Large Tertiary Center Research Articles

Development and External Validation of a Prediction Model for Early Postoperative Cerebral Infarction on Computed Tomography in Spontaneous Intracerebral Hemorrhage.

Early postoperative cerebral infarction (ePCI) significantly worsens outcomes in patients with spontaneous intracerebral hemorrhage (ICH) undergoing surgery. This study aimed to develop and externally validate a nomogram to assess ePCI risk. Adult patients with spontaneous supratentorial ICH who underwent surgery between May 2015 and September 2022 at a large tertiary referral center (development cohort) and another tertiary referral center (external validation cohort) were retrospectively included. ePCI was defined as a newly identified permanent low-density lesion observed within 72h of surgery on computed tomography. We developed a nomogram using predictors identified through least absolute shrinkage and selection operator analysis. The model's discrimination, calibration, and clinical utility were evaluated. The development cohort (n = 453) had 51 ePCI cases, and the external validation cohort (n = 184) had 20. The model incorporated the Glasgow Coma Scale (GCS), the Original Intracerebral Hemorrhage Scale (oICH), uncal herniation stage, and hematoma volume, demonstrating strong discrimination with an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.882-0.948) in the development cohort and an AUC of 0.942 (95% CI 0.897-0.988) in the external independent cohort. The model also showed excellent calibration and clinical applicability. This nomogram, including the GCS, the oICH, uncal herniation stage, and hematoma volume, effectively predicts ePCI risk in patients with spontaneous supratentorial ICH.

Emerging Role of Laser Lithotripsy for Bladder Stones: Real-World Outcomes from Two European Endourology Centers with a Systematic Review of Literature.

Introduction and Objective: We aimed to look at the evidence for laser lithotripsy for bladder stones (BSs) to provide results from two centers on bladder calculi treatment. In addition, the outcomes of prostatic and other surgical interventions performed in nearly half of all patients. Methods: A retrospective analysis of two large European endourology tertiary centers for patients who underwent laser lithotripsy for BS between 2016 and 2024 (7 years). All patients provided consent and were counseled for the study accordingly, and the studies were registered as an audit in the individual centers. Results: A total of 122 patients were analyzed (mean age of 68.17 ±16.38 years; male:female ratio of 97:25). Thirteen (10.7%) patients had a preoperative long-term catheter. Overall, 42 (34.43%) patients had multiple stones (n = 2.19, ±2.08), with a median stone burden of 32.36 ± 24.13 mm. The mean operative time was 61.6 ± 37.25 minutes, with an overall stone-free rate (SFR) of 95.1% (n = 116). Postoperative complications were noted in nine (7.38%) patients, which included urinary tract infection or sepsis (n = 4, 3%), pain (n = 2, 1.6%), and bleeding/acute urinary retention/urethral stone (n = 1 each, 0.82%). All the complications were Clavien-Dindo I/II and treated conservatively. Six patients (4.9%) with planned concomitant surgical intervention needed a completion (second) intervention at a later date. Sixty patients (49.2%) had concomitant procedure along with their BS treatment. Twenty-two patients (18%) with a mean prostate size of 60.71 cc (±30.50 cc) underwent a transurethral resection of prostate (n = 16, 13.1%) or bladder neck incision (n = 6, 4.9%). Others underwent ureteroscopy (n = 13, 10.7%), transurethral resection of bladder tumor (n = 5, 4.1%), suprapubic catheter repositioning (n = 10, 8.2%), or urethral dilation (n = 10, 8.2%). The mean hospital stay was 1.4 ± 1.33 days. Conclusion: Laser fragmentation of BSs stands out as a safe and efficient choice with a good SFR and low risk of major complications, and perhaps should be considered the new gold standard for BS management. It also allows for concomitant treatment of enlarged prostate and other endourologic procedures with good outcomes.

Managing Calciphylaxis: Insights from Real-World Cases at a Tertiary Academic Center.

Calciphylaxis is a rare and potentially fatal condition involving chronic, nonhealing wounds caused by microvascular calcification. There is currently no approved treatment for calciphylaxis, contributing to its devastating impacts on quality of life. In this case series, the authors highlight instances of potentially misdiagnosed calciphylaxis in a cohort of patients and emphasize the importance of accurate diagnosis through multidisciplinary management approaches.The authors report on three patients treated at a large tertiary academic center between March 2021 and March 2023. Consent was obtained from all patients, including for the use of patient images. The first and second patients, a 75-year-old man and 62-year-old woman, respectively, both underwent an extensive course of local wound care as well as sodium thiosulfate therapy. The third patient, a 61-year-old woman, was treated with a combination of medication adjustments, lymphedema therapy, pulse lavage treatment, and cadaveric skin substitute. Tissue biopsy was also obtained in two of the three subjects to aid in the diagnosis of calciphylaxis. Unfortunately, these procedures lead to diagnostic challenges and misadventures, highlighting the risks associated with biopsy of calciphylaxis.This case series demonstrates how correctly diagnosing calciphylaxis relies heavily on providers maintaining a high index of clinical suspicion based on patient history, presentation, and risk factors. The primary goals of treatment for calciphylaxis include appropriate wound care, management of infection and pain, and close monitoring.

