Health Sciences System Research Articles

Health Innovation Manchester as AHSS - the Test of a Hypothesis.

The ambitious and wide-ranging paper on Academic Health Science Systems [‘AHSS’] [1] proposed a new model for health innovation and stimulated considerable interest. The paper made three main assumptions about AHSS: i) university-based centres should play linchpin roles in health and social care innovation; ii) medical innovation cannot be achieved without links to industry; iii) innovation occurs at the scientific end of a discovery-care continuum. But the paper had a pregnant coda for the NHS, and GM devolution in particular: the authors explicitly linked their view of the need for the integration of university-based research and health care delivery to population level approaches, suggesting that vertically integrated AHSSs should ultimately transform into integrated care organisations. When Manchester’s experiment in the devolution of health and social care as a place-based approach to health and social care began in 2015, Health Innovation Manchester was created as an AHSS to support innovation in the Partnership. Five years after the start of devolution, this short paper, which is based on a longer study of Health Innovation Manchester’s development [2], provides an overdue reflection on the proposition advanced just over a decade ago [1].

Negative Consequences of COVID-19 Pandemic on the Life of the Elderly: A Qualitative Study

Negative Consequences of COVID-19 Pandemic on the Life of the Elderly: A Qualitative Study

A pharmacist-managed virtual consult service for patients with rheumatologic conditions requiring specialty or infused medications

To describe a pharmacist-managed virtual consult service practice model for rheumatology patients and evaluate its initial impact on compliance with institutional critical care guidelines for biologic response modifiers (BRMs). Pharmacologic care of patients with rheumatologic conditions often revolves around the use of BRMs. While these drugs are generally well tolerated, nearly all of them carry risks for serious adverse events. The severity of these possible problems necessitates a thorough initial and ongoing clinical workup. Based on results of a needs assessment, a virtual consult service was introduced at the University of Illinois Hospital and Health Sciences System (UI Health) in August 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management of patients with rheumatologic conditions requiring treatment with BRMs. The consult service was managed by an embedded clinical pharmacist and a postgraduate year 1 specialty pharmacy resident, who evaluated each request for therapy appropriateness prior to submission for insurance approval. Forty-one percent of the pharmacy benefit consult orders required a pharmacist intervention prior to referral to the specialty pharmacy. All consults (100%) adhered to the safety management guidelines for BRMs after review by the pharmacist. The pharmacist-managed virtual consult service is a novel practice model in specialty pharmacy that permits pharmacists to manage multiple patients simultaneously, virtually, and with optimal impact on medication selection and management at or before the point of prescribing.

Molecular testing in advanced lung adenocarcinoma: A single-center experience.

e21157 Background: Standard of care testing prior to first-line therapy for advanced lung non-small cell lung cancer (NSCLC) includes EGFR mutations, ALK rearrangements, and PD-L1 expression. There is limited real-world evidence on NSCLC molecular testing patterns in underrepresented racial and ethnic populations. Methods: We identified adult patients newly diagnosed with stage IV lung adenocarcinoma at the University of Illinois Hospital & Health Sciences System between January 1, 2015 and October 1, 2019. Rates of biomarker testing for EGFR, ALK, and PD-L1 were determined, as well as the median time from tissue biopsy to each result. Data were stratified by race and ethnicity. Timelines of molecular testing were studied in relation to cancer therapy initiation. Results: Among 80 patients diagnosed with advanced NSCLC, 70 (87.5%) received EGFR testing, 69 (86.3%) received ALK testing, and 40 (50%) received PD-L1 testing from 2015-2019. Thirty-one (81.6%) patients diagnosed from 2017-2019 had PD-L1 testing. Median time from biopsy to molecular test result in the overall population was 3.0 weeks for EGFR, 3.0 weeks for ALK, and 2.0 weeks for PD-L1. There was no significant difference in EGFR and ALK testing rates between Black and non-Black patients. PD-L1 testing was decreased in Black patients compared to non-Black patients ( p = 0.02) from 2015-2019, but there was no significant difference from 2017-2019. All three biomarkers had similar testing rates between White and non-White patients and between Hispanic and non-Hispanic patients. Median time from biopsy to PD-L1 result decreased from over 12 weeks in 2015 and 2016 to 2 weeks in 2018 and 2019. Six (7.5%) patients received first-line treatment before results were available. Two (2.5%) required treatment changes based on results. Conclusions: In an urban, academic center we found similar EGFR and ALK testing rates among race and ethnicity subgroups. PD-L1 testing was lower in Black patients from 2015-2019 but not after national guidelines recommended PD-L1 testing in 2017. Treatment was initiated without full biomarker data in multiple cases, sometimes leading to changes in therapy after results were obtained. Further studies are indicated to determine strategies for comprehensive, timely, and equitable biomarker testing in advanced NSCLC.[Table: see text]

