Background: Rad17 is a key DNA damage response protein that undergoes ubiquitylation-mediated degradation. Results: USP20 is a deubiquitylase that interacts with and stabilizes Rad17 in a proteasome-dependent manner, and it is required for Chk1 phosphorylation. Conclusion: USP20 is a novel regulator of the DNA damage response. Significance: USP20 role sheds more light on the ubiquitylation events associated with DNA damage, and may predict chemotherapy response.

Intravenous drug use and sexual practices account for 60% of hepatitis C (HCV) and B (HBV) infection. Disclosing these activities can be embarrassing and reduce risk reporting, blood testing and diagnosis. In diagnosed patients, linkage to care remains a challenge. Audio-computer-assisted survey interview (Audio-CASI) was used to guide HCV and HBV infection testing in urban clinics. Risk reporting, blood testing and serology results were compared to historical controls. A patient navigator (PN) followed up blood test results and provided patients with positive serology linkage to care (LTC). Of 1932 patients surveyed, 574 (30%) were at risk for chronic viral hepatitis. A total of 254 (44.3%) patients were tested, 34 (13.5%) had serology warranting treatment evaluation, and 64% required HBV vaccination. Of 16 patients with infection, seven HCV and three HBV patients started treatment following patient LTC. Of 146 HBV-naïve patients, 70 completed vaccination. About 75% and 49% of HCV antibody and HBV surface antigen-positive patients were born between 1945 and 1965. Subsequently, automated HCV testing of patients born between 1945 and 1965 was built into our hospital electronic medical records. Average monthly HCV antibody testing increased from 245 (January-June) to 1187 (July-October). Patient navigator directed LTC for HCV antibody-positive patients was 61.6%. In conclusion, audio-CASI can identify patients at risk for HCV or HBV infection and those in need of HBV vaccination in urban medical clinics. Although blood testing once a patient is identified at risk for infection needs to increase, a PN is useful to provide LTC of newly diagnosed patients.

BackgroundColorectal cancer is the third leading cause of cancer death; therefore early detection by screening is beneficial. Residents at a clinic in NJ, USA were not offering other forms of colon cancer screening when patients refused colonoscopy, which lead to the creation of the quality improvement project.MethodsResidents practicing at the clinic were given an anonymous survey determining which method of colon cancer screening they used and which alternative method they offered when patients refused the original method. The residents were educated about all methods of colon cancer screening and the residents were resurveyed.ResultsA total of 64% of residents offered less invasive testing when colonoscopy was refused. Six months after education, 95% of residents offered less invasive testing when colonoscopy was refused.ConclusionsEarly detection and removal of polyps by colonoscopy reduce the risk of cancer development. Colonoscopy is the gold standard for colon cancer screening; however other less invasive modalities are approved. This quality improvement project lead to offering the fecal immunochemical test or fecal occult blood test once patients refused colonoscopy at the clinic, increasing the number of patients receiving colorectal cancer screening, and thus providing better medical care.

The United States Preventive Services Task Force recommends hepatitis C testing people born from 1945 to 1965, “birth cohort” as well as hepatitis C and hepatitis B testing people from countries of birth with endemic infection risk. We automated the hospital electronic health record system to test birth cohort and those born in countries with endemic infection risk. A script is launched searching the laboratory database upon registration for any hepatitis C antibody, hepatitis C RNA and/or hepatitis B surface antigen result. If no positive result was found, a hepatitis C antibody/reflex RNA and/or hepatitis B surface antigen were ordered. A patient navigator received weekly results and assisted patients with positive serology to schedule an appointment with their primary care provider or treatment specialist. A total of 10 726 participants were hepatitis C antibody tested, with 6.9% antibody positive. Monthly hepatitis C testing from January to July 2016 compared to August 2016‐August 2017 increased 342% as a result of "birth cohort" testing. Following country of birth testing, monthly hepatitis B and hepatitis C testing increased 91%, and 44%, respectively, during June‐August 2017 compared to September 2017‐March 2018. 67% of hepatitis C‐positive patients were linked to care. If the navigator contacted the patient, 92% were linked to care, and 32% were treated. Of hepatitis B surface antigen‐positive patients, 43% were linked to care, 5% were on treatment, and 15% started treatment. Automated electronic health record ordering of hepatitis C and/or hepatitis B testing is feasible and increases testing. In the population tested, much improvement is needed with linkage to care and treatment.

INTRODUCTION: CRC is the third leading cause of cancer death, and therefore early detection by screening is beneficial. Residents in primary care clinics offer screening modalities for CRC starting at the age of 50. At a clinic in New Jersey, the primary method offered for screening has always been colonoscopy every 10 years starting at the age of 50. However, when patients refused colonoscopy, other less invasive tests were not being offered. A QI project was undertaken to assess the % of residents not offering less invasive tests, before and 6 months after education about CRC screening modalities. METHODS: 63 residents were surveyed about their preferred and alternate method of CRC screening. The questionnaire was anonymous. When colonoscopy was refused, results were obtained to assess the % of residents offering less invasive tests before and 6 months after being educated about CRC screening options. RESULTS: At this institution, results revealed that 73% of residents offered colonoscopy as a first test, 19% FOBT and 8% other methods. 64% of residents offered less invasive tests when colonoscopy was refused; this increased to 95% at 6 months post education, accounting for a 31% increase. CONCLUSION: Most cases of CRC develop from adenomatous polyps. Therefore, early detection and removal by colonoscopy reduces the risk of CRC development. Colonoscopy is the gold standard for CRC screening. However, other modalities are also approved such as yearly FOBT. It is important to offer these modalities when colonoscopy is declined. This QI project demonstrated that an educational intervention about CRC screening modalities given to residents in primary care clinics enhanced the number of patients being screened, especially in the group of patients who refused colonoscopy. In conclusion, offering more CRC screening methods yields to better medical care to our patients.