Impact of continuous distribution as the allocation strategy on lung transplantation.

In March 2023, the allocation strategy for lung transplantation (LT) underwent significant changes with the introduction of the new system, referred to as the continuous distribution (CD). The current paper describes the early impact of CD implementation on the mechanics of LT at a large tertiary care medical center. This was a retrospective study conducted across nine months before (March 2022 to November 2022) and after (March 2023 to November 2023) the implementation of the CD allocation system. The number of lung donor offers increased by 59% in the post-CD period (p=0.002). The median offers per waitlisted patient increased even more (p<0.001), leading to a significant reduction in time to transplant (p<0.001). Early clinical outcomes (median length of stay and hospital survival) were unchanged, while the cumulative length of index hospitalization was lower by 10% during the post-CD period. The cost/bed-day increased by 4.5% in a post-CD period, which converted to a 32% decrease in the contribution margin per transplant. In conclusion, the implementation of CD was associated with improved access to donor lungs, leading to favorable trends in the time to transplant while maintaining post-transplant outcomes. The CD was associated with a significant jump in the cost of LT.

P-521. Assessing Infectious Disease Screening and Prevention Practices for Persons who Inject Drugs in a Large Midwestern Academic Medical Center

Abstract Background Persons who inject drugs (PWID) are at risk for infection, including HIV, hepatitis C virus (HCV), and sexually transmitted infections (STIs). Harm reduction counseling, HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and routine STI screening are recommended to prevent infectious complications among those with substance use disorder (SUD). Hospitalizations serve as an opportunity to provide these infection prevention and screening interventions which are often difficult to access in the ambulatory or community setting for patients with active SUD. We sought to describe the frequency of infectious disease screening and preventive counseling and interventions among PWID admitted to our hospital with a serious injection related infection (SIRI). Methods We conducted a retrospective chart review of PWID &amp;gt; 18 years of age admitted to our large tertiary medical center in the Midwest with SIRIs in 2022. The conditions included were bacteremia, endocarditis, skin and soft tissue infection, epidural abscess, septic arthritis, osteomyelitis and other. We assessed the frequency of screening for HIV, hepatitis C, gonorrhea, chlamydia, and syphilis, and the frequency of harm reduction counseling and assessment for HIV-PrEP and PEP eligibility. We collected demographic information, discharge location and conditions, and whether infectious disease and addiction medicine were consulted. Descriptive analysis was performed. Results 45 patients with SIRIs were admitted in 2022. Of the 45, 56% underwent HIV screening, 53% HCV screening, and 16% received gonorrhea, chlamydia, and syphilis screening during the index hospitalization. Harm reduction counseling was documented for 69% of patients and was almost exclusively documented by addiction medicine. There was no documentation of PrEP consideration despite 36 patients meeting eligibility and no PrEP or PEP was prescribed. Conclusion In our institution, there were suboptimal rates of infectious disease screening, harm reduction counseling, and HIV prevention interventions among PWID admitted with SIRI in 2022. The most marked gap in care is regarding consideration for HIV-PrEP. Further work will inform barriers and facilitators to optimizing these practices in the hospital setting. Disclosures Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support

P-2231. The Impact of Cell-free DNA Sequencing in the Evaluation and Management of Infections