Trends in cancer screening volumes at an urban health center during the COVID-19 pandemic.

10551 Background: The Coronavirus-19 (COVID-19) pandemic has disrupted cancer screening for reasons including healthcare resource preservation, infection control efforts, and patient factors. There is limited literature quantifying this interruption of care, particularly in vulnerable and racial/ethnic minorities. Methods: We compared the volume of cancer screening at the University of Illinois Hospital & Health Sciences System before and during the COVID-19 pandemic using data obtained from the electronic medical record. Modalities included mammogram, ultrasound, and MRI for breast; Pap test for cervical; colonoscopy, CT colonography, and flexible sigmoidoscopy for colorectal; low-dose CT for lung; and prostate-specific antigen test for prostate. Of note, screening and diagnostic tests could not be distinguished for colorectal cancer. We examined percent changes in cancer screening counts for each month from February 2020-August 2020, using January 2020 as a reference. Results were stratified by gender, race, and ethnicity. Results: Screening volume declined rapidly after January 2020, with the nadir for each cancer site occurring in April 2020: breast ( n = 0, -100%), cervical ( n = 169, -84%), colorectal ( n = 35, -89%), lung ( n = 0, -100%), and prostate ( n = 108, -72%). Values recovered by August 2020 for most cancer sites except cervical cancer, which remained decreased (-23%). There were no differences in screening trends by gender. With respect to race, breast screening volume in Black patients decreased earlier and exhibited slower recovery compared to White patients. White patients had poorer cervical screening recovery than Black patients by August 2020 (-60% vs. -23%). Hispanics had poorer recovery of breast screening compared to non-Hispanics by August 2020 (-23% vs. 6%). Conclusions: We observed widely decreased cancer screening attributable to COVID-19. Breast cancer screening data specifically showed persistent disparities affecting Black and Hispanic patients. Despite the reassuring recovery of multiple screening methods by August 2020, an increase above baseline is needed to compensate for initial declines. Further studies will likely reveal long-term consequences of this unprecedented situation.[Table: see text]

Effect of Default Order Standardization on Opioid Prescribing Patterns

Opioid misuse, overprescribing, dependency, and overdose remains a significant concern in the United States. A quality improvement study was conducted at the University of Illinois Hospital & Health Sciences System to determine the effect of standardizing the default orders for hydrocodone-acetaminophen products implemented on June 22, 2016. Prior to the intervention, default orders had variable dose tablet numbers (1 or 2) and dosing frequencies (every 4 or 6 hours), and no default dispense quantity. Defaults were modified to 1 tablet every 6 hours as needed for pain and dispense quantities of 3 and 5 days' supply were added. Number of tablets per order, dosing frequency, and days' supply prescribed between January 1, 2016, and June 21, 2016, were compared to those placed between June 22, 2016, and December 31, 2016. Opioid doses were converted into morphine milligram equivalents (MME). Analyses were performed to determine the effect of the intervention on daily opioid dose and number of days' supply prescribed. 22,052 orders were included in this study. Following the intervention, the number of tablets prescribed was reduced by an average of 19,832 tablets per month. Every 6 hours dosing (as opposed to every 4 hours) increased by 21.52 percentage points. Prescriptions with ≥ 50 MME/day dropped by 5.8 percentage points, and > 3 days' supply decreased by 2.54 percentage points. Linear regression demonstrated an increase in opioid prescriptions with daily < 50 MME (odds ratio [OR] = 1.72, p < 0.001) and ≤ 3 days' supply (OR = 1.27, p < 0.001). Default electronic health record settings strongly influence prescribing patterns.

