Medical Chart Review Research Articles

Identifying Drug-Drug Interactions in Diabetic Patients with Chronic Kidney Disease: Pharmacist’s Interventions

Drug-drug interactions (DDIs) can negatively affect patients ‘therapeutic outcomes. Therefore, our aim was to evaluate DDIs among diabetic patients with chronic kidney disease (CKD). To achieve this aim, our objectives were to identify DDIs in diabetic patients with CKD admitted to the Medicine Department of the tertiary care hospital and to evaluate pharmacist’s interventions in managing DDIs among these patients. A prospective observational study was conducted over 6 months. The pharmacist performed a medication chart review, and DDIs were identified by using Lexicomp® drug interaction. The pharmacist informed prescribers regarding the occurrence of DDIs, and all pharmacist`s interventions were classified according to Pharmaceutical Care Network Europe. Overall 307 DDIs were identified among a total of 119 study patients with an average of 2.6 DDIs per patient. The most of identified DDIs (205, 66.7%) belonged to the interaction risk-rating category of C, which indicates that DDIs required close monitoring of patients’ therapy to avoid any potential adverse outcome. DDIs that needed to be managed by considering therapy modification (risk-rating category of D) and avoiding drug combination (risk-rating category of X) were accounted for 19.2% and 14.0% of all detected interactions, respectively. Interactions between Furosemide–Insulin (43, 14.0%), Amlodipine–Calcium carbonate/vitamin D3 (35, 11.4%) were found to be among most commonly identified DDIs. The pharmacist delivered different types of interventions to prescribers, which ranged from monitoring of therapy outcome to stopping DDIs. A great proportion of delivered pharmacist’s interventions (87%) were accepted by prescribers. Clinically significant DDIs occurred commonly in hospitalized diabetic patients with CKD. The pharmacist delivered important interventions in timely identifying DDIs.

A Time Trend Analysis of 5,000 Robotic Thyroidectomies via Bilateral Axillo-Breast Approach.

This study aimed to investigate the time trends of surgical outcomes in patients who underwent bilateral axillo-breast approach robotic thyroidectomy (BABA RT) over the last 14years. From February 2008 to September 2021, we conducted a retrospective medical chart review of 5,011 consecutive patients who underwent BABA RT at three Seoul National University-affiliated hospitals. The patients were divided into three groups based on the main model of the da Vinci robotic surgical system to evaluate trends in surgical treatment strategies and outcomes after BABA RT. Of the 5,011 patients (4,706 malignant and 305 benign), the most common histological subtype was papillary thyroid carcinoma (n = 4,584; 97.4%). The mean tumor size significantly increased from 0.8cm to 1.2cm (p < 0.05). The mean numbers of metastatic and harvested lymph nodes from the central neck dissection and the lateral neck dissection showed a significant difference and tendency to increase (from 0.9 to 1.6, 4.7 to 6.2, p < 0.05, and from 0.6 to 3.9, 5.3 to 17.9, p < 0.05), respectively, throughout the study period. Permanent hypoparathyroidism decreased from 3.4 to 2.9%. The rate of transient and permanent vocal cord palsy decreased from 15.2 to 2.7% and from 0.7 to 0.2%, respectively. With advancements in robotic surgical systems and improvements in the BABA RT technique, surgical indications have expanded to include more advanced thyroid diseases, and surgical outcomes have improved over the last 14years.

A cohort study on neuropathic pain of the saphenous nerve—factors influencing surgical outcome

BackgroundDue to its partially superficial course, the saphenous nerve is vulnerable to injury by trauma or surgery potentially leading to painful neuroma formation. Different surgical techniques to treat neuroma have been described, but so far, no one has proven to be superior to the others. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in saphenous nerve neuropathic pain in our department.MethodsFrom 2010 to 2020, a total of 29 consecutive patients with neuropathic pain and suspected neuroma of the saphenous nerve underwent revision surgery. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered.ResultsPost revision surgery in neuropathic pain of the saphenous nerve, 16 (55.2%) patients suffered from persisting pain. In multivariable logistic regression models evaluating the risk of persisting pain post saphenous nerve revision surgery, both smoking and preoperative opiate consumption represented independent predictors of higher risk for persisting pain.ConclusionsPatients with injury to the saphenous nerve should be coached toward smoking cessation. Whenever possible, forgoing opiate treatment might be beneficial.Level of evidence: Level IV, Risk/Prognostic.