Abstract Background Cell-free DNA Sequencing is a novel diagnostic test that utilizes next generation sequencing to detect pathogens directly from plasma. Microbial cell-free DNA (mcfDNA) can be detected for a large number of pathogens with high analytic sensitivity and specificity; however, testing may be cost prohibitive and the direct impact on clinical care decisions is unclear. Methods A retrospective review was performed at a large inner-city tertiary care medical center from 9/2021 to 3/2024 to assess the results of mcfDNA sequencing (using the Karius Test®) on committee approved patients for whom infection was suspected, and without a definitive diagnosis on traditional microbiologic testing or in patients not improving on current antimicrobial therapy. Clinical, microbiologic, and outcome data were collected, and the impact of a positive or negative test on clinical care decisions was abstracted. Test results were defined as impactful if they led to change in the antimicrobials (e.g. additional agents, dosing adjustment, or discontinuation of antimicrobials). Results Testing was completed on 25 patients, ranging from 5 months to 63 years (mean age 17 years), 16 (64%) female, 12 (48%) immunocompromised. The average result reporting time was 2.6 days. 23 (92%) patients received antibiotics prior to testing with an average duration of 30.8 days. A total of 13 (52%) of tests were positive by mcfDNA (with a mean of 1.6 organisms (SD=0.65) detected), and 7 (53.8%) polymicrobial results. The positive vs negative did not vary by suspected site, though sample size was small (Fig1). A total of 15 (60%) patients were positive by traditional microbiology tests with an organism correlation of 5 (20%). The mcfDNA results were impactful in 9 (36%) of the patients. A positive test was more likely to be impactful than a negative test (p=0.01). Ninety-day mortality was noted in 10 (40%) of patients and the average duration of hospitalization was 75.5 days – with no difference among patients with a positive mcfDNA (Table 1). Conclusion A positive mcfDNA sequencing result was noted to be clinically impactful in 36% of cases. Our data suggests that testing would be most beneficial for patients that lack a definitive infectious diagnosis or those not responding to appropriate therapy. Disclosures All Authors: No reported disclosures

Patient and tumour characteristics in older patients (70 years or older) undergoing transperineal prostate biopsy: a retrospective cohort study.

PSA screening is advocated in men with a life expectancy of >10 years. With a rising mean life expectancy of 81 years in Australia, many men in their 70s have life expectancies of >10 years. Additionally, advanced age is an independent risk factor for high grade prostate cancer. Hence, we aimed to identify patient and disease characteristics and outcomes of men >70 years undergoing transperineal prostate biopsies (TPB) for suspected prostate cancer. All patients aged 70 years old and above who underwent TPB for suspected prostate cancer between 1st January 2019 and 1st July 2022 at a large tertiary centre were identified. Data including patient Charlson Comorbidity Indices (CCI), pre-operative PSA, Multiparametric prostate MRI (mpMRI), histopathological results, subsequent intervention, and treatment intent (curative vs palliative) were obtained via scanned and electronic medical records. Of 229 patients, median age was 74 years and 72.5% patients had a CCI of ≤4 (>53% estimated 10-year survival). 80.8% were diagnosed with prostate cancer and 65.9% had ISUP ≥ 2 disease. 86.4% of patients with PIRADS 4 or 5 lesions resulted in clinically significant prostate cancer. 3.9% had mild biopsy complications. 76.8% of those with prostate cancer underwent treatment with curative intent. Men >70 years of age have a higher risk of clinically significant prostate cancer and low biopsy risk. Hence, many may benefit from early diagnosis and treatment. Decision on screening and further investigation should be based on assessment of individual risks, benefits and life expectancy.

How Often Is Rifampin Therapy Initiated and Completed in Patients With Periprosthetic Joint Infections?

Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases Society of America (IDSA) guideline. Given the well-established effectiveness of rifampin as adjunctive therapy in staphylococcal PJI, it is crucial to evaluate its utilization in practice and identify factors that contribute to its underuse or incomplete administration, as these deviations may undermine treatment efficacy and patient outcomes. Among patients who met clear indications for rifampin use having undergone DAIR or one-stage revision for staphylococcal PJI, (1) what proportion of patients did not receive it? (2) What proportion of patients started it but did not complete the planned course? (3) Where documented in the medical record, what were the common reasons for not using it or prematurely discontinuing it, and in what percentage of the patients' charts was no reason given? (4) What proportion of patients were taking a medication that put them at risk for a drug-drug interaction (DDI)? Using an institutional database, patients who underwent DAIR or revision arthroplasty for PJI from January 2013 to April 2023 were identified (n = 935). We defined clear indications for rifampin use as a patient diagnosed with staphylococcal PJI treated via DAIR or one-stage revision, as set forth by the clinical practice guidelines of the IDSA. Based on those indications, we surveyed patients' electronic medical records (EMRs) and calculated the proportion of patients who did not receive the drug in situations where it would have seemed appropriate that they receive it. We then determined the planned length of antibiotic management and calculated the proportion of patients whose planned courses of rifampin were not completed based on what was documented in each patient's chart. Next, we performed a review of the EMR and recorded qualitatively the reasons why patients either did not receive rifampin or why the planned course was not completed, as well as the percentage of patients whose medical records did not indicate why the drug was not used or was discontinued before the planned course had been administered. Last, we retrospectively reviewed the medications that the patients were taking at the time of indicated adjunctive rifampin initiation and evaluated whether there were DDIs and the potential severity of those interactions. A total of 9% (87 of 935) of patients who underwent DAIR or revision arthroplasty for PJI met IDSA criteria, suggesting that rifampin use would have been appropriate. Of those meeting IDSA criteria, 49% (43 of 87) started rifampin. Of those who started on rifampin for staphylococcal PJI, 19% (8 of 43) discontinued it before the planned 6-week course was complete as documented in the EMR. Among the patients who did not receive rifampin when it appeared that they ought to have based on IDSA criteria, no reason for this decision was documented in 70% (31 of 44); among those for whom a reason was documented, it was DDI in 8 of 13, concern for hepatotoxicity in 1 of 13, history of a side effect in 1 of 13, and other reasons in 3 of 13. Among the patients whose courses were terminated before the planned course was completed, it was a gastrointestinal issue in 5 of 8, acute kidney injury in 1 of 8, or other reasons in 2 of 8. Only about one-half of patients who met IDSA criteria for adjunctive rifampin therapy for staphylococcal PJI after DAIR or one-stage revision at a large tertiary referral academic center were started on treatment. For most patients who did not receive rifampin, there is no documentation for why not. Given the evidence of superior outcomes for patients treated with adjunctive rifampin, it is imperative that all patients meeting criteria be started on the medication unless there is a clear contraindication, which should be documented. Future studies should further evaluate the clinical benefit of rifampin when treating staphylococcal PJI and which DDIs would be considered true contraindications of treatment. This could be achieved with a prospective study that evaluates successful long-term infection-free survival after treatment with adjunctive rifampin while accounting for and stratifying the potential clinical risk of these DDIs. Level IV, therapeutic study.

