The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for >1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.

Abstract Background Invasive fungal infections (IFIs), though uncommon, are on the rise and have a high mortality rate. Fungal colonization is common, but its clinical significance is unclear. Our study aims to characterize the impact of these diagnoses and their management on outcomes in a large ICU population. Methods We utilized the Multiparameter Intelligent Monitoring in Intensive Care III database for this retrospective cohort study. Adults with positive fungal cultures were classified as colonized or infected using definitions from the EORTC/MSG guidelines and the Blot protocol for Aspergillus. Outcomes were compared between groups matched by age, SOFA score, admission diagnosis, culture results, and comorbidities. Results There were 595 hospital admissions with IFI (11.7/1000 admissions) and 5789 with colonization (114/1000 admissions). In-hospital mortality was 52% in patients with IFIs and 36% in colonized patients. Mortality post-discharge remained high and was not significantly different in the two groups. 67% of patients with IFIs had the diagnosis documented. 24% of patients with IFIs and 8% of colonized patients received antifungal therapy. Treatment did not significantly impact mortality in infected or colonized patients but was associated with increased length of hospital and ICU stay. Infectious disease (ID) consultation was performed in 39.8% of patients with IFIs and 20% of patients with colonization. In the group of IFI patients with ID consultation, in-hospital mortality was higher, but survival post-discharge increased significantly. There was a significant increase in diagnosis of IFI in the ID group and a trend toward increased treatment. In colonized patients with ID consultation, in-hospital mortality and survival post-discharge improved. Hospital and ICU length of stay were longer for patients with ID consultation. Conclusion Critically ill patients with IFIs have high mortality rates, which were not reduced by treatment. The prevalence of colonization was high, and colonized patients experienced significant in-hospital and post-discharge mortality. This study supports the need for additional investigation into ID consultation, which may improve outcomes in critically ill patients with fungal infection and colonization. Disclosures All Authors: No reported disclosures

The Eustachian valve is an embryologic remnant of the inferior vena cava valve that if not regressed, can form as a thickened fold of endocardium in the right atrium. Eustachian valve endocarditis (EVE) is extremely rare complication in patients with intravenous drug use, indwelling catheters, and

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. A significant number of HIV-positive patients are still affected, including those not yet diagnosed with HIV and those not taking antiretroviral therapy or prophylaxis. Diagnosis and treatment often present challenges. CASE PRESENTATION: A 39 year-old man presented with several weeks of worsening shortness of breath and pleuritic chest pain. He was mildly tachypneic, and oxygen saturation decreased to 80% upon ambulation. He was found to be HIV positive with a CD4 count of 9. Serum beta-D-glucan and lactate dehydrogenase levels were elevated. PaO2 was 64 mmHg with an alveolar-arterial gradient of 35 mm Hg. Calcofluor white (CW) stain of induced sputum was negative. Chest radiography showed increased perihilar interstitial markings. Computed tomography showed septal thickening with scattered ground glass opacities. Bronchoscopy with bronchoalveolar lavage (BAL) was performed. BAL CW stain and Pneumocystis polymerase chain reaction (PCR) were positive. He was treated with trimethoprim-sulfamethoxazole (TMP-SMX) and steroids and developed hyperkalemia. He was switched to primaquine and clindamycin with a plan for 21 days of therapy. DISCUSSION: Traditional diagnostic testing for PCP relied on staining and visualization of organisms in BAL fluid. The sensitivity of non-immunofluorescent stains such as CW ranges from 31-97% depending on sample quality and stain interpretation. Many centers have started to utilize sputum staining for diagnosis of PCP, but as our case demonstrates, this is not adequate to rule out PCP in patients for whom there is high clinical suspicion. BAL fluid has greater sensitivity than sputum testing, and bronchoscopy after negative sputum testing yields the diagnosis in 51% of cases. PCR on BAL fluid is the best test for detection with 97-99% sensitivity. Unfortunately, no PCR-based diagnostic methods have been approved to date by the FDA. TMP-SMX remains the first line treatment for PCP. Its side effect profile includes hyperkalemia, hypersensitivity reactions, hepatitis, myelosuppression, and interstitial nephritis. Because toxicity necessitates a change in therapy in up to 17% of patients, it is crucial to be familiar with second line treatments such as pentamidine, atovaquone, and clindamycin-primaquine. Clindamycin-primaquine was chosen for our patient, as it has been shown to lead to higher clinical response and survival rates than pentamidine. Corticosteroids should be used as an adjunct therapy if PaO2 is under 70 mmHg on room air or the alveolar-arterial gradient is greater than 35, as this can improve outcomes in HIV-positive patients. CONCLUSIONS: Practitioners should not rely on negative sputum testing if clinical suspicion for PCP is high. Patients should be monitored for side effects of TMP-SMX and switched to an alternative regimen if necessary. Reference #1: Bateman ME, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii Pneumonia: A Review of Current Methods and Novel Approaches. Medical Mycology. 2020. PMID: 32400869. Doi: 10.1093/mmy/myaa024. Reference #2: Cruciani M, Marcati P, Malena M, et al. Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1 infected patients. European Respiratory Journal. 2002; 20: 982-989. Reference #3: Huang L, Hecht FM, Stansell JD, et al. Suspected pneumocystis carinii pneumonia with a negative induced sputum examination. Is early bronchoscopy useful? American Journal of Respiratory and Critical Care Medicine. 1995; 151: 1866-1871. DISCLOSURES: No relevant relationships by Marjorie Bateman, source=Web Response No relevant relationships by JENNIFER CHIURCO, source=Web Response

Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. Traditional diagnostic testing has relied on staining and direct visualization of the life-forms in bronchoalveolar lavage fluid. This method has proven insensitive, and invasive procedures may be needed to obtain adequate samples. Molecular methods of detection such as polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and antibody-antigen assays have been developed in an effort to solve these problems. These techniques are very sensitive and have the potential to detect Pneumocystis life-forms in noninvasive samples such as sputum, oral washes, nasopharyngeal aspirates, and serum. This review evaluates 100 studies that compare use of various diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) in patient samples. Novel diagnostic methods have been widely used in the research setting but have faced barriers to clinical implementation including: interpretation of low fungal burdens, standardization of techniques, integration into resource-poor settings, poor understanding of the impact of host factors, geographic variations in the organism, heterogeneity of studies, and limited clinician recognition of PCP. Addressing these barriers will require identification of phenotypes that progress to PCP and diagnostic cut-offs for colonization, generation of life-form specific markers, comparison of commercial PCR assays, investigation of cost-effective point of care options, evaluation of host factors such as HIV status that may impact diagnosis, and identification of markers of genetic diversity that may be useful in diagnostic panels. Performing high-quality studies and educating physicians will be crucial to improve the rates of diagnosis of PCP and ultimately to improve patient outcomes.

Abstract Background Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians. Methods A randomized controlled trial will be conducted in two large academic medical centers. Two hundred ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modeled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief, and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed. Discussion With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population. Trial registration ClinicalTrials.gov NCT04347811 . Registered on 15 April 2020

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

CASE PRESENTATION:A 54-year-old man presented with 6 months' history of dry cough and dyspnea on exertion. He also reported intermittent joint pain and orthopnea. He denied fevers, chills, and rashes. His medical history was significant for rheumatoid arthritis, for which he was taking 20 mg of prednisone daily. He had not been receiving adalimumab or methotrexate for several months. He never smoked and drank alcohol occasionally. Family history was significant for rheumatoid arthritis.

