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Context.— Despite widely prevalent burnout and attendant disengagement in medicine, the specific patterns and drivers within pathology and laboratory medicine are uncommonly studied. Objective.— To assess the prevalence and drivers of burnout among pathology and laboratory medicine professionals, retrospectively, prior to the COVID-19 pandemic. Design.— This was a cross-sectional, mixed-methods study engaging pathology and laboratory medicine professionals as subjects. Results.— Of 2363 respondents, 438 identified as pathologists, 111 as pathology assistants, and 911 as pathology and laboratory professionals. The burnout rate was 58.4% (1380 of 2363) across all respondents in pathology and laboratory medicine. Burnout varied by job role (P < .01) and was highest among pathology and laboratory professionals. Disparities in burnout rate were observed by race. Fifty-six percent (1323 of 2363) of respondents felt that they had at least 1 symptom of burnout and were advancing toward a breaking point. Underlying factors ranked highly among all groups included control over workload and loss of meaning in work. Conclusions.— Data provided from this cohort may help departments create successful strategies to reduce disengagement and burnout in the laboratory, especially during periods of increased stress as experienced during the COVID-19 pandemic. Further, these data may serve as a baseline comparison for future studies.

PURPOSE: Although Common Variable Immunodeficiency (CVID) is considered the most prevalent symptomatic primary antibody deficiency (PAD), there is a population with symptomatic PADs that do not meet criteria for CVID. We analyzed clinical and immunological profiles of patients with different PADs to better understand the differences and similarities between CVID and other PADs. METHODS: We extracted clinical and laboratory data of patients with PADs from electronic medical records. Patients were categorized into CVID, IgG subclass 2 deficiency (IgG2D), IgG deficiency (IgGD) and selective antibody deficiency (sAbD) based on basal immunoglobulin levels and pneumococcal vaccine responses. We compared clinical and immunological characteristics in these groups. RESULTS: All patients, regardless of PAD types, showed similar frequencies of infections, bronchiectasis, and interstitial lung disease (ILD). Hematopoietic malignancies were more frequently found in the CVID than in the IgG2D, IgGD and sAbD groups, while the latter groups trended towards an increased frequency of connective tissue diseases (CTD). Low counts of natural killer (NK) cells were associated with malignancy, autoimmunity, and ILD in CVID but not in other PAD groups. CONCLUSIONS: Higher frequency of hematopoietic malignancy in CVID than in the other PADs and association of lower NK cell counts with non-infectious complications in CVID suggest a relationship between immune alterations and the development of non-infectious manifestations in PADs.

Abstract 53 Background: Cervical cancer remains the most common cancer in women of the developing world, largely as a result of a lack of screening. The gold standard screening test for cervical cancer, the Pap smear, has been effective in reducing cervical cancer incidence and mortality by identifying precancerous and cancerous lesions; however, little is known about quality assurance practices for gynecologic cytopathology in resource-limited settings. The goal of this study was to document baseline clinical and laboratory characteristics in the hope of improving the efficacy of cervical cancer screening and informing future quality improvement initiatives. Methods: A retrospective study of cervical cytology at Kamuzu Central Hospital, Malawi, from January 1, 2013, to April 30, 2016, was conducted. Results: Of 2,809 Pap smears processed, 2,396 (85.3%) samples were diagnostic, with 92.3% of nondiagnostic smears (381 of 413) deemed unsatisfactory because of improper collection techniques. The 18-month patient follow-up rate for unsatisfactory Pap smear was found to be 23.0% (n = 95), with repeat smears reflecting a similar satisfactory rate (n = 82; 86%). Of diagnostic Pap smears, 6.1% (n = 147) were premalignant, whereas 2.0% (n = 48) were malignant. Cytology-histology correlation was also investigated one the basis of the corresponding samples collected concurrently. Of 70 pairs, 55 pairs (78.6%) were concordant, whereas six (8.6%) and nine (12.9%) were majorly and minorly discordant, respectively. The sensitivity and specificity of the Pap smear as a screening test were 83.8% and 81.8%, respectively. Conclusion: The Pap smear is a sensitive and specific screening method for cervical cancer in our setting. We hope that documentation of baseline quality and services of cervical cytology will inform future quality assurance programs and assist other laboratories in the development of similar programs in resource-limited settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Daniel Liauw No relationship to disclose Bal Mukunda Dhungel No relationship to disclose Tamiwe Tomoka No relationship to disclose Robert Krysiak No relationship to disclose Coxcilly Kampani No relationship to disclose Fred Chimzimu No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Consulting or Advisory Role: Alexion Pharmaceuticals