P0797 Clinical outcomes of dose escalated vedolizumab in Inflammatory Bowel Disease: a retrospective tertiary centre experience

Abstract Background Dose escalation has emerged as a key strategy in optimising the effectiveness of biologic therapies in patients with inflammatory bowel disease (IBD) facing secondary loss of response (SLOR). Emerging data supports dose escalation of anti-tumour necrosis factor α (TNF-α) biologics, with many centres employing the use of therapeutic drug monitoring (TDM) guided by serum drug levels 1. However, titration of vedoluzimab remains challenging due to the lack of available TDM 2. The effectiveness and safety of dose escalated vedolizumab is an area of ongoing interest, particularly, with vedolizumab perhaps being a safer alternative in patients who warrant avoidance of systemic immunosuppression 3. As such, we evaluated clinical outcomes of dose escalated vedolizumab at a large tertiary centre. Methods We performed a retrospective analysis of IBD patients receiving dose escalated vedolizumab from 2016 to 2024 at the Royal Melbourne Hospital. Dose escalation was defined as an increase of dose (&amp;gt;300mg) and/or frequency [every 8 weeks (&amp;gt;Q8W)] and/or received additional induction doses. We reported primary outcomes as treatment persistence, clinical disease status (SCCAI &amp; HBI) and biochemical markers (faecal calprotectin &amp; CRP), at the following intervals: 3-12 months, 12 months, and yearly up to 36 months following escalation. Secondary outcomes include hospitalisation and surgery rates. Results Of the 16 patients (median age 43.5, 56% female) who had previously received dose escalated vedolizumab, 12 had ulcerative colitis (UC) and 4 had Crohn’s disease (CD). Indications for dose escalation included: sonographic features of disease progression on intestinal ultrasound (18.8%), concerning endoscopic findings (6.3%) and clinical loss of response (75%). Dose escalation led to significant improvements in UC activity scores (Simple Clinical Colitis Activity Index (SCCAI): p=0.043), but not CD activity scores (Harvey-Bradshaw Index (HBI): p&amp;gt;0.05), at 3-12 months respectively. Dose escalation did not yield statistically significant reductions in CRP and faecal calprotectin (p &amp;gt; 0.05) at all measured time points. Patients previously exposed to biologics had higher persistence at 36 months compared to biologic naïve patients – at 69% and 50% respectively. Surgery was required in 0% of patients, although 25% of patients (n=4) had prior bowel resections, and 6.25% required hospitalisation (n=1). No serious adverse reactions were reported in any followed up patients. Conclusion Dose escalation of vedolizumab appears to be safe and effective in IBD patients with secondary loss of response. Our study demonstrates that dose escalation prolongs treatment persistence and improves patient quality of life.