92. Incidence of Adenovirus Respiratory Infection and Coinfection in a Longitudinal Birth Cohort

Abstract Background Adenoviruses (AdVs) are a common cause of acute respiratory illness (ARI) in children and are often detected with other viruses (coinfection). However, the community incidence of AdV infections is poorly understood due to a lack of prospective studies outside the hospital setting. Here, we aim to characterize respiratory AdV infections and coinfections in a prospective birth cohort of children. Methods The PREVAIL cohort is a CDC-funded, 2-year birth cohort, conducted from 2017–2020 in Cincinnati, OH. ARI was defined as the presence of cough or fever identified with weekly maternal text surveys and medical chart review. Mid-turbinate nasal swabs were collected weekly. Swabs were tested using Luminex Respiratory Pathogen Panel. AdV infection was defined as a swab positive for AdV and included subsequent positives &amp;lt; 30 days apart. Coinfection was defined as detection of any other virus(es) during an AdV infection. Children who submitted at least 70% of weekly samples were included in our analysis. Results 101 children met inclusion criteria, representing 165 child-years. 137 distinct AdV infections were identified (incidence 0.84 infections per child year), with 98 (97%) children having ≥1 AdV infection. Only 40% (n=55) of AdV infections were symptomatic. Of those with symptomatic infections, 51% (n=28) sought medical care, with 42% (n=23) presenting to a primary care provider and 9% (n=5) resulting in an ED visit or hospital admission. Coinfections were detected in 67% (n=92) of AdV infections, with 45% (n=62) coinfected with 1 virus, 19% (n=26) with 2 viruses, and 3% (n=4) with ≥3 viruses. 77% of coinfections (n=71) were rhino/enterovirus. The number of coinfections or the specific coinfection virus was not associated with an increase in symptom prevalence or symptom severity (all p &amp;gt; 0.05). Viral Coinfection Frequency with Adenovirus Infection in the PREVAIL Cohort. Adenovirus Infection and Coinfection in the PREVAIL Cohort. Conclusion In this cohort of healthy children, AdVs were a common cause of respiratory infection. Most infections were asymptomatic or resulted in mild symptoms. Two-thirds of AdV infections involved viral coinfections, but coinfection was not associated with more frequent or severe symptoms. Our findings suggest studies that only include symptomatic or hospitalized patients may overestimate AdVs disease severity. Disclosures All Authors: No reported disclosures.

1279. Real World Treatment Experience of Treatment-Naïve People with HIV who Initiated Treatment with Single Tablet Dolutegravir/Lamivudine in a Test and Treat setting in the US.

