8/25/2016
PATHPrimer
Dr. David Hicks, director of Surgical Pathology at URMC, is a lead editor for the new online pathology educational tool, PATHPrimer (Elsevier, 2016).
PATHPrimer is a web-based pathology curriculum that contains anatomic pathology learning modules and assessments.
Others from URMC Pathology also contributed – Drs. Bruce Smoller and Linda Schiffhauer served as leads for the Dermatopathology and Breast Pathology sections.
In the clinical pathology modules, Dr. Victoria Zhang led sections on the Toxicology, Body Fluids and Special Techniques with collaboration from Dr. Sapna Patel.
Past URMC faculty members, Drs. Gabrielle Yeaney (Neuropathology) and Rochelle Simon (Gynecology) were also recruited to write content.
Breast Book; Second Edition
Earlier this year, Dr. David Hicks finished the second edition of “Diagnostic Pathology: Breast” (Elsevier, 2016) which he co-authored with fellow breast pathologist Dr. Susan C. Lester of Brigham and Women’s Hospital in Boston.
Hicks and Lester released the first edition in 2012 in an effort to provide “real-time diagnostic support” for pathologists in diagnosing and developing treatment for breast cancer patients.
The second book has taken nearly four years to complete. In addition to print copies, the second book has an interactive e-edition. Many of the high quality images were taken by pathologist assistants at URMC.
8/23/2016
Four URMC researchers who received a U.S. patent for their innovative method of predicting the risk of recurrent heart attacks are eager to see their work brought to clinics, hospitals, and physicians’ offices around the world.
In 2015, the University of Rochester was granted a patent based on the work of James Corsetti, M.D., Ph.D., Charles Sparks, M.D., Daniel Ryan M.D., and Arthur Moss, M.D. The patent details a graphical exploratory data analysis tool called “outcome event mapping”, or OEM, as an approach for identifying subgroups of individuals at high or low risk for a medical outcome.
OEM has been applied to identify heart attack patients at increased risk for further heart attacks. In this example, the method graphically illustrates risk over levels of two biomarkers of heart health: HDL (“the good”) cholesterol, and C-reactive protein (CRP), a marker of systemic inflammation.
The graph at right delineates combinations of the two marker levels associated with high-risk patient subgroups (peaks) and low-risk patient subgroups (valleys).
In this example, the OEM approach has been extended to treat genetic data with the figure presenting OEMs for two states of a single nucleotide polymorphism (SNP) that show a well-defined, high-risk subgroup for one of the SNP states and virtually no risk for the other SNP state. OEM can therefore be used to predict whether patients who have already suffered heart attacks are at higher risk for a repeat occurrence.
The team of researchers behind the patent has been collaborating since the late 1990s to come up with new approaches to identify high risk populations. They believe this method has the potential to help physicians improve personalized patient care.
UR Ventures, the technology transfer operation at the University of Rochester, is actively seeking an industrial partner who can make this diagnostic tool available to healthcare providers.
To learn more about licensing OEM, contact Matan Rapoport at UR Ventures.
8/8/2016
While many teenagers are spending their summer riding bikes or going to the beach, students in the University of Rochester Medical Center’s Pathology IT Group can be found learning gross anatomy in the morgue, studying histology in the library, or huddled over a microscope together discussing a possible diagnosis.
In my eight weeks at Strong Memorial Hospital, I was able to explore medicine and pathology at a level that is a privilege rarely granted to college undergraduates. I spent my days among Pathology attendings, residents, and medical students, and was fortunate enough to be welcomed as a part of the Pathology team.
Not only was I able to observe medical students on their Pathology rotation, but I also saw the director of Autopsy testify on a homicide case in court. I went to weekly conferences with residents and attendings, watched an autopsy, and learned how to read pathology reports. I learned about how patient diagnoses are made and became personally involved in research on Lynch Syndrome. Furthermore, I got to shadow in general surgery and explore other paths within the medical field.