P1049 Intestinal ultrasound for assessment of steroid-refractory disease in patients hospitalized due to Acute Severe Colitis

Abstract Background Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition. Intravenous corticosteroids are recommended as the initial treatment for adult patients with ASUC. However, one-third of patients with ASUC are steroid-refractory and will require medical salvage therapy or surgery. Timely identification of patients who will not adequately respond to steroid treatment is crucial. This study aimed to evaluate whether intestinal ultrasound (IUS), could potentially be of additional value in predicting inadequate response to IV steroids in patients admitted with ASUC. Methods A retrospective cohort study was conducted including all patients with ASUC admitted between 1/2018-12/2023 to a large tertiary referral center (Rabin Medical Center) in Israel. All patients who had laboratory tests, sigmoidoscopy and IUS were included. We used inflammatory markers, Milan Ultrasound Criteria (MUC) and Mayo endoscopic score (EMS) to assess disease activity. The need for in hospital salvage therapy (infliximab or cyclosporine) was detected. Results Out of 158 patients with ASUC admitted during the study period, baseline IUS was available in 43. Medical salvage therapy was required in 19 (44%): infliximab n=13, cyclosporine n=6. Patients ultimately requiring salvage therapy during their hospitalization had significantly worse laboratory baseline disease activity parameters. Specifically, median albumin, hemoglobin and c-reactive protein were 2.5 vs. 3.7 g/dl; 8.9 vs 11.9 g/dl; and 10.2 vs. 6.8 mg/dl in the salvage therapy group vs. steroid therapy only group, respectively (p&amp;lt;0.05). An EMS of 3 was detected in 14/19 (74%) of patients requiring medical salvage therapy compared to 14/24 (58%) in the steroid therapy only group. Finally, bowel wall thickness (BWT) and MUC of the sigmoid colon in the medical salvage therapy group was 5.1, 9 compared to 4.9, 8.5 in the steroid therapy only group (p&amp;gt;0.05). Conclusion In patients hospitalized with ASUC, laboratory values were significantly worse in patients ultimately needing salvage therapy. IUS measurements were not significantly different between these two groups. In this sick subgroup of patients with ASUC, IUS was not able to provide additional information regarding the risk of steroid failure. Defining specific cutoffs in larger studies may contribute to early non-invasive risk-stratification.

P1159 New onset acne reported in the majority of patients with upadacitinib-treated Inflammatory Bowel Disease

Abstract Background Upadacitinib (UPA), a janus kinase inhibitor (JAKi) with selectivity for JAK-1, is licensed in ulcerative colitis (UC) and Crohn’s disease (CD). Acne was seen commonly in the CD and UC registration studies of UPA. We sought to investigate the prevalence of acne in a real-world cohort of IBD patients using UPA. Methods We performed a retrospective review of all patients who received UPA for UC, CD or IBD-unclassified (IBD-U) between Sep 2022 and Sep 2024 at a large tertiary referral centre. Data were collated from electronic health records supplemented by telephone calls to individual patients. Demographic data, previous advanced treatments, dose and length of time on UPA were recorded in addition to skin related adverse effects. Self-reported acne was considered acceptable as a diagnosis, given that it is easily recognisable by the general public. Results The patient cohort is described in table 1. Out of 159 eligible subjects, 132 (83%) were reachable by telephone, 50 (38%) of whom were females. The indication for UPA was UC (67, 51%), CD (60, 45%), and IBD-U (5, 4%). 14 patients (11%) reported a history of acne at time of starting UPA and 60 (45%) were aware that acne was a potential side effect prior to starting the medication (Table 1). After a median duration of UPA therapy of 10 months (IQR 4-12), acne was reported by 77 (58%) patients (34 (51%) UC and 39 (65%) CD; 50 (61%) male and 27 (54%) female). Acne was reported to have involved the face (n=30, 41%), body (n=7, 9%) or both (n=37, 50%). The majority of UPA-associated acne was reported during the initial higher dose 45mg daily induction period (70, 91%) although acne persisted in 45 (58%) patients after reduction to 30mg. Notably, 35 (45%) patients with UPA-associated acne consulted their general practitioners, and 15 (19%) required specialist input from dermatologists. Importantly, acne-induced UPA dose reduction occurred in 4 (5%) patients and 3 (4%) patients discontinued UPA because of acne (Table 1). Conclusion The study suggests that self-reported acne is very common amongst patients who are receiving UPA for IBD, although acne-driven dose reduction or discontinuation is infrequent. Nearly half of the affected patients required GP assessments, and one fifth needed specialist dermatology input, suggesting substantial patient inconvenience and considerable impact on healthcare resource utilisation. Specific risk factors for acne, as well as potential benefits of dose reduction, should be further explored amongst upadacitnib users in larger, prospective studies.