ES12.02 Defining High Risk

ES12.02 Defining High Risk

Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor.

BackgroundChronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum.MethodsRetrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses.ResultsIndividuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99).ConclusionsThe study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

PROBLEMS AND PROSPECTS FOR IMPROVING FINANCIAL SUPPORT FOR COMPONENTS OF THE SOCIAL SPHERE IN UKRAINE

Introduction. Modernization of health care, education and science systems in Ukraine are key components of promoting the socio-economic development of the last decade. The strategic preconditions for the development of health care, education and science have much in common. First, there is the objective need to change the sources of funding. Secondly, the need for change is complicated by the lack of: the necessary experience, material and human resources. The most acute problem arose during the COVID-19 pandemic. Therefore, financial support for health, education and science is not only social but also economic. Goal. The aim of the article is to study the problems and identify ways to improve the financial security of health, education and science in the crisis periods of development caused by COVID-19. Method (methodology). The main scientific methods used in the research process: a systematic approach (when studying the problems of financial support of health care, education and science), the method of comparison, synthesis and analysis (when studying the financial support of the studied systems), abstract logical method (to identify the main problems and areas of improving the financial security of the components of the social sphere). Results. The article identifies two important components of the social sphere of any country: health care and education and science. The main problems of financial security in the pre- and pandemic period of the economy are identified. The main problems that arise in the systems of health care, education and science during their modernization are outlined. The state of financial support of the specified systems is analyzed and the basic priority directions of improvement of their functioning and possibilities of rendering of qualitative services are offered. Conclusions. The financial support of medical and educational institutions to provide quality services to the population is not only to preserve and restore the health of citizens - a major component of the productive forces of society, but also provides training for highly intelligent capital. The socio-economic importance of health, education and science is particularly high in the face of outbreaks of dangerous diseases and pandemics.

Abstract C110: Implementation of an integrated framework for a breast cancer screening and navigation program for under-resourced women

Abstract Background As detection and treatment for breast cancer in the United States have improved, racial and ethnic disparities persist. Utilizing an implementation science framework to inform an evidence-based breast cancer screening and navigation program within Federally Qualified Health Centers (FQHCs) with community stakeholders can mitigate multiple barriers to breast cancer screening. Methods Utilizing an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model (PRISM) and the social ecological model (SEM), the University of Illinois Cancer Center, University of Illinois Hospital &amp; Health Sciences System (UI Health) including Mile Square Health Centers (MSHC) FQHC, and the Chicago Department of Public Health (CDPH) developed a breast cancer screening and navigation program to tackle breast cancer disparities in Chicago among under-resourced women, known as the Mi-MAMO program. To increase access to screening services, patient navigators conducted community outreach and engagement activities. Program partnerships were forged with community-based organizations, healthcare systems and insurers. Program outcomes were monitored using standardized performance measures. Results Between January-December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, the Mi-MAMO program was started in August 2017. Between January-December 2018, the number of women who received a screening mammogram at MSHC increased to 1051. From August 2017 (start of program) to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%) and 95.5% were racial/ethnic minorities. Twenty-four percent (n=185) of women completed diagnostic services and ten women received positive breast cancer diagnoses (mean age 49.7 years). All diagnosed women were successfully navigated to treatment. The Mi-MAMO program is on-going. Conclusion Deploying an integrated framework that merges an implementation science and multi-level behavioral health framework for patient navigation programs has the potential to increase breast cancer screening utilization and awareness among under-resourced populations who may be at higher risk for breast cancer. Citation Format: Vida A Henderson, Katherine Tossas-Milligan, Erica Martinez, Barbara Williams, Paola Torres, Nasima Mannan, Lauren Green, Beti Thompson, Robert Winn, Karriem S Watson. Implementation of an integrated framework for a breast cancer screening and navigation program for under-resourced women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C110.

