Andrew M. Harris

Transcriptional changes during neuronal death and replacement in the olfactory epithelium

The olfactory epithelium has the unusual ability to replace its neurons. We forced replacement of mouse olfactory sensory neurons by bulbectomy. Microarray, bioinformatics, and in situ hybridization techniques detected a rapid shift in favor of pro-apoptotic proteins, a progressive immune response by macrophages and dendritic cells, and identified or predicted 439 mRNAs enriched in olfactory sensory neurons, including gene silencing factors and sperm flagellar proteins. Transcripts encoding cell cycle regulators, axonogenesis proteins, and transcription factors and signaling proteins that promote proliferation and differentiation were increased at 5--7 days after bulbectomy and were expressed by basal progenitor cells or immature neurons. The transcription factors included Nhlh 1, Hes 6, Lmyc 1, c-Myc, Mxd 4, Id 1, Nmyc 1, Cited 2, c-Myb, Mybl 1, Tead 2, Dp 1, Gata 2, Lmo 1, and Sox1 1. The data reveal significant similarities with embryonic neurogenesis and make several mechanistic predictions, including the roles of the transcription factors in the olfactory sensory neuron lineage.

Radiation Exposure to the Urologist Using an Over-Couch Radiation Source Compared to an Under-Couch Radiation Source in Contemporary Urology Practice

OBJECTIVE To compare radiation dosage to the urologist using an overcouch system, x-ray tube over table, and an undercouch system, x-ray tube under table. Urologists continue to perform more endoscopic surgery requiring fluoroscopy. Fluoroscopy, or electromagnetic radiation, can cause cellular damage when passing through tissues. These systems are compared with respect to radiation dosage to the urologist. METHODS A single urologic surgeon utilized a dosimeter badge while using an overcouch system. The dosimeter exposure was higher than expected and an undercouch system was then employed. Dosimeter exposure levels between the overcouch and the undercouch systems were examined and compared. RESULTS Over the 4 months reviewed for the overcouch system, radiation doses to the body averaged 3.63 mSv, those to the eye averaged 3.73 mSv, and those to the extremities averaged 3.72 mSv. The 3-month averages for the undercouch system exposure to the body, the eye, and the extremities were 0.31, 0.35, and 0.35 mSv, respectively. The difference in radiation exposure between the 2 systems was significant (P ≤.001). The average number of radiation cases between the 2 systems was not significantly different (P = .37). The average fluoroscopy time for the procedures between the 2 systems was not significantly different (P = .24). CONCLUSION Overcouch fluoroscopy systems expose the urologist to significantly higher, potentially dangerous levels of radiation. Urologists using an overcouch system should strongly consider as low as reasonably achievable precautions and proper utilization of lead aprons, thyroid shields, and lead glasses. Radiation safety training should be considered.

PD28-02 IMPLEMENTING A PATIENT SAFETY CULTURE SURVEY TO IDENTIFY AND TARGET PROCESS IMPROVEMENTS IN ACADEMIC AMBULATORY UROLOGY PRACTICES: A MULTI-INSTITUTIONAL COLLABORATIVE

INTRODUCTION A shared professional culture focused on patient safety is critical to delivering high-quality care. There is a need for objective metrics to help identify target areas for improvement in patient safety culture. The Medical Office Survey on Patient Safety Culture (SOPS) was developed and validated by the United States Agency for Healthcare Research and Quality to measure patient safety culture in the ambulatory setting. In this study we report on safety culture and practices in six academic urology clinics utilizing this validated questionnaire. MATERIALS AND METHODS The SOPS was administered to all staff in ambulatory urology practices affiliated with participating centers. Percent positive responses were calculated for each of 10 validated composite domains and were compared between sites and respondent roles. Nonparametric statistical analyses were performed to identify differences between groups. RESULTS The survey was administered to 185 staff members, with an overall response rate of 66%. Within each domain there was substantial variability between sites, with significant differences observed in staff training (p = 0.034), office processes/standardization (p = 0.008), patient care tracking (p = 0.047), communication about errors (p = 0.001), and organizational learning (p = 0.015). Similar variation was seen between respondent roles with significant differences for patient care tracking (p = 0.002) and communication about errors (p = 0.014). CONCLUSIONS The SOPS is a clinically useful tool to identify issues impacting a practices safety culture. Substantial variability was observed within each composite domain at the levels of practice site and respondent role. Comparing composite domain results between clinics will allow leadership to identify gaps and evaluate policies and resources of higher performing peer sites.