P0265 A retrospective cohort study of pregnant women with Inflammatory Bowel Disease – outcomes from a multidisciplinary clinic in a tertiary centre

Abstract Background Inflammatory bowel disease (IBD) has an impact on pregnancy outcomes due to disease activity and medication use. We conducted a retrospective cohort study to evaluate pregnancy outcomes at a large tertiary IBD centre in the UK. Methods Pregnant IBD patients at our unit are managed by a multidisciplinary team with joint obstetric medicine and gastroenterology review. Consecutive patients from January 2023 to December 2023 were included. Data was extracted from EPIC electronic health record. Multiple logistic regression analysis was performed using Prism version 10.4 Results 90 unique women were included in the study. 55 (61.1%) had Crohn’s disease (CD), 32 (35.6%) had ulcerative colitis (UC) and 3 (3.3%) had IBD-U. 9 (10%) had either prior or active perianal disease. Median disease duration was 8 years and the median age at conception was 35 years. Median preconception BMI was 23.1kg/m2. At conception, 37 (41.1%) were on biologics, 9 (10.0%) were on thiopurines, 25 (27.8%) were on mesalazine, 4 (4.4%) were on oral steroids and 22 (24.4%) were not on any treatment. A flare was defined as a faecal calprotectin of ≥250ug/g or exacerbation of symptoms (SCCAI &amp;gt;2 or HBI &amp;gt;4). 43 (47.8%) experienced a flare during pregnancy. Flares were treated with mesalazine (n = 20, 22.2%) and/or systemic corticosteroids (n=12, 13.3%) with 5 (5.6%) patients initiated on biologic therapy during pregnancy. Biologics were stopped in the third trimester in only 6 (16.2%) patients. 86 (96%) patients had a live singleton birth. There were 3 (3.3%) miscarriages and 1 (1.1%) termination of pregnancy due to fetal anomalies. The majority of women had a vaginal delivery (n=36, 41.8%) or an elective caesarean section (n=31, 36.0%). There were 3 (3.4%) preterm births and the median gestational age at birth was 39 weeks. The median birth weight was 3282g. There were 5 (5.8%) neonates with a low birth weight and 5 (5.8%) had fetal macrosomia. Maternal infections occurred in 5 (5.6%) with the majority being intrapartum sepsis (n=3). One neonate was admitted to neonatal intensive care due to complications from an emergency vaginal breech delivery. Gestational diabetes (GDM) occurred in 20 women (22.2%) which was higher than the European prevalence of 5%. [1] Based on multivariable logistic regression analysis, the higher rates of GDM was independent of steroid exposure, baseline BMI and active disease in pregnancy. Conclusion IBD flares were common in our cohort which reflects the complexity of patients referred to our service. Obstetric and neonatal outcomes were similar to the general population. We observed a higher rate of GDM which was independent of steroid exposure, BMI and disease activity.

P0796 Comparison of Disease Severity, Treatment, and Outcomes in Elderly and Younger Patients Hospitalized with Acute Severe Ulcerative Colitis (ASUC)

Abstract Background Acute severe ulcerative colitis (ASUC) is a life-threatening complication that requires prompt and effective treatment. Disease severity, treatment approaches, and outcomes may differ between elderly patients (aged ≥60 years) and younger patients. This study aims to compare these factors in a cohort of hospitalized ASUC patients. Methods A retrospective cohort study was conducted including all patients admitted between 1/2018-12/2023, with ASUC who failed oral steroid therapy to Rabin Medical Center in Israel, a large tertiary referral center. Baseline disease severity was assessed using hemoglobin, albumin, and C-reactive protein (CRP). Treatments analyzed included the use of rescue therapies such as infliximab and calcineurin inhibitors for patients failing intravenous corticosteroid therapy. Outcomes such as colectomy and mortality associated with ASUC were recorded. Results 158 patients met the inclusion criteria and were stratified into two groups: elderly patients (≥60 years, n=16) and younger patients (&amp;lt;60 years, n=142).Elderly patients had a mean age of 72.9 years compared to 32.1 years in younger patients. Baseline hemoglobin levels were similar between the two groups (11.7 g/dL in elderly vs. 11.8 g/dL in younger patients). Albumin levels were also similar in elderly patients (3.6 g/dL) compared to younger patients (3.8 g/dL) as were CRP levels (5.7 mg/dl vs 5.8 md/dl) respectively. The use of infliximab was less common in elderly patients (12.5%, n=2) compared to younger patients (24.6%, n=35). Calcineurin inhibitors (ciclosporin or tacrolimus) were used in only 1 elderly patient (6.25%) but were used in almost 15 % (n=19) of younger patients. No elderly patients underwent colectomy during admission, while 7.0% (n=10) of younger patients did. Mortality was higher in elderly patients, with a case fatality rate of 12.5% (n=2), compared to no reported mortality in younger patients. Conclusion Elderly patients hospitalized with ASUC had similar baseline disease severity but received less rescue therapies and had worse outcomes compared to younger patients, including a higher mortality rate. These findings suggest that while disease severity may be comparable across age groups, elderly patients may experience greater complications, underscoring the need for tailored treatment approaches in this population.