Nutrition Access in Adult Sickle Cell Patients: An Exploratory Study

Background Sickle Cell Disease (SCD) is the most common lethal genetic blood disease in the world, impacting approximately 100,000 people in the US, and about 25 million people worldwide (WHO, CDC 2019). Some literature refers to the SCD patients' barriers to appropriate care as "biopsychospiritual," indicating the complexity of the disease, and hence, call for a multi-dimensional approach to care (Adegbola et al., 2012). Considering the role of energy, protein and Vitamin D deficiency in SCD patients, a multi-dimensional approach to care that includes nutritional supplementation is worth investigating (Hyacinth, Gee and Hibbert 2010). There is limited research that illuminates the relationship between nutrition, food insecurity and health outcomes of those with SCD. Patients with SCD experiencing challenges of undernutrition are more prone to growth retardation in childhood, disease exacerbation, impaired immune function, and poor ulcer healing among other complications (Mandese et al., 2015). In Chicago, Illinois on the South and West Side where many SCD patients live, it is estimated that 35.1%-57.8% of people are food insecure (Gunderson, Dewey, Crumbaugh,Kato &amp; Engelhard, 2016). This study aims to better understand food insecurity for SCD patients at the University of Illinois Hospital and Health Science Systems (UIHHSS) in Chicago, the largest adult sickle cell center in the Midwest. Physicians are uniquely positioned to address health inequities among their patients when they practice patient centered-care (Law, Leung, Veinot, Miller &amp; Mylopoulos, 2016). Research shows that healthcare providers who are aware of external factors such as food insecurity, can be better advocates for their patients, and help them find ways to gain access to healthy foods (Nesbitt and Palomarez, 2016). Methods An exploratory study involving data collection of patient demographics, food consumption, and ability to access food was conducted. All patients at the Sickle Cell Clinic at UIHHSS who were interested in participating received a full explanation of the purpose of the study.Twenty-seven adult patients (19 female, 8 male) were recruited in the Sickle Cell Center waiting room. Food intake by patients with SCD was documented using the validated Food Insecurity Experience Scale (FIES) from the Food and Agriculture Organization (FAO). Participants self-administered the FIES questionnaire, followed by a one-on-one discussion with the interviewer. Qualitative data gathered from the follow-up interviews was used to investigate themes and provide clarity. Demographic information was collected to supplement the screening tool, as it is not a sufficient stand alone measure. Patient zip codes were referenced with the Distressed Community Index (DCI), a comparative measure of community well-being using census bureau data from 2012-2016. Outcomes Results of the analysis indicated the nutritional status of sickle cell patients and identified barriers to food access especially economic factors. Of the twenty-seven patients interviewed, 40% screened moderate and 22% screened as severe for food insecurity. The remaining 48% screening negative for food insecurity, but 80% of all patients did not consume the daily recommended dietary allowance of vegetables and fruits, and 44% worried about having enough money for food, citing that the cost of healthy food was a barrier to eating healthy. Based on zip code, 80% of patients live in a high DCI zone. Discussion and Limitations This study utilizes convenience sampling with a small sample size, which limits external validity. Conclusions from the data should not be made, but rather used to design larger confirmatory studies. The information could aid in aligning undernourished patients with social support and provide potential insight for clinicians into the management of patients with SCD. Disclosures No relevant conflicts of interest to declare.

Real-world evaluation of the safety and tolerability of abacavir/dolutegravir/lamivudine in an incarcerated population.

A trend of increased adverse effects and laboratory abnormalities was observed in patients treated at the University of Illinois Hospital and Health Sciences System (UIH) HIV Telemedicine Clinic after switching to abacavir/dolutegravir/lamivudine (ABC/DTG/3TC). Therefore, we sought to investigate if major clinical trials overestimated the safety and tolerability of DTG-based antiretroviral therapy (ART). This study was a single-center, retrospective, pre- and post-analysis of incarcerated patients receiving care at the UIH HIV Telemedicine Clinic, USA. Patients included were adults with HIV switched from previous ART to ABC/DTG/3TC. Primary endpoints included patient-reported adverse effects and changes in renal and hepatic function from baseline. A total of 95 patients were included in the study. After switching from previous ART to ABC/DTG/3TC, 20% of patients reported incidence of adverse effects. Most common were headache (7.4%), nausea (6.3%) rash (3.2%), fatigue (3.2%), and insomnia (2.1%). There were statistically significant increases in serum creatinine (SCr), in 20% of the patients (P &lt; 0.0001), with a median increase of 0.38 mg/dl. ABC/DTG/3TC appears to have similar or fewer adverse effects in the real-world incarcerated population compared to clinical trials. DTG-based ART can cause statistically significant increases in SCr in some patients.

