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Objectives: The healthcare industry is grappling with escalating expenses, partially attributed to the inefficient use of medical resources, particularly by ordering unnecessary laboratory tests. Such practices not only increase costs but also result in extended hospital stays, patient discomfort, and potential clinical complications such as iatrogenic anemia. Blood tests, although essential for guiding medical decisions, are associated with significant clinical and financial costs. This quality improvement project aimed to decrease unnecessary laboratory testing at Wellstar Spalding Medical Center, a community hospital with a newly established residency program., Methods: Our study team played a pivotal role in formulating an algorithm that outlined the indications for a complete blood count and basic or comprehensive metabolic profile. We then conducted standardized didactic sessions for resident physicians and faculty, educating them on the use of "add-on" laboratory values, providing electronic medical records training, and highlighting the compounding costs of these simple laboratory tests. We analyzed data during a 3-month period, both before and in the intervention phase, adjusting for the number of physician-patient interaction days to account for potential variations in patient census in the hospital., Results: The number of complete blood count orders and basic/comprehensive metabolic profile orders underwent an absolute decrease in the postintervention period. When adjusted for the number of physician-patient interaction days, this decrease remained consistent, although not statistically significant., Conclusions: Our project has yielded clinically and administratively meaningful results. We have seen a measurable decrease in costs and the prevention of unnecessary laboratory testing. If it also can be shown that we have prevented iatrogenic anemia, our project could be seen as enhancing the patient experience and reducing hospital length of stay. We also have raised awareness about high-value care and instilled clinical awareness among residents regarding ordering daily blood tests contributing to an improvement in patient care.

Hypertrophic cardiomyopathy (HCM) is a genetically acquired disease of cardiac myocytes. Studies show that 70% of this disease is a result of different mutations in various sarcomere genes. This review aims to discuss several genetic mutations, epigenetic factors, and signal transduction pathways leading to the development of HCM. In addition, this article elaborates on recent advances in gene therapies and their implications for managing this condition. We start by discussing the founding mutations in HCM and their effect on power stroke generation. The less explored field of epigenetics including methylation, acetylation, and the role of different micro RNAs in the development of cardiac muscle hypertrophy has been highlighted in this article. The signal transduction pathways that lead to gene transcription, which in turn lead to increased protein synthesis of cardiac muscle fibers are elaborated. Finally, the microscopic events leading to the pathophysiologic macro events of cardiac failure, and the current experimental trials of gene therapy models, and the clustered regularly interspaced short palindromic repeats (CRISPR) type 2 system proteins, are discussed. We have concluded our discussion by emphasizing the need for more studies on epigenomics and experimental designs for gene therapy in HCM patients. This review focuses on the process of HCM from initial mutation to the development of phenotypic expression and various points of intervention in cardiac myocardial hypertrophy development., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Pradeep et al.)

Digital microscopy (DM) is one of the cutting-edge advances in pathology, which entails improved efficiency, diagnostic advantages, and potential application in virtual diagnosis, particularly in the current era of the coronavirus disease (COVID-19) pandemic. However, the diagnostic challenges are the remaining concerns for its wider adoption by pathologists, and these concerns should be addressed in a specific subspecialty. We aim to identify the common diagnostic pitfalls of whole slide imaging (WSI), one modality of DM, in gastrointestinal (GI) pathology. From validating studies of primary diagnosis performance, we included 16 records with features on GI cases involved, at least two weeks wash-out periods, and more than 60 case study designs. A tailored quality appraisal assessment was utilized to evaluate the risks of bias for these diagnostic accuracy studies. Furthermore, due to the highly heterogeneous studies and unstandardized definition of discordance, we extract the discordant cases in GI pathology and calculate the discrepant rate, resulting from 0.5% to 64.28%. Targeting discrepancy cases between digital microscopy and light microscopy, we demonstrate five main diagnostic pitfalls regarding WSI as follows: additional time to review slides in WSI, hard to identify dysplasia nucleus, missed organisms like Helicobacter pylori ( H. pylori ), specific cell recognitions, and technical issues. After detailed reviews and analysis, we generate two essential suggestions for further GI cases signing out by DM. One is to use systematized 20x scans for diagnostic workouts and requesting 40x or even 60x scans for challenging cases; another is that a high-volume slides training should be set before the real clinical application of WSI for primary diagnosis, particularly in GI pathology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Shi et al.)