Abstract Background Dolutegravir/lamivudine (DTG/3TC) is indicated as a 2DR for both treatment-naïve and virally suppressed PLWH. The feasibility of DTG/3TC use in a Test &amp; Treat (T&amp;T) setting has been demonstrated in a clinical trial, but there is limited evidence with this approach in US real world clinical settings. Methods TANDEM was a retrospective medical chart review conducted across 24 US sites. Eligible PLWH were adults initiated on DTG/3TC or DTG/rilpivirine (DTG/RPV) prior to Sept/30/2020 with a minimum clinical follow-up of six months. Treatment-naïve (TN) PLWH had no prior history of HIV therapy. Clinical characteristics, treatment history and outcomes were abstracted. Analyses were descriptive. Reported here are results for the sub-group of TN PLWH that were initiated DTG/3TC as part of a T&amp;T strategy, defined as clinician attestation of treatment initiation shortly after diagnosis and in the absence of known lab values for HIV-1 RNA viral load, CD4 cell count and HIV-1 resistance mutations. Results From an overall sample of 469 PLWH on DTG-based 2DR, 318 received DTG/3TC, of whom, 126 were TN and 192 were stable switch. Almost half 48% of PLWH received DTG/3TC as part of a T&amp;T paradigm. Characteristics of the cohort are described in Table 1. In the T&amp;T sub-group, the most common reasons for initiating DTG/3TC were avoidance of long-term toxicities (n=26), followed by simplification/streamlining (n=8) and convenience (n=7). Overall, 114 (90.5%) of TN PLWH achieved the desired health outcome per clinician attestation. At data cut-off, 61 (94%) non T&amp;T achieved virologic suppression, 57 (93%) of the T&amp;T sub-group achieved virological suppression, 3 (5%) did not, and 1 (2%) was still unknown. Of the 3 who did not achieve suppression, 2 remained on DTG/3TC while 1 was switched to bictegravir/emtricitabine/tenofovir alafenamide. Virologic rebound occurred in 6 TN PLWH overall with only 1 occurring in the T&amp;T sub-group. Baseline Characteristics and Virologic Outcomes Conclusion Reflecting results from clinical trials, DTG/3TC achieved its desired health outcomes in the majority of cases regardless of treatment paradigm, with virtually no difference in virological suppression rates across the two cohorts (93-94% achieving suppression in a median duration of 10-11 weeks). Disclosures Cindy Donovan, PharmD, Johnson &amp; Johnson: Stocks/Bonds|ViiV Healthcare: Employee/Salary|ViiV Healthcare: Stocks/Bonds Gavin Harper, BA, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare.|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Deanna Merrill, PharmD, MBA, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds Katie L. Mycock, MChem, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Alan Oglesby, MPH, GlaxoSmithKline (GSK): Employment|GlaxoSmithKline (GSK): Stocks/Bonds Aimee Metzner, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds Jimena Patarroyo, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds|ViiV Healthcare: Stocks/Bonds.

1278. Real World Treatment Experience of Single Tablet Dolutegravir/Lamivudine in Those Naïve to Treatment with Baseline Viral Loads ≥ 100,000 copies/mL in the US

Abstract Background Treatment for people living with HIV-1 (PLWH) continues to advance with a two-drug regimen (2DR) approach. Dolutegravir/lamivudine (DTG/3TC) is indicated as a 2DR for both treatment-naïve and virally suppressed PLWH. Despite high and sustained virologic efficacy for DTG-based 2DRs observed in clinical trials, there is limited evidence in US real world clinical settings. This study characterizes prescribing behaviors and treatment outcomes for DTG-based 2DR in the real world. Methods TANDEM was a retrospective medical chart review conducted across 24 US sites. Eligible PLWH were adults initiated on single tablet DTG/3TC or DTG/rilpivirine prior to Sept/30/2020 with a minimum clinical follow-up of six months. Treatment-naïve PLWH had no prior history of HIV therapy. Clinical characteristics, treatment history and outcomes were abstracted. Analyses were descriptive. Reported here are viral outcomes for the DTG/3TC cohort of treatment-naïve PLWH with baseline viral loads (VLs) ≥ 100,000 (c/mL). Results From an overall sample of 469 PLWH on DTG-based 2DR, 318 received DTG/3TC. Of the DTG/3TC cohort, 126 were treatment-naïve. Of the treatment-naïve, 58 PLWH had known VLs available at DTG/3TC initiation. For those with baseline VLs ≥ 100,000 c/mL, 9 had values 100,000-250,000 c/mL while 7 were &amp;gt; 250,000 c/mL. Characteristics of this sub-cohort are described in Table 1. Overall, the most common reason for DTG/3TC initiation in this sub-cohort was patient preference (n=5), followed by avoidance of long-term toxicities and convenience (both n=3). For those with VLs between 100-250k, median CD4 count was 312 while 8/9 became virally suppressed (HIV-1 RNA &amp;lt; 50c/mL) and 1 PLWH had missing data. For those with VLs &amp;gt; 250k, median CD4 count was 114 while 6/7 became virally suppressed and 1 PLWH had missing data. One of these 6 PLWH experienced virologic rebound yet remained on DTG/3TC. Table 1:Clinical Characteristics Conclusion These real world results reflect data from clinical trials, demonstrating DTG/3TC is effective and well tolerated in the real world. Nearly all DTG/3TC users, regardless of baseline VL, experienced sustained virologic suppression with few treatment discontinuations. Caution should be used when extrapolating these results due to limited population size of the sub-cohorts. Disclosures Paul Benson, DO, AAHIVS, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Speakers Bureau and Advisory Boards Cindy Donovan, PharmD, Johnson &amp; Johnson: Stocks/Bonds|ViiV Healthcare: Employee/Salary|ViiV Healthcare: Stocks/Bonds Gavin Harper, BA, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare.|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Deanna Merrill, PharmD, MBA, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds Katie L. Mycock, MChem, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Alan Oglesby, MPH, GlaxoSmithKline (GSK): Employment|GlaxoSmithKline (GSK): Stocks/Bonds Jimena Patarroyo, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds|ViiV Healthcare: Stocks/Bonds Aimee Metzner, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds.