An Explorative Longitudinal Study on the Five-Year Patient Portal Use among an Underserved Patient Population

The purpose of the study was to identify and assess multiple aspects of patient portal usage behavior in an underserved urban patient population. Given the rise of patient-centered care, patients are required to take active roles to gather health information, make informed health decisions and manage their own healthcare, which behavior were associated with health outcome (Barry &amp; Edgman-Levitan, 2012; Oates, Weston &amp; Jordan, 2000). Patient portals serve as a mean to coordinate patient-centered care by delivering health information to patients (e.g. medical test results), exchanging information with healthcare providers (e.g., messaging providers), and facilitating the delivery of health care services (e.g., scheduling appointments). However, studies often showed that patients in underserved communities did not take full advantages of the patient portals (e.g,. Cazaja et al., 2015, Wallace et al., 2016). These disparities in patient portal usages were associated with many factors, including the complexities of the American healthcare system, lack of internet access, lack of support to navigate through the health systems, and the lack of health literacy among an underserved adult population. To better understand the current use of patient portal of an underserved patient population, we conducted an explorative analysis of portal usage at the University of Illinois Hospitals and Health Sciences System (UIHealth). UIHealth serves throughout the city of Chicago, including areas with high racial segregation (minority population higher than 75%), where patients’ household income is lower than the median of Chicago residents. The majority of patient populations in UIHealth are African Americans (61%) followed by Hispanic/Latino (17%) and White (17%). The study was conducted using a retrospective analysis of Google Analytics portal data from March 2015 to March 2019. User behavior data were extracted to show aspects of usage, including most popular portal functions, language used, time spent on each page, and returning user visits, etc. We used weekly summary data as individual data points (208 data points in total) in the analysis. We found that, over four years, both retuning and new users increased by more than 50%. Regarding the number of users per week, there were local drops in the overall growth which drops were associated with fewer visits to UIHealth during holidays or cold weather. Hence, portal visits were associated with clinic visits. With regards to the most popular functions, writing messages to healthcare providers and viewing medical test results were the most used functions over the years. Results suggested that patients would utilize portal to gather information about their health status (for later discussion with physicians or making informed decisions) and communicate with healthcare providers. Interestingly, we found the dominant devices used to access the portal have shifted from desktop computers (2015-2017) to mobile phones (2017-2019), suggesting the increasing need to present health information in bitable size in smaller screens; and the increasing smartphone adoptions of underserved adults as an alternative solution to get internet access. Overall, improving the accessibility of patient portals remains to be a major issue for empowering patients in contemporary value-based healthcare systems. The explorative study has shed lights on the longitudinal trends of portal usage among an underserved population, which creates practical implications on the design of a more efficient interface between patients and their healthcare providers with the ultimate goal to improve health equity.

Outcomes of systematic anticoagulation management in pharmacist and nurse specialized clinics

BackgroundWhile systematic anticoagulation management leads to improved outcomes, there is limited data comparing outcomes in anticoagulation clinics managed by pharmacists vs nurses. The objective of this study was to evaluate the effect of pharmacist vs nurse‐managed clinics on the quality of anticoagulation and warfarin‐related hospitalizations and emergency department (ED) admissions.MethodsA retrospective observational cohort study of patients treated with warfarin and referred to a pharmacist‐managed anticoagulation clinic (PMAC) or a nurse‐managed anticoagulation clinic (NMAC) was conducted at the University of Illinois Hospital and Health Sciences System. The primary outcome was the proportion of international normalized ratio levels in therapeutic range (PIR). The secondary outcome was warfarin‐related hospitalizations and ED visits. Multivariate regression models were used to evaluate the effect of the model of care (PMAC vs NMAC) on PIR and hospitalization/ED visits, respectively. An economic evaluation of adverse events was also undertaken.ResultsA total of 200 consecutive patients (100 patients in the PMAC group and 100 patients in the NMAC group) were included. The majority of patients were females (58.5%) and average age was 61.4 ± 14.6 years. Patients in the PMAC group were more nonadherent to warfarin therapy and had more than three missed clinic appointments compared with the NMAC group ([19.1% ± 10.1% vs 4.1% ± 4.1%, P &lt; 0.05]; and [78% vs 33%, P &lt; 0.05]) respectively. The average PIR was 51.8% ± 15.9% and 56.2% ± 13.9% (P = 0.04) in the PMAC and NMAC groups, respectively. After controlling for confounders, the adjusted PIR was not different between the two groups. The NMAC group, however, had over seven times greater odds of hospitalization/ED visits compared to the PMAC group. The PMAC saved $505 349 over a 1.25 year period.ConclusionThe quality of warfarin anticoagulation did not differ between pharmacist and nurse‐managed models of anticoagulation care, however, PMACs decreased the odds of warfarin‐related hospitalizations/ED visits and their associated costs.

