an introductory health disparities course for graduate students and research and clinical fellows at an academic medical center in the Midwest. We compared pre/postcourse assessments to determine changes in learners’ perceptions and knowledge of health disparities using an unpaired analysis to permit inclusion of responses provided only at baseline. Results: Sixty-two learners completed preassessment, with 56 completing the postassessment (90%). In the postcourse assessment, learners reported an increase in knowledge of disparities and had changes in their perceptions of health disparities linked to treatment of different patient groups based on demographic characteristics. There was a statistically significant difference in learners’ perceptions of how patients are treated based on gender identity (P=0.02) and sexual orientation (P=0.04). Conclusions: The results detail how an academic medical center can provide training on health disparities for diverse learners. This study underscores the influence of health disparities from the perspective of learners who conduct biomedical research and patient care. This course serves a model for introductory-level health disparities courses.

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708. Evaluation of Fungal Culture versus Bacterial Culture for the Identification of Various Mold Species

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.905 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S453-S454

Author(s):

Erin Su ◽

Rosemary She

Keyword(s):

Los Angeles ◽

Bacterial Culture ◽

Medical Center ◽

Fungal Culture ◽

Dimorphic Fungi ◽

Bacterial Cultures ◽

Invasive Mold Infections ◽

Respiratory Specimens ◽

Specimen Sampling ◽

Wound Tissue

Abstract Background Invasive mold infections are challenging to diagnose and in part relies on fungal cultures. A large proportion of mold isolates are recovered on routine bacterial cultures in our medical center, thus we sought to define the utility of bacterial versus fungal cultures for isolation of mold from clinical specimens. Methods Routine bacterial and fungal culture results from wound, tissue, body fluid, and respiratory specimens from Jan 2019-Dec 2020 from Keck Medical Center of USC (Los Angeles, CA) were retrospectively reviewed. Cases were excluded if specimens were collected specifically for dermatophyte recovery or for blood culture. Cultures in which mold, including dimorphic fungi, were isolated were included in the evaluation. Results Mold was isolated from 612 specimens from 408 patients, with recovery from 329 bacterial and 450 fungal cultures. Among the 329 bacterial cultures, fungal cultures were not requested in 119 (36.2%) while the remaining 210 had concurrent fungal cultures which recovered mold in 167 cases (79.5%). Of 450 fungal cultures recovering mold, a corresponding bacterial culture was performed in 445, isolating mold in 181 (38.8%) of these cases. Two or more molds were found in 28 fungal cultures and in 5 bacterial cultures. Of positive specimens with both fungal and bacterial cultures performed (n=488), mold was isolated in fungal cultures in 446 (91.4%) and in bacterial cultures in 209 (42.9%) (Table). Yield of molds in 488 specimens with concomitant bacterial and fungal cultures Conclusion Although a significant number of molds are recovered in routine bacterial cultures, over half would be missed without concomitant fungal cultures. Conversely, recovery of clinically relevant mold species was optimal when both bacterial and fungal cultures were requested on a specimen. This may be related to increased specimen sampling and incubation conditions allowing for broader organism recovery. Disclosures All Authors: No reported disclosures

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Clinical evaluation of a new thyroglobulin immunoradiometric assay in the follow-up of differentiated thyroid carcinoma

Nuklearmedizin ◽

10.1055/s-0038-1625299 ◽

2003 ◽

Vol 42 (02) ◽

pp. 71-77 ◽

Cited By ~ 4

Author(s):

I. Schreivogel ◽

C. Angerstein ◽

U. Siefker ◽

K. Lehmann ◽

G. Altenvoerde ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Residual Disease ◽

False Negative ◽

Differentiated Thyroid Carcinoma ◽

Threshold Concentration ◽

High Rate ◽

Functional Assay ◽

Hypothyroid Patient ◽

Assay Sensitivity ◽

Significant Difference

SummaryAim: Formal and clinical comparison of a new 3rd-gene-ration-Tg-IRMA (3-G-IRMA; Dynotest®Tg-plus) with a conventional Tg-IRMA (3-G-IRMA; SELco®Tg-assay) for patients with differentiated thyroid carcinoma. In addition we evaluated, if thyroglobulin (Tg) levels above a specific threshold concentration indicate the need for further investigations for residual disease. Patients, methods: Tg concentration of 105 sera of 93 consecutive patients with a differentiated thyroid cancer was determined with both assays and compared at different cut-off values (Dynotest®Tg-plus: 0.2, 1, 2 ng/ml; SELco®Tg-assay: 0.5, 1, 2 ng/ml) with the clinical results in respect to the corresponding TSH concentration. Results: Tg concentration did not show any significant difference (SELco®Tg-assay 0.5 ng/ml, Dynotest® Tg-plus 0.2 ng/ml). The Tg-values of both assays correlated with 97%. However, correlation of recovery in both assays was small (40%). The sensitivities and specificities of both assays at different cut-offs and TSH values did not reveal significant differences. In patients with TSH concentration >30 µU/ml the functional assay sensitivity was superior to arbitrary cut-offs in the decision to start further evaluations. Conclusions: In our study neither formal nor clinical significant differences between two Tg-assays were found. In a hypothyroid patient (TSH >30 µU/ml, Tg concentration exceeding the functional assay sensitivity) further investigations for residual disease are warranted. Higher thresholds are of limited value, due to a inacceptable high rate of false negative results.

