scholarly journals MammaPrint Feasibility in a Large Tertiary Urban Medical Center: An Initial Experience

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
C. Francisco Espinel ◽  
Shaughn Keating ◽  
Hanina Hibshoosh ◽  
Bret Taback ◽  
Kathie-Ann Joseph ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Groups ◽  
Breast Cancer Patients ◽  
Fresh Tissue ◽  
Tissue Samples ◽  
Receptor Status ◽  
Estrogen Receptor Positive

Background. The MammaPrint (MP) diagnostic assay stratifies breast cancer patients into high- and low-risk groups using mRNA analysis of a 70-gene profile. The assay is validated for assessment of patients with estrogen receptor positive or negative tumors less than 5 cm with 3 or fewer malignant lymph nodes. TargetPrint (TP) is an assay for assessing estrogen, progesterone, and HER2-neu receptor status based on mRNA expression. A potential limitation of these assays is that they require an evaluation of fresh tissue samples. There is limited published experience describing MP or TP implementation.Methods. Over 10 months, 4 breast surgeons obtained samples from 54 patients for MP/TP analysis. The samples were analyzed by Agendia Labs. The tumors were independently evaluated for receptor status using immunohistochemistry (IHC). Retrospectively, we identified patients who were assessed by MP/TP during this period. Patients who underwent OncotypeDx evaluation were also identified.Results. Of the 54 patients receiving MP, 4 were found ineligible for MP risk assessment because >3 lymph nodes were found to be malignant. Out of all eligible patients, 14/50 (28%) had samples whose quantity of tumor was not sufficient for analysis (QNS). Out of eligible patients with tumors <1 cm, 7/8 (88%) had QNS samples. 7/42 with tumors ≥1 cm (17%) had QNS samples. Nine patients had discordant receptor results when evaluated by IHC versus. TP. Of patients who also underwent OncotypeDx testing, 6/14 (43%) had discordant results with MP.Conclusions. This study indicates that using MP/TP assay is feasible in a tertiary care center but there may be utility in limiting MP testing to patients with tumors between 1 and 5 cm due to high likelihood of uninformative results in subcentimeter tumors. Further study is needed to explore the discordance between oncotype and MP results.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Teppei Shimasaki ◽  
Yoona Rhee ◽  
Rachel D Yelin ◽  
Michelle Ariston ◽  
Stefanie Ollison ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Targeted Prevention ◽  
Prevention Measures ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Clinical Culture

Abstract Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had &gt;1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with &gt;1 MDRO. Disclosures All authors: No reported disclosures.

MicroRNA Expression Profiling of Cutaneous Squamous Cell Carcinomas Arising in Different Sites

2020 ◽  
Vol 163 (3) ◽  
pp. 538-545
Author(s):  
Alexander N. Rock ◽  
Mason D. Fisher ◽  
Gwenyth Amborski ◽  
Dawn C. Allain ◽  
Victoria Klee ◽  
...  
Keyword(s):  
Head And Neck ◽  
Squamous Cell ◽  
Mirna Expression ◽  
Statistical Significance ◽  
Care Center ◽  
Normal Skin ◽  
Tertiary Care ◽  
Tissue Samples ◽  
Qrt Pcr ◽  
Candidate Mirnas

Objective To examine the microRNA (miRNA) expression profile of cutaneous squamous cell carcinoma (cSCC) tumors from aggressive head and neck locations compared with nonaggressive anatomic sites and normal controls. Study Design Retrospective analysis of miRNA expression. Setting Tertiary care center. Subjects and Methods Tissue samples were collected from 3 anatomic regions: aggressive head and neck sites (ie, ears/lip), nonaggressive locations (ie, extremities/trunk), and adjacent normal skin. RNA was isolated from tissue cores of 45 samples (18 aggressive sites, 15 nonaggressive sites, and 12 normal-adjacent skin). miRNA expression analysis was completed for approximately 800 miRNAs using the NanoString nCounter panel. Five candidate miRNAs were selected for validation. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed on the original samples plus 30 additional tissue samples (7 aggressive sites, 14 nonaggressive sites, and 9 normal-adjacent skin). Results Five candidate miRNAs with significant differences in miRNA expression ( P < 0 ≤ .001) from discovery samples were selected: miR-21, miR-31, let-7g, miR-93, and miR-22. Relative expression for these miRNAs using qRT-PCR in the new sample set did not reveal any significant differences using 1-way analysis of variance. When sets were combined, miR-21 showed increased expression in aggressive tumors relative to nonaggressive tumors ( P = .009), but no others reached statistical significance. Conclusion cSCC behaves more aggressively when originating from specific anatomical subsites of the head and neck. Of 5 miRNAs evaluated, only miR-21 showed significantly higher expression in tumors from aggressive sites relative to nonaggressive sites. Larger sample sizes are needed to evaluate other miRNAs.