Cancer Incidence in Sickle Cell Disease:an Institutional Experience

Background. The incidence of cancer in sickle cell disease (SCD) is of substantial interest since life expectancy of SCD patients has improved with 85-94%SCD patients surviving to adulthood1and the risk of cancer increases with advancing age. A limited number of case reports and surveys have suggested an increased risk of cancer in the SCD population. Two large population based studies have recently examined the incidence of cancer in the SCD population. Goldacre et al. reported an increased incidence of hematologic cancers and some solid tumors among 7512 SCD patients in England compared with patients hospitalized for minor medical and surgical conditions2. Wun et al. reported that compared to the general population, SCD patients had a 72% increased risk of hematologic malignancies and a 38% reduced risk of solid tumors3Methods. We studied the incidence of cancer in SCD at the University of Illinois at Chicago (UIC) in a retrospective cohort study that identified SCD patients and cancer cases using ICD-9-CM codes. The study included SCD patients, all ages, seen at UIC between September 30, 2010 and September 30, 2015. An age, gender, race and ethnicity matched non-SCD cohort was selected from the general population of UIC patients from the same time frame. The incidence of cancer was compared between the SCD and non-SCD UIC patient cohorts. The study was approved by the Institutional Review Board. The data was provided by the University of Illinois Hospital and Health Sciences System Clinical Research Data Warehouse and stored in secure Redcap database.Results. There were 1327 patients in the SCD cohort, 41.8% males and 58.1% females. The breakdown by ethnicity was 94.8% African Americans (AA), 4.8 % other and 0.38% white patients as shown in Fig.1. There were 23 cancer cases identified in the SCD cohort (1.25%). The electronic medical records of all these cancers cases were reviewed to verify the cancer diagnosis. Amongst the cancer cases identified in SCD cohort there were 5 patients (22.7%) on hydroxyurea (HU) and 17 (77.3%) were not on HU. There were 8 (34.8%) hematological and 15 (65.2%) solid malignancies in the SCD Cohort as shown in Table1.There were 5295 patients in the control cohort, with breakdown by gender and race was identical to the SCD cohort. There were 87 cancer cases identified in this cohort (1.6%). There were 12 (13.8%) hematologic and 48 (55.2%) solid malignancies of the total cancers in control cohort. Fischer exact test was used to compare the cancer incidence in the SCD and control cohorts. Our study did not show statistically significant differences between the SCD and control cohorts for the incidence of total cancers (p=0.81) and solid tumors (p=0.87). There was increased incidence of AML and total hematological malignancies in SCD cohort and the difference was statistically different between SCD and control cohort (p=0.04) as shown in Table 2.Discussion. To the best of our knowledge this is the only study where instead of relying on the registry and billing codes the SCD and cancer diagnosis was manually verified in the SCD cohort to maximally eliminate any inaccuracies in estimation of incidence. Goldacre et al. used hospitalization data in England and reported a threefold to 10-fold higher incidence of hematologic cancers among SCD patients and an increased risk for colon cancer, nonmelanoma skin cancer, kidney cancer, and thyroid cancer. Wun et al. reported increased risk of leukemia and low risk of solid cancers based on hospital admission and emergency department (ED) data, so healthier SCD patients, particularly children, may have been excluded. Our study data is not limited to inpatient and ED department and includes patients of all ages.Our study shows that overall the cancer rates of those with sickle cell disease are not significantly different from the general population. There is increased incidence of hematological malignancies but the sample size is small. Nevertheless, due to treatment advances including hematopoietic stem cell transplant, increased awareness and better access to health care patients with SCD are living longer and there is a need to screen SCD patients for cancer just as vigilantly as for non-SCD patients.Reference.Maitra P,Ataga KI, Hematologica 102(4):626-636.(apr 2017)Olena O Seminog, Michael J Goldacre, Journal of the Royal Society of Medicine; 2016, Vol. 109(8) 303-309Ann Brunson,Ted Wun,Blood Volume 130 Number 13(September 2017) [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Abstract 4236: Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women