986: HOW ARE WE OVERSEDATING OUR MECHANICALLY VENTILATED PATIENTS IN THE MICU AT A TERTIARY CARE CENTER?

Introduction: Endotracheal intubation and invasive mechanical ventilation are distressing interventions in the Medical Intensive care Unit (MICU). Mechanically ventilated patients often receive analgesic and sedative medications to reduce agitation and pain. According to recommendations in the Society of Critical Care (SCC) PADIS guidelines, sedatives should be used only when pain and delirium have been addressed with specific pharmacologic and non-pharmacologic strategies. Despite this, we observe that many mechanically ventilated MICU patients are sedated on a routine basis without any clear indication. Methods: We performed a retrospective medical chart review of patients above 18 years of age who were intubated for more than 24 hours between January 2020 till October 2021. We analyzed indications for intubation and excluded patients requiring a deep level of sedation from the final study sample. We analyzed the type and number of sedatives initiated in the first 24 hours of intubation, associated RASS parameters set for sedation titration and its monitoring frequency by nurses, and the effect of our practices on intubation and hospitalization outcomes. Statistical analysis was performed using SPSS and SAS. Results: Of the 281 patients, 83% received fentanyl, 66% received propofol or dexmedetomidine, and 33% received midazolam in the first 24 hours. About 53% and 11% of patients were simultaneously started on a 2- and 3-agents sedative regimen in the first 24 hours, respectively. The most common upper and lower RASS limits for sedation titration were set at 0 and -3, respectively. The average frequency of nurses’ RASS documentation was once every 10 hours. There was a positive correlation between the number of sedative agents used in the first 24 hours and the associated length of intubation, hospitalization, and extubation failure. Furthermore, the use of benzodiazepine led to a higher rate of extubation failure, length of intubation, and hospitalization. Conclusions: In the absence of clear medical indication for deep sedation and appropriate sedation administration and titration parameter protocol, the indiscriminate use of sedatives leads to poor patient outcomes. There is a dire need to implement sedation protocols in institutions to standardize practices and improve sedation performance metric.

Specialized Palliative Care and Intensity of End-of-Life Care Among Adolescents and Young Adults with Cancer: A Medical Chart Review.

