Demonstration of an expedited breast care (EBC) clinic

16023 Background: Women report waiting for a breast biopsy result as a time of psychological distress. Waiting also delays entry into definitive oncology care, and patients in underserved communities may be lost to follow up. In this proof-of-concept demonstration, an Expedited Breast Care (EBC) clinic was developed to give patients the opportunity to receive same-day biopsy results. Methods: Patients requiring core breast biopsy at a community hospital were approached sequentially to participate. Following surgical biopsy, tissue underwent ultra-rapid fixation and processing. After paraffin sections were prepared and stained, the glass histopathology slides were imaged with a virtual slide scanner. Digital images were stored on a server and viewed on the Internet by a telepathologist at a tertiary care center. Light microscopy review was concurrently performed as the gold standard. After telepathology review and light microscopy confirmation, patients presented to the telemedicine suite to receive biopsy results. A teleoncologist at the tertiary care center presented all pathology results to the patient, whether benign or malignant. Time and patient satisfaction data were collected. Results: Nine patients have participated. Within 2 hours from the time the tissue arrived at the laboratory, digital images were available to the telepathologist. The teleoncologist presented results to patients within 3–5 hours after the biopsy procedure. Patients reported satisfaction with the same-day service, and stated they would seek EBC again in the event of a future breast biopsy. Many patients expressed relief at receiving results so promptly and felt they had avoided the stress of waiting longer for results. The elapsed time from mammogram to definitive oncology care was shorter for EBC patients compared to a control group of patients at a clinic not offering EBC, although the results did not reach statistical significance (Mann-Whitney U: Z = −1.804, p = 0.0713). Conclusions: These data indicate EBC can be successfully accomplished. Current studies to assess EBC’s role in facilitating prompt entry into definitive oncology care are underway. By incorporating rapid tissue processing with telepathology and teleoncology, EBC can improve access to breast care in underserved areas. [Table: see text]

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Effect of outside referrals to a tertiary care liver tumor board on diagnostic testing and initial curative therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.259 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 259-259

Author(s):

Yapei Zhang ◽

Jennifer Arango ◽

Jeffrey Weinreb ◽

Tamar Hamosh Taddei

Keyword(s):

Liver Disease ◽

Diagnostic Method ◽

Care Center ◽

Tertiary Care ◽

Tumor Board ◽

Tertiary Care Center ◽

Disease Etiology ◽

Time To Treatment ◽

Curative Therapy ◽

To Receive

259 Background: Hepatocellular carcinoma (HCC) is a complex and unique cancer. Arriving at the optimal treatment plan is best accomplished by a multidisciplinary tumor board (MDTB). We hypothesized that patients referred from outside institutions to our tertiary care center for MDTB review may face disparities in diagnosis and treatment. Methods: We performed chart review of incident HCC cases presented from 2/1/13-2/1/16 at an American College of Surgeons accredited MDTB that convenes weekly at a tertiary care, university-affiliated hospital. We examined variables such as demographics, originating institution, liver disease etiology, location of index imaging, date of first tumor board presentation, diagnostic method (imaging, biopsy, tumor board consensus), BCLC stage at diagnosis, initial treatment, and time to treatment. Results: 167 cases of HCC were referred from 37 outside institutions (outside cases); 127 cases originated from our institution (internal cases). The two groups were comparable in gender distribution, liver disease etiology, and BCLC stage at tumor board presentation. Compared to internal cases, outside cases were diagnosed less often by imaging (47% vs. 77%, p < 0.000001) and more often by biopsy (38% vs. 17%, p < 0.001) or MDTB consensus (16% vs. 6%, p < 0.05). When stratified by BCLC stage, this difference in diagnostic method persisted in early and mid-staged patients (Stages 0, A, B), but not in advanced staged patients. Outside cases were also more likely to receive tumor biopsy (33% vs. 9%, p < 0.05) and less likely to receive initial curative therapy (resection, ablation, transplantation) (22% vs. 32%, p < 0.05). There was no significant difference in time to treatment. Conclusions: Despite similar demographics and disease profiles compared to patients from our tertiary care center, patients referred from outside facilities for MDTB review more often required biopsies or MDTB consensus to diagnose HCC, and were less likely to receive curative therapy. Differences in HCC diagnostic imaging protocols across institutions may help explain these results. Further study will help identify disparities in receipt of curative therapy.