Abstract Background: We examined racial/ethnic differences in Charlson comorbidity index scores (CCI) pre and post breast cancer (BC) diagnosis among Non-Hispanic White (NHW), Hispanic, and African-American (AA) women. Methods: We conducted a retrospective chart review to calculate CCI scores (excluding age and BC) for 387 women diagnosed with BC between December 2013 and June 2017 at the University of Illinois Hospital and Health Sciences System. Using all available electronic records, we used International Chronic Disease 9 and 10 codes to determine presence or absence of a chronic condition pre and post BC diagnosis. Data was collected on race, ethnicity, stage, age at diagnosis, and vital status. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and CCI among BC patients. Results: Of the 387 BC patients, 63% were AA, 15% were Hispanic, and 16% were NHW. Mean ages were 56, 56, and 57 years, respectively. 217 women had a CCI of 0 (no comorbidity), 101 women had a CCI ≥1 at their BC diagnosis (mean CCI 4.8), and 69 women developed at least one chronic condition after their BC diagnosis (mean CCI 5.2; with a mean duration of follow-up of 1.9 years). AA women had a higher average CCI score compared to Hispanic and NHW women (CCI= 4.3 versus 3.9 &amp; 3.3, p=0.006). Although not statistically significant, mean CCI scores were higher for Hispanic versus NHW women (CCI= 3.9 vs 3.3, p=0.08). At the time of their BC diagnosis, AA and Hispanic women were 2.2 times more likely to have a CCI ≥ 1 compared to NHW women [(AA vs NHW 95% CI (1.3-3.9), p=0.004); (Hispanic vs NHW 95% CI (1.1-4.3), p=0.02)]. Overall, compared to NHW women, AA women were 3.1 times more likely to have a cancer diagnosis other than breast [95% CI (1.1-8.9), p=0.04] and 5.4 times more likely to suffer from heart failure [95% CI (1.3-23.3), p=0.02]. Compared to NHW women, rates of diabetes were 2.3 times higher among AA women [95% CI (0.95-5.7), p=0.06] and 3.9 times higher among Hispanic women [95% CI (1.4-10.9), p=0.008]. Of the women with a CCI=0 at the time of their BC diagnosis, AA women were 3.3 times more likely [95% CI (1.3-8.1), p=0.01] and Hispanic women were 2.9 times more likely [95% CI (1.0-8.6), p=0.05] to go on to develop at least one chronic condition compared to NHW women. Additionally, of the women who died (n=16), AA and Hispanic women were diagnosed with BC at significantly younger mean ages compared to NHW women [(AA mean age=55 years; Hispanic mean age=64 years; NHW mean age=88 years; p=0.05)]. Conclusion: AA and Hispanic women enter their BC diagnosis with higher mean CCI scores and are more likely to develop ≥1 chronic health condition after their BC diagnosis. Our findings suggest that the burden of chronic disease both before and after BC diagnosis is greater for minority vs. NHW BC survivors. Future studies examining how this impacts survivorship for minority women are warranted. Citation Format: Alpana Kaushiva, Susan Hong. Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4236.

Testis Morphologic Assessment in Patients undergoing Sex Reassignment Surgery with Gender Dysphoria: Case Series and Literature Review

Purpose: To study the morphologic changes to testicular architecture in response to estrogen therapy in gender dysphoric patients undergoing sexual reassignment surgery. Materials and methods: A retrospective morphologic review of testicular architecture was performed on ten cases of male-to-female sex reassignment surgery testis from the University of Illinois Hospital and Health Sciences system. Cases were from adult males undergoing sexual reassignment surgery at the University of Illinois Hospital and Health Sciences System between 2016 and 2017. Architectural changes were measured including Leydig cell changes, basement membrane fibrosis, spermatogonia maturation, and interstitium changes. Results: Various stages of maturation and regression were seen despite all patients being on estrogen therapy for at least one year prior to undergoing surgery. Conclusion: There are a range of estrogen therapy-related maturation and regression effects on testicular architecture in this growing patient population. It is important for the clinician and pathologist to know these effects as benign changes related to treatment.