N23 Volume and Impact of Text Communications with an IBD Nurse– A Large Tertiary Center Experience

Abstract Background Patients with inflammatory bowel diseases (IBD) face a range of medical and psychosocial challenges . Coping is facilitated by the support of IBD nurse that plays a pivotal role in addressing a large variety of disease related issues and logistical hurdles associated with a long-term disease. Accessibility and easy of contact with an IBD nurse is significant. Text communication is a preferable mode of communication for IBD patients. However, there are scant data about the work-load and the implications of establishing mobile-phone text communication route between patients and IBD nurses. Objective To Characterize volume, time distribution and topics text communications between an IBD nurse and patients treated in IBD unit Methods Text communications were carried out using WhatsApp application. WhatsApp messages between September 2020 and September 2024 were extracted. A series of messages exchanged within a three-day period continuously , was defined as a 'conversation'. Communication that followed a break of more than one day was considered a new 'conversation'. The analysis framework process chat text data that extracted and underwent conversation segmentation based on temporal gaps (&amp;gt;1 days), feature extraction including message types, timestamps and participant roles. The system employed model for conversation classification across six pre defined categories (medical problems, medical instructions, administrative guidance, general administrative, scheduling and other) with severity scoring (1-10) and handling multilingual content (Hebrew, Arabic, English).. Results Between September 2020 –September 2024 (1476 days) a total of 3,927 patients had at least 1 visit to our IBD unit, 1,623 (49.2%) received at least 1 advanced therapy. 2,173 (55.3%) contacted an IBD nurse at least once during the study period. 15,962 conversations were conducted , with 174,814 messages, average of 118 messages per day. Median response time was 1.9minutes (36 sec-19.3min). Most of the conversations occurred in weekdays (92.4%) , in office hours (8am-4pm, 60.5%). Main topics of communication were administrative scheduling , administrative guidance (26.4%, 20.5% respectively), medical – problem 15.8%, medical instruction 12.8%, administrative general 9.9%, other 14.6%. Conversation severity levels were defined as acute (grades 7-10; 2.1%), non-severe(grads 1-3; 50.1%) and intermediate (grades 4-6; 25.6%) Conclusion High volume and efficiency of communication, combined with the nurses' quick response times, contribute to faster treatment and potentially prevent complications. However, their workload might benefit from utilizing AI tools like chatbots for routine tasks, allowing nurses to focus on more complex aspects of care. References Rosso, C.; Aaron, A.A.; Armandi, A.; Caviglia, G.P.; Vernero, M.; Saracco, G.M.; Astegiano, M.; Bugianesi, E.; Ribaldone, D.G. Inflammatory Bowel Disease Nurse—Practical Messages. Nurs. Rep. 2021, 11, 229–241. Chang S, Hamilton M, Lees C, Atreja A. Mobile Health in IBD: Enhancing Care, One Phone at a Time. Inflamm Bowel Dis. 2020 Jan 6;26(2):163-166. doi: 10.1093/ibd/izz262. PMID: 31675058 Bernstein, K.I., Promislow, S., Carr, R., Rawsthorne, P., Walker, J.R., Bernstein, C.N. (2011) Information needs and preferences of recently diagnosed patients with inflammatory bowel disease. Inflamm Bowel Dis 17: 590–598. Sturm, A., &amp; White, L. (Eds.), Inflammatory Bowel Disease Nursing Manual (1 ed., pp. 417-422). Springer Cham.

Intrahepatic portosystemic shunt: salvage mechanism for oligohydramnios complicating fetal growth restriction.

Portosystemic shunts in growth-restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow-up. This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5-year period in a large tertiary referral center. Our routine evaluation of growth-restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical-portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f-TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed-rank test for paired non-parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth. A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21-30) weeks. The estimated fetal weight was at the 1st percentile in10/12 fetuses. The median amniotic fluid index was 5 (range, 2-5) cm at the initial appointment and improved significantly to 13 (range, 11-20) cm following the shunt diagnosis (P = 0.002). Among fetuses with f-TAPSE data available, the f-TAPSE increased significantly from 4.0 (range, 3.0-5.0) mm before the diagnosis of CIPSS to 8.0 (range, 5.0-9.4) mm following the diagnosis (P = 0.043). The median gestational age at delivery was 36.3 (range, 30.8-38.4) weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow-up revealed spontaneous shunt resolution within 30 months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure. The development of CIPSS in growth-restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f-TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Epidemiology of Biliary Acute Pancreatitis—A Seven-Year Experience of a Large Tertiary Center

Epidemiology of Biliary Acute Pancreatitis—A Seven-Year Experience of a Large Tertiary Center

Desmopressin prescription safety in adult inpatients: a real-world tertiary centre experience.