Purpose: Adolescents and young adults (AYAs) with cancer often undergo aggressive end-of-life (EOL) care. We evaluated whether specialized palliative care (SPC) involvement is associated with the receipt of intensive EOL care among AYAs. Methods: This retrospective study included patients with cancer treated between the ages of 15 and 39 years at a university hospital, who died during 2009-2022. The primary outcome was high-intensity EOL (HI-EOL) care, which was defined as ≥1 session of intravenous chemotherapy <14 days from death or during the final 30 days of life, ≥1 hospitalization at an intensive care unit, >1 emergency room admission, or >1 hospitalization at an acute care unit during the final 30 days of life. We determined predictors of outcomes using multiple logistic regression models. Results: We analyzed 132 AYAs (75 with SPC involvement), of whom 42.4% (95% confidence interval [CI]: 33.9%-51.3%) underwent HI-EOL care. The prevalence of HI-EOL care was significantly lower in those who had SPC involvement than in those without SPC involvement (adjusted odds 0.30; 95% CI: 0.13-0.69; p = 0.005). Using no SPC involvement group as a reference, the adjusted odds for SPC involvement ≤60 days and >60 days were 0.71 (95% CI: 0.18-2.78; p = 0.63) and 0.22 (95% CI: 0.09-0.57; p = 0.002), respectively. Conclusion: In AYAs with cancer, SPC involvement and duration were associated with a lower incidence of HI-EOL care. Thus, integrating SPC into oncology may improve EOL care for AYAs.

Risk Factors and Surgical Outcomes of Diabetic Foot in Diabetic Patients at King Fahad University Hospital.

Diabetes mellitus affects a large number of the population worldwide. One of the most important complications is diabetic foot ulcers, which are debilitating to the patient and the health care system. To assess the risk factors leading to diabetic foot complications and the surgical outcome of management of patients affected by diabetic foot at King Fahd University Hospital. This is a retrospective case series study conducted at King Fahd University Hospital. The study included 52 patients who were admitted from the period 2007 to 2017 with cases of diabetic foot ulcers. The study includes a review of medical charts for diabetic foot patients including demographics, diabetic profile, associated comorbidities, clinical signs, laboratory investigations and surgical outcome. Our study shows thatdiabetic foot patients had comorbidities like hypertension at 69.2% and hyperlipidemia at 55.8%. Regarding the association between comorbidities and surgical outcomes, we did not find any significance. Furthermore, we found that patients with gangrene were more likely to undergo amputation. Patients who underwent amputation had hemoglobin A1c (HbA1c) of 10.3 ± 2.4% and random blood sugar (RBS) of 259 ±107 mg/dl, indicating poor diabetic control. Diabetic foot is the result of poor blood sugar control. Surgical intervention plays an important role in the management of diabetic foot. Depending on the presentation, patients may undergo surgical debridement, revascularization, or amputation. We found that patients who developed gangrene were more likely to undergo amputation.

Real-World Patterns and Decision Drivers of Radiotherapy for Lung Cancer Patients in Romania: RADIO-NET Study Results.

Radiotherapy (RT) plays a crucial role in all stages of lung cancer. Data on recent real-world RT patterns and main drivers of RT decisions in lung cancer in Romania is scarce; we aimed to address these knowledge gaps through this physician-led medical chart review in 16 RT centers across the country. Consecutive patients with lung cancer receiving RT as part of their disease management between May-October 2019 (pre-COVID-19 pandemic) were included. Descriptive statistics were generated for all variables. This cohort included 422 patients: median age 63 years, males 76%, stages I-II 6%, III 43%, IV 50%, mostly adeno- and squamous cell carcinoma (76%), ECOG 0-1 50% at the time of RT. Curative intent RT was used in 36% of cases, palliative RT in 64%. Delays were reported in 13% of patients, mostly due to machine breakdown (67%). Most acute reported RT toxicity was esophagitis (19%). Multiple disease-, patient-, physician- and context-related drivers counted in the decision-making process. This is the first detailed analysis of RT use in lung cancer in Romania. Palliative RT still dominates the landscape. Earlier diagnosis, coordinated multidisciplinary strategies, and the true impact of the multimodal treatments on survival are strongly needed to improve lung cancer outcomes.