Trans-gastric pancreaticogastrostomy reconstruction after pylorus-preserving robotic Whipple: a proposal for a standardized technique.

A number oftechnical improvements regarding the pancreatic anastomosis have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) remainsis the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined. This study is a retrospective review of a prospectively maintained database. Data were collected from all consecutive robot-assisted pancreaticoduodenectomies (RAPD), performed by a single surgeon, at the University of Illinois Hospital & Health Sciences System, between September 2007 and January 2016. A total of 28 consecutive patients (16 male and 12 female) who underwent a RAPD were included in this study. Patients had a mean age and mean BMI of 61.5years (SD = 12.3) and 27kg/m2 (SD = 4.9), respectively. The mean operative time was 468.2min (SD = 73.7) and the average estimated blood loss was 216.1ml (SD = 113.1). The mean length of hospitalization was 13.1days (SD = 5.4). There was no clinically significant POPF registered. Trans-gastric pancreaticogastrostomy (TPG) represents a valid and feasible option as a pancreatic digestive reconstruction during RAPD. Initial results showed decreased incidence of POPF with an increased risk of postoperative bleeding. Our experience suggests that TPG might be safer than pancreaticojejunostomy (PJ); further studies are needed in order to confirm.

Sleeve Gastrectomy Among Males and Females Who Are Super-Super Obese (Body Mass Index ≥60 kg/m2)

Introduction: There are few publications regarding the surgical treatment of obesity among super-super obese (SSO) patients undergoing sleeve gastrectomy (SG).The aim of this study is to examine weight outcomes (6, 12, and 24 months), presurgical comorbidities, and perioperative outcomes in SSO men and women patients undergoing SG. Material and Methods: This is a retrospective study with 109 SSO patients who underwent SG at the University of Illinois Hospital and Health Sciences System between January 2008 and June 2015. Results: Out of 674 patients who underwent SG, 109 (16.2%) were SSO. There were no significant differences in perioperative outcomes (operative time, length of hospitalization, and complication rates). Women had a greater percent excess weight loss (%EWL) (p = 0.039) and percent total weight loss (%TWL) (p = 0.026) than men at 6 months. Whereas at 12 and 24 months follow-up, there were no significant differences in %EWL and %TWL between SSO men and women. Conclusions: There were no signif...

Implementation of a New Clinic-Based, Pharmacist-Managed PCSK9 Inhibitor Consultation Service.

The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab were approved by the FDA in 2015. In anticipation of provider interest and a potential increase in referrals to the on-site specialty pharmacy, we created a pharmacist-managed consultation service. The development of a clinic-based pharmacist-managed consultation service for the management of the PCSK9 inhibitor agents alirocumab and evolocumab is described. Key implementation steps included (a) creation of a pharmacy team and collaboration with cardiology; (b) completion of a needs assessment; (c) service creation; (d) collaboration with the on-site specialty pharmacy; (e) development of an electronic consult order and consult pool; (f) personnel training; and (g) service approval and marketing. The service development occurred over 9 months (July 2015-April 2016) and was implemented hospital-wide in May 2016. The University of Illinois Hospital and Health Sciences System PCSK9 inhibitor consultation service successfully integrated the benefits of a clinical review process, information technology capabilities of an electronic medical record system, and collaboration with the on-site specialty pharmacy to provide a comprehensive service that aimed to facilitate appropriate medication management from prescribing to patient administration and provide monitoring for this class of specialty medications. The PCSK9 pharmacist-managed consultation service provides a method for complex therapies to be managed comprehensively through the collaboration of ambulatory care clinics and outpatient specialty pharmacies. No outside funding supported this study. Groo reports speaker bureau fees from Pfizer and Bristol-Myers Squibb. The other authors have nothing to disclose. All the authors contributed to study concept and design. Atande took the lead in data collection, and data interpretation was performed by Groo and Atanda. The manuscript was written by Atanda and revised by all the authors.