This program challenged me and my fellow students to grow both intellectually and emotionally. At first, it seemed daunting to learn about the histology of the human body and medical terminology used to diagnose things like a “tubular adenoma” or “sessile serrated polyp.” However, we made rapid progress so that, by the end of the summer, our confidence grew. We experienced both the power and pitfalls of medicine as we learned to discuss an emotionally-charged autopsy and consider the needs of patients that go beyond their medical conditions. Gradually, we learned more about the emotional maturity necessary to handle these challenges – and this was illuminating.
Under the mentorship and guidance of Dr. Jennifer Findeis-Hosey, each member of the Pathology IT Group was able to tailor the experience to his or her own personal interests and ambitions. I emerged from my own experience better prepared for medical school, even more motivated for my sophomore year at Cornell. This experience gave me a strong desire to give back to the Department of Pathology and Laboratory Medicine and the medical community, and to pay forward the mentorship that I have received.
About the Author:
Elena Gupta is a rising sophomore at Cornell University. She is one of more than a dozen high school and undergraduate students enrolled in the Pathology IT Program at URMC.
8/1/2016
Dr. Richard Burack, director of Hematopathology, together with Dr. Tim Mosmann of the Center for Vaccine Biology and Immunology, has received a $50,000 pilot grant from Wilmot Cancer Institute.
The investigators will use the funding to develop multiple research collaborations to investigate the role of immune-senescence in lymphomagenesis, the role of immune microenvironment in determining response to therapy, and the role of immune function in the symptoms of lymphoma via analysis of rare immune cell populations by advanced flow cytometry.
The proposal was one of two winners in the latest round of Wilmot Pilot Awards for cancer research, announced in July. There were seven applicants in total.
According to research director Hucky Land, Ph.D, the awards went to the projects that the reviewers thought had the most potential to develop into Program Project Grants (P01) from the National Institute of Health (NIH). Wilmot’s goal is to obtain several P01s in the coming years.
- Courtesy of Wilmot Cancer Institute
7/13/2016
Have you ever wondered what happens to blood donations when they are taken to a hospital?
According to the American Red Cross, 6.8 million Americans give blood each year. The Blood Bank and Transfusion Medicine Unit at Strong Memorial Hospital receives and stores these blood products to be ready for patients around the clock.
We spoke with Debra Masel, Blood Bank chief supervisor, and Aimee Kievitt, lab supervisor, to learn more.
Where do blood products stored in the Blood Bank come from?
The vast majority of our blood comes directly from the American Red Cross located on John Street in Henrietta.
There is also a small donor room located off the main lobby at SMH where patients scheduled for surgery, and who qualify to donate their own blood, can have a unit of blood collected. This blood is then stored in the Blood Bank specifically for them if a transfusion is needed during their surgery.
What are the main functions of the Blood Bank?
We do testing to make sure that the blood received from the American Red Cross is compatible with patients who need it. If a patient has any type of transfusion issue, we need to identify and resolve the problem to ensure that the blood is truly compatible and that we’re not causing more harm by transfusing them.
Our attending physicians, nurses, residents and fellow provide clinical consultation on effective and safe use of blood transfusions, and evaluate transfusion reactions.
How much blood does the Blood Bank receive each day?
We transfuse about 100 units a day. During the blood collection process, approximately 500 milliliters of whole blood is collected which is then separated into red cell, plasma and platelet products. A unit of red cells has a volume of approximately 400 milliliters, which includes a preservative solution to increase the shelf life of the product.
What’s the difference between a blood sample and a blood product?
A blood sample is drawn directly from the patient and is used to complete pretransfusion testing to ensure compatibility with the intended blood product. Blood products are collected from volunteer donors.
A donation is separated into its component parts – plasma (55%), red blood cells (45%), and white blood cells and platelets (less than 1%) – which are each stored and used separately to help multiple patients.
What happens when there’s a trauma patient in the Emergency Department who needs blood products?
The Blood Bank has a trauma pager so when a Level 1 trauma patient is being transported to the hospital, the technologists are notified. They then prepare the trauma cooler with four units of O Negative (O-) uncrossmatched red blood cells, commonly known as the “universal donor.” When a staff member from the ED comes to pick up the blood, he or she will bring a patient blood sample for testing to be performed.