Medication related problems among ambulatory patients with chronic kidney disease at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Medication related problem (MRP) is an event occurring, as a result, the medication therapy that actually or potentially interferes with desired health outcomes. Evidences reported that the prevalence of MRPs may result in a high burden of morbidity and decrease patients' quality of life. The problem is more significant among patients with chronic kidney disease (CKD) as a decline in kidney function and increase number of medications required to treat kidney disease and its complications. Thus, this study aimed to assess MRPs and its associated factors among patients with chronic kidney disease. Hospital-based cross-sectional study was conducted among 248 adult ambulatory patients with CKD (stage 1-4) at St. Paul's Hospital Millennium Medical College. Data were collected through patient interview and medical chart review from 1st of June to 30th of August 2019. MRPs were identified based on the standard treatment guidelines. Cipolle MRPs classification was used to classify the MRPs and Micromedex® was used as drug interaction checker. Binary logistic regression was utilized to identify the associated factors and p value <0.05 was considered as statistically significant. A total of 325 MRPs were identified from 204 (82.3%) study participants giving 1.6 MRPs per participant. One MRP was identified among 114 (55.9%) patients while two MRPs were identified among 64 (31.4%). The most common class of MRPs were need additional drugs 114 (35.1%) followed by non-compliance 54 (16.6%), unnecessary drug therapy 46 (14.2%) and dose too low 46 (14.2%). The two most common reasons for non-compliance were unaffordability of drugs 26(48.1%) and the lack of patient understanding about drug taking instruction 10 (18.5%). The study showed that only occupation (AOR = 5.2, 95% CI: 1.292-21.288, P = 0.020) and angiotensin converting enzyme inhibitor use (AOR = 6.6, 95% CI: 2.202-19.634, P = 0.001) had an association with the occurrence of MRPs. The prevalence of MRPs among ambulatory patients with CKD was high and need of additional drug therapy was the commonest MRPs.

A Cohort Study on Neuropathic Pain of the Sural Nerve-Can Neurectomy Be Considered a Valid Treatment Option?

Sural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department. From 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered. After neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified. For sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.

A Random Forest Classification Model for Spasticity after Stroke

<h3>Research Objectives</h3> The objective of this analysis was to developed a Random Forest Classification Model to determine which sociodemographic and clinical health characteristics predict the development of post-stroke spasticity (PSS). <h3>Design</h3> Random Forest Classification Modelling with data collected from a retrospective review of patients' medical charts and the National Rehabilitation Reporting System. <h3>Setting</h3> Specialized stroke rehabilitation inpatient and outpatient units from a large, urban centre in Ontario, Canada. <h3>Participants</h3> A total of 922 individuals (102 spastic) attended stroke rehabilitation between July 1, 2015 and June 30, 2020. A synthetic minority oversampling technique was used to generate a dataset of 1632 individuals (408 spastic). <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Clinical health data (i.e., number, type and location of stroke, age at stroke), length of stay, LOS); presence of spasticity, presence of aphasia, endovascular or tissue plasminogen activator treatment, Chedoke-McMaster impairment inventory scores, Functional Independence Measure motor and cognitive sub-scores. <h3>Results</h3> Based on the results of a feature hyper-parameterization procedure, a model with 1501 trees was selected with 8 variables (mtry=8). A random forest model was then trained using these parameters on 80% of the dataset. The relative importance of predictor variables was assessed by examining the decrease in model accuracy when a particular variable is permutated. Chedoke McMaster impairment scores, age at stroke onset, Functional Independence Measure motor sub-scores and length of stay appear to be the most important predictor variables when compared to the remaining 7. When testing the model performance on the untrained 20% of the dataset, the model performed with a balanced accuracy of 82.5%, a Cohen's kappa value of 0.71 and a spasticity classification error of 32.1%. <h3>Conclusions</h3> Overall, our model performed relatively well, but could be tuned more for sensitivity to prioritize the correct identification of spasticity. In the future, more data will be required to validate the generalizability of the model and robustness of fit, as well as to eliminate the need for synthetically created data. <h3>Author(s) Disclosures</h3> None.

Clinical Features and Management of Small Bowel Masses Detected During Device-Assisted Enteroscopy: A Multi-Center Experience.