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An Analysis of the US News & World Report Methodology for Attribution of Specialty Care in Otolaryngology and Urology

Otolaryngology ◽

10.1177/0194599820941016 ◽

2020 ◽

pp. 019459982094101

Author(s):

Ankur A. Shah ◽

Ryan M. Carey ◽

Jason A. Brant ◽

Gregory E. Tasian ◽

Justin B. Ziemba

Keyword(s):

Care Center ◽

Tertiary Care ◽

Specialty Care ◽

Hospitalized Patients ◽

Tertiary Care Center ◽

The Us ◽

World Report ◽

To Receive

US News & World Report ( USNWR) rankings can assist patients with choosing where to receive their specialty care. USNWR methodology assumes that the specialty caring for hospitalized patients is equivalent to the specialty assigned by administrative coding. We examined the frequency of discordance between USNWR methodology-assigned specialty and the actual specialty care received for 2 surgical specialties, otolaryngology (ENT) and urology (GU). Our analysis included inpatient deaths identified by USNWR coding for these specialties from 2013 to 2017 at a single academic tertiary care center. We found that a minority of patients with deaths attributed by USNWR to these 2 specialties were actually cared for by ENT (6/14; 43%) or GU (3/19; 16%). Only 5 of 14 (36%) and 2 of 19 (11%) deaths were potentially associated with ENT and GU care, respectively. We identified a significant discordance between USNWR-assigned specialty and the actual specialty care received.

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Mycobacterium indicus pranii vaccine immunoprophylaxis in anti-phenolic glycolipid-1-positive leprosy contacts – A pilot study from a tertiary care center in North India

Indian Journal of Dermatology Venereology and Leprology ◽

10.25259/ijdvl_882_18 ◽

2021 ◽

Vol 0 ◽

pp. 1-4

Author(s):

Muthu Sendhil Kumaran ◽

Tarun Narang ◽

Seema Chabbra ◽

Raihan Ashraf ◽

Sunil Dogra

Keyword(s):

Pilot Study ◽

Care Center ◽

Tertiary Care ◽

North India ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Tertiary Care Center ◽

Leprosy Patients ◽

Mycobacterium Indicus Pranii

Background: Contacts of leprosy patients have an increased risk of infection with Mycobacterium leprae. Contact tracing and chemo- or immunoprophylaxis are important means of preventing leprosy transmission. Aims: We aimed to evaluate the efficacy of immunoprophylaxis with Mycobacterium indicus pranii vaccine in reducing anti-phenolic glycolipid-1 titers in household contacts of leprosy patients. Methods: This prospective single-center study was conducted in a tertiary care center in North India from January 2015 to December 2016. Contacts of leprosy patients (both paucibacillary and multibacillary) were screened for anti-phenolic glycolipid-1 antibodies with enzyme-linked immunosorbent assay. Those found positive were given immunoprophylaxis with a single dose of Mycobacterium indicus pranii vaccine, and anti-phenolic glycolipid-1 titers were evaluated at six and 12 months. All contacts were clinically followed for three years. Results: Of the 135 contacts of 98 leprosy patients that were screened, 128 were recruited. Seventeen of these contacts were positive for anti-phenolic glycolipid-1 antibodies and were given Mycobacterium indicus pranii vaccine. Two contacts were lost to follow-up. After immunoprophylaxis, anti-phenolic glycolipid-1 titers were negative in all patients at all intervals, and no contact developed any clinical signs or symptoms of leprosy during the three-year follow-up. Limitations: The small number of contacts studied, the short follow-up period and the absence of a control group were limitations of this study. Dicussion: We could not find any papers on natural decline of PGL 1 titres in contacts, although in leprosy patients, these titres may even increase after completion of treatment. However the titres do correlate with bacterial load (reference: Int J Lepr Other Mycobact Dis. 1998 Sep;66(3):356-64) so if the tires decrease or become negative it may be considered as an indirect evidence of bacillary clearance. Hence we may suggest the protective efficacy. Furthermore, as the editor mentioned, considering the small number of positive patients, a control group was not possible in the present pilot study, but such studies may be carried out in the future. Conclusion: Immunoprophylaxis with Mycobacterium indicus pranii vaccine is effective and safe in preventing disease in contacts of leprosy patients. However, these findings need to be replicated in larger studies.

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