It is important to switch the patient to blood products identically matched to their own blood type as soon as possible, since our research at SMH shows that ABO identical transfusions are safer than use of “universal donor” red cells or plasma.
What kind of testing does Blood Bank perform?
The Blood Bank processes about 120 patient samples a day, many of which are outpatient samples for pre-operative and prenatal testing. About 90 percent of our transfusions are given to inpatients and the remaining 10 percent are transfusions received by outpatients.
What happens if a patient with very rare blood type needs a transfusion?
Sometimes there are other complications besides a patient’s blood type. If a patient has multiple antibodies, for example, finding compatible donors in the available blood inventory may not be possible.
In that case, we contact the Rare Donor Registry via the American Red Cross and a national search is initiated to identify a compatible donor. If we request something that’s available in the registry, they send it to us. We have gotten products from Florida, California, and other states.
What if the Red Cross can’t find what you’re looking for?
If we have a need for a rare unit and the American Red Cross has nothing in inventory, they can search their database to find a donor who matches the patient’s needs. They contact the donor and let them know that they are a rare match for a patient in need and request that they come to a center to donate.
How does a critical shortage in blood donations affect the work of the Blood Bank and Transfusion Medicine Unit?
In the event of a critical shortage (and it would have to be very dramatic) hospital administration and our attending physician and resident on call are notified. Our physicians and technologists will triage requests so that only clinically urgent transfusions are performed during the shortage.
The hospital chief medical officer may ask surgeons to reschedule elective surgeries so that the available blood supply can be conserved for urgent needs.
Thankfully, the community response to blood shortages has been good in bolstering the blood supply so that the drastic measure of rescheduling surgeries hasn’t happened in many years.
What’s a more common type of shortage you encounter?
When there’s a shortage of O- blood and the Red Cross can’t provide our normal inventory levels, we may need to evaluate every requested transfusion for clinical necessity and urgency.
It’s very important to obtain a patient sample as quickly as possible so that trauma patients receive products identical to their blood type instead of group O- blood. In those cases, it requires a higher level of communication and coordination between Blood Bank and the ED or Operating Room so we can appropriately supply their needs.
The same is true for platelet shortages. Our physicians, nurse and technologists evaluate each request for necessity and urgency. We discuss orders with providers to hold off on transfusion or reevaluate whether a transfusion is absolutely necessary when the necessity or urgency are not clear from the order.
When do you have the greatest need for blood donations?
Summers (around the Fourth of July) and December tend to be the two times when supplies are running lowest. Schools, which hold many blood drives, are closed, and people are on vacation so they are not available to donate blood.
What have been the biggest changes in blood banking within the last decade?
There has been a national push for restrictive transfusion practices, and this is a good thing. Blood transfusion can be lifesaving in certain situations but it’s not the cure-all. A transfusion is like a liquid transplant. If a patient doesn’t have a specific need to be transfused, they shouldn’t be.
Research performed here has led to substantial changes in transfusion practices to render them safer for the recipient, such as use of ABO identical transfusions, leukoreduced transfusions for all patients and washed transfusions for select patient groups. This has led to many fewer complications of blood transfusion and increased survival in some instances.
How has your role in patient care changed over time?
In the last decade, our staff has started to interact more directly with nurses and ordering providers to discuss patient cases; their underlying diagnosis, signs, symptoms, and whether transfusion is the most appropriate course of action. There have been more of those types of collaborative and educational discussions.
In photos:
Top: The Blood Bank at URMC stores all blood products in a cooler where staff can pull units needed for patients.
Middle: Lisa Hughes, a medical technologist, performs a test to determine the blood type of a patient who has received a bone marrow transplant.
Bottom: Medical technologist, Kim Bastian, releases a blood product to a patient for a transfusion. In this case, the patient has had transfusion reactions, so the product has been "washed" with saline to help prevent further reactions from occurring.
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