SESSION TITLE: Outcomes of Respiratory Infections in the Immunocompromised Host SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: Systemic fungal infections are relatively uncommon in critically ill patients. Previous studies have been limited by small size, limiting the ability to establish the incidence of less common fungal infections (1). We sought to describe the epidemiology of systemic fungal infections in the intensive care unit (ICU). METHODS: We used the Multiparameter Intelligent Monitoring in Intensive Care III [MIMIC-III] database. Adult surgical and medical ICU patients with any positive fungal culture were included in this retrospective cohort study. RESULTS: 13.2% (6,689/50,765) of critically ill adult patients had fungal infections. The average age of these patients was 63.9 (±15.5). The mean SOFA score was 5.8 (±3.4), and most patients had several medical comorbidities. The majority of these patients were admitted for sepsis, pneumonia, or respiratory failure. The most common sources of fungal infection were the respiratory tract, urinary tract, deep tissues, gastrointestinal tract, and bloodstream. Candida (17.7%), Aspergillus (2.9%), and Pneumocystis (0.7%) were the most frequently identified isolates. Cryptococcus, Coccidioides, Histoplasma, and Mucormycosis were also identified. 88.9% of isolates were unidentified yeast. Significant risk factors for fungal infections included hematologic malignancies (4.6%), solid tumors (11.6%), organ transplant (5.5%), immunosuppressive medications (11.9%), and human immunodeficiency virus (3.1%). 72% of patients had concurrent isolation of bacterial pathogens. Approximately 9.4% of patients were on antifungal therapy with azoles as the most commonly used antifungal agent, followed by echinocandins. Hospital length of stay was 20.8 (±17.9) days while ICU length of stay was 10.0 (±11.3) days. Mortality was 38% prior to hospital discharge, 50% at 1 month, 68% at 6 months, and 76.4% at 1 year. Mortality in invasive Aspergillosis was 52.3% prior to hospital discharge, 61.6% at 1 month, 74.2% at 6 months, and 76.8% at 1 year. Patients with Aspergillosis had significantly higher in-hospital mortality than patients with Candidiasis (p<0.05), but the mortality in the two groups did not differ significantly at 1 month, 6 months, or 1 year. CONCLUSIONS: This study describes the epidemiology of invasive fungal infections in a heterogenous cohort of ICU patients in the United States, the largest cohort in the literature to date. This cohort includes a large number of patients with Aspergillus and Pneumocystis isolates and includes positive fungal cultures from various sources. CLINICAL IMPLICATIONS: This study will inform intensivists in caring for critically ill patients and advise future clinical trials by giving baseline mortality endpoints. DISCLOSURES: No relevant relationships by Marjorie Bateman, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response

Background Challenges remain for establishing a specific diagnosis in cases of interstitial lung disease (ILD). Bronchoscopic lung cryobiopsy (BLC) has impacted the diagnostic impression and confidence of multidisciplinary discussions (MDDs) in the evaluation of ILD. Reports indicate that a genomic classifier (GC) can distinguish usual interstitial pneumonia (UIP) from non-UIP. Research Question What is the impact of sequentially presented data from BLC and GC on the diagnostic confidence of MDDs in diagnosing ILD? Study Design and Methods Two MDD teams met to discuss 24 patients with ILD without a definitive UIP pattern. MDD1 sequentially reviewed clinical-radiologic findings, BLC, and GC. MDD2 sequentially reviewed GC before BLC. At each step in the process the MDD diagnosis and confidence level were recorded. Results MDD1 had a significant increase in diagnostic confidence, from 43% to 93% (P = .023), in patients with probable UIP after the addition of GC to BLC. MDD2 had an increase in diagnostic confidence, from 27% to 73% (P = .074), after the addition of BLC to GC. The concordance coefficients and percentage agreement of categorical idiopathic pulmonary fibrosis (IPF) and non-IPF diagnoses were as follows: GC vs MDD1: 0.92, 96%; GC vs MDD2: 0.83, 92%; BLC1 vs MDD1: 0.67, 83%; BLC2 vs MDD2: 0.66, 83%. Interpretation GC increased diagnostic confidence when added to BLC for patients with a probable UIP pattern, and in appropriate clinical settings can be used without BLC. In contrast, BLC had the greatest impact regarding a specific diagnosis when the likelihood of UIP was considered low following clinical-radiographic review.