Small bowel mass lesions (SBMLs) are rare, span a range of different histologies and phenotypes, and our understanding of them is limited. Some lesions occur in patients with recognized polyposis syndromes and others arise sporadically. The current literature regarding SBMLs is limited to small retrospective studies, case reports, and small case series. This large multi-center study aims to understand the various clinical presentations, histologies and management options for SBMLs. After obtaining Institutional Review Board (IRB) approval, electronic records were used to identify all device-assisted enteroscopy (DAE) performed for luminal small bowel evaluation in adult patients at three US referral centers (Duke, LSU and UMass) from January 1, 2014, to October 1, 2020. We identified all patients within this cohort in whom a SBML was detected. Using a focused electronic medical record chart review, we collected patient, procedure, and lesion-related data and used descriptive statistics to explore relationships between these data and outcomes. A total of 218 patients (49 at Duke, 148 at LSU, and 21 at UMass) in this cohort had at least one SBML found on DAE. The most common presenting symptoms were iron-deficiency anemia/bleeding (73.3%) and abnormal imaging (33.6%). Thirty-five percent of patients had symptoms for more than a year prior to their diagnosis. Most patients (71.6%) underwent video capsule endoscopy (VCE) prior to DAE and 84% of these exams showed the lesion. The lesion was seen less frequently (48.9%) on computed tomography (CT) scan performed prior to DAE. The majority of lesions were found on antegrade (56%) or retrograde (29.8%) double-balloon enteroscopy (DBE). The most common lesion phenotypes were submucosal (41.3%) and pedunculated (33%) with a much smaller number being sessile (14.7%) or obstructing/invasive (11%). They were found equally as commonly in the jejunum (46.3%) and ileum (49.5%). Most lesions were 10 - 20 mm in size (47%) but 22.1% were larger than 20 mm. The most common histologies were neuroendocrine tumors (NETs, 20.6%) and hamartomas (20.6%). Primary adenocarcinoma of the small bowel was rare, constituting only 5% of lesions. The majority of polyps (78.4%) were sporadic, compared to 21.7% associated with a polyposis or hereditary cancer syndrome, most commonly Peutz-Jeghers syndrome (18.3%). After DAE, 37.6% were advised to undergo surgical resection and 48% were advised to undergo endoscopic surveillance or no further management because of benign histology or successful endoscopic resection. In this multi-center retrospective study we found that SBMLs are more likely to be sporadic than syndromic, medium in size and either pedunculated or submucosal. NETs and hamartomas predominated and symptoms, most commonly anemia, can be present for more than a year prior to diagnosis. Close to one half of lesions required either no further intervention or only endoscopic surveillance.

An Exploration of Smoking Patterns Among People with Serious Mental Illness Attending an Outpatient Clinic in Qatar.

Studies have shown that tobacco use is exceptionally high in people affected with serious mental illness (SMI). Many countries worldwide have observed a decrease in the prevalence of tobacco smoking; however, the smoking rates among people with SMI have declined much less than in those without mental illness. To date, no nationally representative data have examined the smoking patterns or the sociocultural factors that influence smoking among SMI people in Qatar. A retrospective medical chart review was conducted to collect patient demographics, psychiatric and medical comorbidities, medications, the most recently documented smoking status and if on tobacco cessation treatment. A descriptive and inferential analysis of the data was performed. Of 346 patients included in the cohort, 196 (56.6%) had their smoking status documented, of which 72 (36.7%) were "currently smoking." Significantly more males than females were "current smokers" (62.9% versus 15.0%, respectively, p < 0.001). Significantly more patients with psychotic disorders than those with any other SMI were "current smokers", and this difference was statistically significant (p = 0.006). Positive and significant associations with current smoking were found for the male gender, psychotic disorders, and high levels (≥6.2 mmol/L) of total cholesterol. Only 12 (16.7%) of current smokers were receiving smoking cessation treatment. More than half of a sample of people with SMI attending outpatient psychiatric services in Qatar had documented smoking status. Still, only a few current smokers were on smoking cessation treatment. Efforts are needed to implement smoking cessation strategies in this population.