scholarly journals The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

2017 ◽  
Vol 35 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Elise C. Carey ◽  
Ann M. Dose ◽  
Katherine M. Humeniuk ◽  
Yichen C. Kuan ◽  
Ashley D. Hicks ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Hospital Death ◽  
Personal Care ◽  
Predominately White ◽  
Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

Incidence of Involvement of Nipple Areola Complex in Breast Cancer

2015 ◽  
Vol 24 (Number 1) ◽  
pp. 33-38
Author(s):  
Md. R Hoq ◽  
A Sayeed ◽  
B Khan ◽  
R Parvin ◽  
S I Khan
Keyword(s):  
Breast Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
Age Distribution ◽  
Oncologic Outcome ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Areola Complex ◽  
Areolar Complex ◽  
Study Population

In this prospective study, fifty cases of breast cancer were studied in a tertiary care center & different hospitals of Dhaka city for one year, aimed to determine the incidence of malignant involvement of NAC in breast cancer patients of our country with clinically uninvolved nipples from history and postoperative histopathological reports of mastectomy specimens. The age distribution of Breast cancer varied from 25 to 75 years. Highest incidence was in 5th and 6th decades numbering 30 (60%) cases. Incidence of 3rd decades was 8 (16%) cases and in 7th decades was 12 (24%) casesin relation to menstrual cycle Breast Ca incidence is more in post-menopausal women numbering 28 (56%).Lump size of most of the study population found within 2-Scm (T2 stage). Incidence of axillaty lymph node metastasis found positive in 28 patients (56%) and no metastasis in 22 patients (44%). Of 50 patients maximum no 22 (44%) found with moderately differentiated tumour, 16 (32%) patients found poorly differentiated, differentiation could not be assessed in 12 (24%) patient and well differentiated tumour found in only 2 (4%) patients. The most common histological type found in the study population is IDCC 44 (88%). Skin involvement was 0% and only 2% patients have malignant involvement of NAC from underling breast cancer. The conclusion in respect to this study is, Nipple areolar complex can be preserved with breast reconstruction in carefully selected patients going for breast cancer surgery with safe oncologic outcome.

Toxicities and adherence rates of hormone treatment in male breast cancer patients treated at a tertiary care center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11613-e11613
Author(s):  
H. Visram ◽  
S. F. Dent
Keyword(s):  
Breast Cancer ◽  
Male Breast Cancer ◽  
Psychiatric Treatment ◽  
Negative Impact ◽  
Care Center ◽  
Tertiary Care ◽  
Male Breast ◽  
Breast Cancer Patients ◽  
Duration Of Treatment ◽  
Er Status

e11613 Background: Male breast cancer (BC) comprises approximately 1% of all breast cancer cases, and over 80% of male BC tumours express the estrogen receptor (ER). Male BC patients (pts) are often offered hormonal treatment (HT) with tamoxifen (T), or more recently aromatase inhibitors (AI's). There is a paucity of information in the literature on the toxicities (Tx) and adherence rates of HT in this population. Methods: We conducted a retrospective chart review of 24 pts diagnosed with male BC at the Ottawa Regional Cancer Centre from 1986–2003. Data collected included pt age, ER status, progesterone receptor (PR) status, systemic chemotherapy, HT, and Tx of treatment. Results: Median age of 24 male BC pts was 70.0 years (r: 46–83 years). The majority (16/24) of pts had ER/PR testing: 12 (75.0%) ER/PR +, 1 (6.3%) ER +/PR-, 2 (12.5%) ER +/PR unknown, and 1 (6.3%) ER/PR-. Of the 15 pts who were ER +, 13 received T and 5 received anastrozole (A) monotherapy during their treatment. One ER - pt received adjuvant T. Three pts with ER status unknown received T. Median duration of treatment with T (17 pts) was 38.0 months (r: 2–79 months). Hot flashes (23.5 %) was the most common reported Tx. Decreased libido, weight gain, rash, and malaise were reported in 2 pts (11.8%) each. Increased liver enzymes, pulmonary embolism, and erectile dysfunction were reported in 1 pt (5.9%) each. Five pts (29.4%) terminated treatment early due to T toxicity (median treatment 15 months; r: 2–54 months). Five pts were treated with A (median 10 months; r: 3–60 months), 4 of whom received prior T treatment. One pt reported loss of libido, and 1 significant depression /suicidal ideation requiring psychiatric treatment. Conclusions: This study provides contemporary data on toxicities and adherence rates of HT in male BC pts in a non-clinical trial setting. Approximately 30 % of male BC pts discontinued T therapy due to Tx, potentially having a negative impact on clinical outcome. Future studies will examine differences in adherence rates and outcomes between T and A in male BC pts. No significant financial relationships to disclose.

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