Omissions or delays in desmopressin can result in serious patient harm in patients with Arginine-Vasopressin Deficiency (AVP-D), formally known as Cranial Diabetes Insipidus (CDI). Desmopressin administration practice in hospitals has not been thoroughly investigated previously. This study evaluated desmopressin prescription and administration practice at a large tertiary centre. A retrospective electronic case notes review of all admissions (≥24 hours) with AVP-D between 2018-2021 at Sheffield Teaching Hospitals was undertaken. The outcomes were defined as: total number of missed and delayed doses, time to prescription and administration from admission, and incidence of dysnatraemias. A qualitative survey to determine knowledge of AVP-D and desmopressin among staff members was also carried out. Total 102 admissions were identified, of which 38% of admissions were via emergency department (ED). The total number of missed and delayed doses were 132/1315 (10.0%) and 139/1283 (10.9%), respectively. 33% of admissions had ≥1 missed doses while ≥1 doses were delayed in 54% admissions. ED rates of desmopressin prescription were low at 5%. The most common reasons documented for missed or delayed doses were unavailability of desmopressin followed by inability of patient to take the medication. Median [IQR] prescription and administration times from admission were 5.6 [2.7-10.7] and 15.1 [8.7-27.0] hours, respectively. The incidence of inpatient hypernatraemia and hyponatraemia was 7.6% and 30.4%, respectively. The staff survey showed below-average knowledge of the condition, advocating for an urgent need for education.

A Longitudinal Graduate Medical Education Curriculum in Clinical Informatics: Function, Structure, and Evaluation.

There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education and the body of undergraduate medical education for implementation of informatics curricula. This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform U.S. Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution. The curriculum aligns with the core content for the subspecialty of clinical informatics (CI) and is led by a multidisciplinary team with both informatics and clinical expertise. This educational pathway has a low direct cost and is a practical example of the academic learning health system (aLHS) in action. The pathway is housed within an internal medicine department at a large tertiary academic medical center. The curriculum has yielded 13 graduates from both internal medicine (11, 85%) and pediatrics (2, 15%) whose projects have spanned acute and ambulatory care and multiple specialties. Projects have included clinical decision support tools, of which some will be leveraged as substrate in applications seeking extramural funding. Graduates have gone on to CI board certification and fellowship, as well as several other specialties, creating a distributed network of clinicians with specialized experience in applied CI. An informatics curriculum at the GME level may increase matriculation to CI fellowship and more broadly increase development of the CI workforce through building a cadre of physicians with health information technology expertise across specialties without formal CI board certification. We offer an example of a longitudinal pathway, which is rooted in aLHS principles. The pathway requires a dedicated multidisciplinary team and departmental and information technology leadership support.

Consolidation With Second High Dose Therapy and Autologous Stem Cell Transplantation Is Associated With Improved Overall Survival in Patients With Multiple Myeloma in First Relapse.

High dose chemotherapy and autologous stem cell transplantation (HDT/ASCT) remains the preferred first line consolidation strategy for newly diagnosed multiple myeloma (MM). However, The role of HDT/ASCT in first relapse is uncertain in the context of novel therapies. This study evaluates real-world outcomes of MM patients in first relapse, focusing on the role of consolidative HDT/ASCT. This retrospective cohort study was conducted at a large tertiary referral center in Northern Netherlands. MM patients who received first-line HDT/ASCT and obtained a good response were included. The time to next treatment or death (TTNT-D 2) and overall survival (OS) were evaluated, while identifying prognostic factors. A landmark analysis was performed at 6 months, including only patients with a partial response (PR) or better after re-induction. This study identified 237 patients potentially eligible for repeated HDT/ASCT of whom 111 (47%) underwent a second consolidative HDT/ASCT. The median follow-up is 40 months. Baseline characteristics were largely similar, though second HDT/ASCT was applied only after achieving PR or better. In the landmark analysis, absence of high-risk cytogenetics and good performance status were associated with longer TTNT-D 2. Consolidative second HDT/ASCT, absence of high-risk cytogenetics and longer first response duration were associated with longer OS. Transplantation-related mortality rate was < 1%. This study highlights the viability of second HDT/ASCT as treatment option for relapsed MM, particularly for patients with good responses to first-line HDT/ASCT. In the era of novel agents, second HDT/ASCT should be considered a feasible and effective consolidative strategy.

Real-world analysis of acamprosate use in patients with cirrhosis and alcohol-associated hepatitis

ObjectivePreventing return to alcohol is of critical importance for patients with alcohol-related cirrhosis and/or alcohol-associated hepatitis. Acamprosate is a widely used treatment for alcohol use disorder (AUD). We assessed the...