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Assessment of indicators of nervous and emotional stress in medical center personnel depending on the characteristics of their professional activity

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2020-60-10-650-657 ◽

2020 ◽

Vol 60 (10) ◽

pp. 650-657

Author(s):

Irina V. Fedotova ◽

Tatyana N. Vasilyeva ◽

Tatyana V. Blinova ◽

Irina A. Umnyagina ◽

Yuliya V. Lyapina ◽

...

Keyword(s):

Oxidative Stress ◽

Emotional Stress ◽

Functional State ◽

Working Conditions ◽

Medical Staff ◽

Medical Center ◽

The Body ◽

Office Workers ◽

Glutathione System ◽

Medical Centers

Introduction. Digital technologies are actively used in the work of specialists of medical centers of various profiles, which causes the impact on employees of a number of professional factors that determine the characteristics of their work. The aim of the study is to evaluate the influence of professional factors on the functional state of the employees' body and the glutathione system as an objective indicator of stress based on the analysis of the subjective perception of the medical center employees of the specifics of working with personal computers and psychophysiological testing. Materials and methods. The study involved 109 specialists of medical centers (25 ophthalmologists, 31 representatives of the secondary medical staff - nurses and paramedics, 53 office employees). The anonymous survey concerned the assessment of working conditions and their impact on the functional state of the body of the respondents. Performance and stress tolerance indicators were evaluated using three standard questionnaires. The study of 66 subjects' levels of glutathione in the blood: total, reduced, oxidized and the ratio of reduced and oxidized - was used to analyze the relationship of the neuro-emotional nature of labor with the reaction of oxidative stress. Statistical processing of the obtained data was carried out using traditional methods of variation statistics and calculating the value of the odds ratio (OR) with a 95% confidence interval (CI). Results. The survey revealed a significant proportion of people in all groups of respondents who constantly use computer technology in their work. Describing the quality of the processed information, doctors more than representatives of other groups note its complexity, importance, negative emotional color, a high degree of responsibility and tension. Doctors more often than average medical staff and office workers associate the manifestation of fatigue with an uncomfortable state of the visual organ, nervous system, and musculoskeletal system. The subjects showed reduced performance and stress tolerance with the most pronounced negative trends in the group of doctors. Changes in the glutathione system were detected, indicating the presence of oxidative stress in 40% of ophthalmologists and office workers, and in half of nurses. Conclusions. The work of specialists of medical centers of various profiles in accordance with their assessment is characterized by high nervous and emotional stress, due to the need to process a significant amount of complex and important professionally significant information. Subjectively noted by respondents the influence of working conditions on the functional state of the body is confirmed by indicators of the glutathione system, which can be used as indicators of nervous and emotional stress.

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Liquid materials for biomedical research: a highly IT-integrated and automated biobanking solution

Journal of Laboratory Medicine ◽

10.1515/labmed-2017-0118 ◽

2019 ◽

Vol 43 (6) ◽

pp. 347-354 ◽

Cited By ~ 1

Author(s):

Daniela Popp ◽

Romanus Diekmann ◽

Lutz Binder ◽

Abdul R. Asif ◽

Sara Y. Nussbeck

Keyword(s):

Life Cycle ◽

Medical Center ◽

Research Results ◽

Long Term Storage ◽

Medical Centers ◽

It Systems ◽

Complete Life Cycle ◽

The University ◽

Term Storage

Abstract Various information technology (IT) infrastructures for biobanking, networks of biobanks and biomaterial management are described in the literature. As pre-analytical variables play a major role in the downstream interpretation of clinical as well as research results, their documentation is essential. A description for mainly automated documentation of the complete life-cycle of each biospecimen is lacking so far. Here, the example taken is from the University Medical Center Göttingen (UMG), where the workflow of liquid biomaterials is standardized between the central laboratory and the central biobank. The workflow of liquid biomaterials from sample withdrawal to long-term storage in a biobank was analyzed. Essential data such as time and temperature for processing and freezing can be automatically collected. The proposed solution involves only one major interface between the main IT systems of the laboratory and the biobank. It is key to talk to all the involved stakeholders to ensure a functional and accepted solution. Although IT components differ widely between clinics, the proposed way of documenting the complete life-cycle of each biospecimen can be transferred to other university medical centers. The complete documentation of the life-cycle of each biospecimen ensures a good interpretability of downstream routine as well as research results.

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The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.109 ◽

2021 ◽

pp. 1-15

Author(s):

Kevin Hauck ◽

Katherine Hochman ◽

Mark Pochapin ◽

Sondra Zabar ◽

Jeffrey A Wilhite ◽

...

Keyword(s):

New York ◽

New York City ◽

Medical Center ◽

The United States ◽

Lessons Learned ◽

Front Line ◽

Clinical Leadership ◽

Team Members ◽

Medical Centers ◽

Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

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