Objective: The objective of this review is to describe the safety and efficacy of ASC and SVF in treating common diseases and the next steps in research that must occur prior to clinical use. Evidence Review: Pubmed, Ovid Medline, Embase, Web of Science, and the Cochrane Library were searched for articles about use of SVF or ASC for disease therapy published between 2012 and 2017. One meta-analysis, 2 randomized controlled trials, and 16 case series were included, representing 844 human patients. 69 studies were performed in pre-clinical models of disease. Findings: ASCs improved symptoms, fistula healing, remission, and recurrence rates in severe cases of inflammatory bowel disease. In osteoarthritis, ASC and SVF improved symptom-related, functional, radiographic, and histological scores. ASC and SVF were also shown to improve clinical outcomes in ischemic stroke, multiple sclerosis, myocardial ischemia, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, chronic liver failure, glioblastoma, acute kidney injury, and chronic skin wounds. These effects were primarily paracrine in nature and mediated through reduction of inflammation and promotion of tissue repair. In the majority of human studies, autologous ASC and SVF from liposuction procedures were used, minimizing the risk to recipients. Very few serious, treatment-related adverse events were reported. The main adverse event was postprocedural pain. Conclusions and Relevance: SVF and ASC are promising therapies for a variety of human diseases, particularly for patients with severe cases refractory to current medical treatments. Further randomized controlled trials must be performed to elaborate potential safety and efficacy prior to clinical use. Significance Statement Stem cell therapy has shown potential benefit in a variety of human diseases. However, there are limitations to the widespread clinical application including the use of invasive procedures to isolate cells and the need for processing. Adiposederived stromal/stem cells (ASC) are adult cells that possess the capacity for homing, immunomodulation, promotion of repair, and direct regeneration of damaged tissues, which make them promising therapeutic candidates. Furthermore, these cells can be easily obtained in large quantities from subcutaneous tissue, allowing for an abundance of cells to be isolated relatively easily. This article is protected by copyright. All rights reserved.

SESSION TITLE: Chest Infections 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Endobronchial Actinomycosis is a rare manifestation of pulmonary actinomycosis that can present as an endobronchial mass. It is a curable condition that requires high clinical suspicion for timely diagnosis and management. CASE PRESENTATION: We present a 58-year-old gentleman with a history of sarcoidosis, who reported a four-month history of productive cough, dyspnea on exertion and subjective fever. He had recently been treated with levofloxacin for a right lower lobe (RLL) pneumonia with only transient relief. Social history was significant for 20 pack-years of tobacco use, but the patient did not drink alcohol. On exam, his breath sounds were diminished in the right lung base. Chest X-ray was notable for a right lower lobe opacification. CT showed RLL patchy infiltrates with peribronchial thickening. Chronic upper lobe fibrotic changes consistent with sarcoidosis were also identified. Flexible bronchoscopy revealed an endobronchial mass in the RLL bronchus occluding > 90 % of the lumen with pus draining from behind the mass. Histopathological analysis revealed sulfur granules with branching organisms that were acid-fast negative, representing Actinomyces species. His BAL culture grew MRSA. He responded well to an 8-week course of clindamycin, and follow-up bronchoscopy confirmed complete resolution of the endobronchial mass. DISCUSSION: Pulmonary actinomycosis is caused by aspiration of organisms from the mouth or gastrointestinal tract, and comprises 15% of actinomycosis cases (1). Poor oropharyngeal hygiene, dental disease, and alcoholism are the main risk factors (1). While our patient did not have these conditions, he did have sarcoidosis, a chronic lung disorder that may promote an anaerobic milieu to favor actinomycete growth (2,3). Radiographic findings, sputum samples and bronchial brushings can be nonspecific due to lack of routine use of selective culture medium or use of empiric antibiotics. Additionally, positive samples from sputum, BAL or brushings often represent colonization or contamination with saliva (1,3). Definitive diagnosis is most often based on histopathological specimens showing sulfur granules and negative acid-fast stain (2). Repeat bronchoscopy after antibiotic treatment is recommended to ensure resolution of the infection and to exclude a foreign body, given that 45% of cases involve inflammation around a foreign body nidus (3). Untreated actinomycosis may invade the pleura, chest wall, soft tissues, and bony structures through formation of sinus tracts (1,2). CONCLUSIONS: Radiographic findings, respiratory cultures, and bronchial brushings have poor sensitivity and specificity for actinomycosis. Bronchoscopy is necessary to obtain a histopathological specimen, which can be analyzed for the presence of actinomycetes. For endobronchial actinomycosis, repeat bronchoscopy is key to ensuring resolution of the infection. Reference #1: 1. Farrokh D, Rezaitalab F, Bakhshoudeh B. Pulmonary Actinomycosis with Endobronchial Involvement: A Case Report and Literature Review. Tanaffos. 2014; 13(1): 52-56. Reference #2: 2. Katsenos S et al. Primary Bronchopulmonary Actinomycosis Masquerading as Lung Cancer: Apropos of Two Cases and Literature Review. Case Rep Infect Dis. 2015; 2015: 609637. Reference #3: 3. Thomas M, Raza T, Langawi MA. A 37-Year-Old Man With Nonresolving Pneumonia and Endobronchial Lesion. CHEST. 2015; 148(2): e52-e55. DISCLOSURES: No relevant relationships by Marjorie Bateman, source=Web Response No relevant relationships by Karin Halvorson, source=Admin input No relevant relationships by Sanket Thakore, source=Web Response

Idiopathic pulmonary fibrosis (IPF) is a fibroproliferative lung disease, and fibroblast-myofibroblast differentiation (FMD) is thought to be a key event in the pathogenesis of IPF. Histone deacetylase-8 (HDAC8) has been shown to associate with α-smooth muscle actin (α-SMA; a marker of FMD) and regulates cell contractility in vascular smooth muscle cells. However, the role of HDAC8 in FMD or pulmonary fibrosis has never been reported. This study investigated the role of HDAC8 in pulmonary fibrosis with a focus on FMD. We observed that HDAC8 expression was increased in IPF lung tissue as well as transforming growth factor (TGF)β1-treated normal human lung fibroblasts (NHLFs). Immunoprecipitation experiments revealed that HDAC8 was associated with α-SMA in TGFβ1-treated NHLFs. HDAC8 inhibition with NCC170 (HDAC8-selective inhibitor) repressed TGFβ1-induced fibroblast contraction and α-SMA protein expression in NHLFs cultured in collagen gels. HDAC8 inhibition with HDAC8 siRNA also repressed TGFβ1-induced expression of profibrotic molecules such as fibronectin and increased expression of antifibrotic molecules such as peroxisome proliferator-activated receptor-γ (PPARγ). Chromatin immunoprecipitation quantitative PCR using an antibody against H3K27ac (histone H3 acetylated at lysine 27; a known HDAC8 substrate and a marker for active enhancers) suggested that HDAC8 inhibition with NCC170 ameliorated TGFβ1-induced loss of H3K27ac at the PPARγ gene enhancer. Furthermore, NCC170 treatment significantly decreased fibrosis measured by Ashcroft score as well as expression of type 1 collagen and fibronectin in bleomycin-treated mouse lungs. These data suggest that HDAC8 contributes to pulmonary fibrosis and that there is a therapeutic potential for HDAC8 inhibitors to treat IPF as well as other fibrotic lung diseases.

Struggling students are less likely to seek academic assistance and may start at a lower level of comfort with asking for help. Peer and near-peer tutoring programs may reduce the stigma of asking for academic assistance, but studies of the efficacy of such interventions are lacking in the literature. A near-peer tutoring elective called “Upperclassmen Tutoring Underclassmen in Basic sciences And Test-taking” (UpTUBAT) was developed to provide academic support to struggling first and second year medical students. Fourth year medical students were trained in effective tutoring practices through online modules, activities, standardized learner experiences, and faculty-led discussions. Tutors then designed and hosted weekly tutoring sessions. An average of 31 learners attended each session, and 188 total medical students received tutoring. The effects of the tutoring sessions were assessed through pre- and post-tutoring surveys and learner grades. Positive tutoring session themes included identification of relevant information, active engagement, concept clarification, opportunity for review, and diversity of approaches. Attendance of more than half of the sessions increased learners’ self-reported comfort (on a 5-point Likert scale) with asking for help from an upperclassman (4.5 versus 3.2, p = 0.01) or from a professor (4.3 versus 3.1, p = 0.01). More students who were struggling sought tutoring through these sessions, and this intervention helped to maintain learner grades at the same level as the students not receiving tutoring. This study establishes an effective method of training tutors to host large group tutorials in the basic sciences which can lead to development of a cohesive learning community across medical school classes. Near-peer tutoring may be an effective approach to improve learner comfort with seeking academic assistance in the medical school setting.