Instituting interprofessional preoperative anesthesia interview guidelines at an outpatient periodontics office

Preoperative anesthesia interviews lacking necessary health history information may lead to cancelled or delayed elective cases on the day of surgery (DOS) in outpatient settings. This project introduced interprofessional preoperative anesthesia interview guidelines (IPAIG) at an outpatient periodontics office to reduce case cancellations and improve efficiency. A pre-and-post descriptive project involving interview instructions, a script, and revised patient intake forms was implemented to compare the reasons for DOS case cancellations before and after the introduction of IPAIG for office staff. A Fisher's exact test was used to describe changes in clinical outcomes. Six months post-implementation of IPAIG, a retrospective medical chart review revealed decreased avoidable DOS case cancellations from 0.67% in the pre-implementation period to 0.36% in the post-implementation period. The IPAIG reduced avoidable day of surgery case cancellations, improved office efficiency, and can be applied to a variety of clinical settings.

Validation of claims-based algorithms to identify non-live birth outcomes.

Perinatal epidemiology studies using healthcare utilization databases are often restricted to live births, largely due to the lack of established algorithms to identify non-live births. The study objective was to develop and validate claims-based algorithms for the ascertainment of non-live births. Using the Mass General Brigham Research Patient Data Registry 2000-2014, we assembled a cohort of women enrolled in Medicaid with a non-live birth. Based on ≥1 inpatient or ≥2 outpatient diagnosis/procedure codes, we identified and randomly sampled 100 potential stillbirth, spontaneous abortion, and termination cases each. For the secondary definitions, we excluded cases with codes for other pregnancy outcomes within ±5 days of the outcome of interest and relaxed the definitions for spontaneous abortion and termination by allowing cases with one outpatient diagnosis only. Cases were adjudicated based on medical chart review. We estimated the positive predictive value (PPV) for each outcome. The PPV was 71.0% (95% CI, 61.1-79.6) for stillbirth; 79.0% (69.7-86.5) for spontaneous abortion, and 93.0% (86.1-97.1) for termination. When excluding cases with adjacent codes for other pregnancy outcomes and further relaxing the definition, the PPV increased to 80.6% (69.5-88.9) for stillbirth, 86.6% (80.5-91.3) for spontaneous abortion and 94.9% (91.1-97.4) for termination. The PPV for the composite outcome using the relaxed definition was 94.4% (92.3-96.1). Our findings suggest non-live birth outcomes can be identified in a valid manner in epidemiological studies based on healthcare utilization databases.

Disparities in Postoperative Endocrine Outcomes After Endoscopic-Assisted Transsphenoidal Pituitary Adenoma Resection.

Objectives Socioeconomic factors can influence morbidity in patients with pituitary adenoma. This study aims to identify associations between socioeconomic factors and postoperative outcomes in patients with pituitary adenomas. Methods A retrospective medical chart review was conducted on adultpatients who underwent resection of purely sellar nonfunctional and functional pituitary adenomas between May 1, 2014, and May 31, 2020, at the University of North Carolina Medical Center. The main outcome measures included the incidence ofpostoperative diabetes insipidus (PDI), postoperative hyponatremia (PHN), and postoperative hypopituitarism (PHP). Outcome measures were analyzed using univariate and multivariate analyses against preoperative tumor volume as well as socioeconomic and demographic factors (self-identified race/ethnicity, age, gender, address assessed by the Area Deprivation Index (ADI), and insurance status). Results On univariate analysis, patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods had an increased incidence of postoperative diabetes insipidus. Patients who experienced PDI were significantly younger on average in both univariate and multivariate analyses. When analyzed further, patients of Hispanic race/ethnicity were significantly younger and more likely to be uninsured compared to their respective racial/ethnic counterparts. No significant correlations were found for PHN or PHP. Conclusions Patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods were more likely to experience PDI. This finding, when combined with findings regarding age and insurance status, suggests complex disparities in medical care that are confirmed or corroborated by prior literature. These results may enhance clinicians' management of patients from disadvantaged socioeconomic backgrounds through increased awareness of disparities and the provision of resources for assistance.

Patient Adherence to Immunosuppressive Therapy in Treatment of Chronic Inflammatory Eye Disease

ABSTRACT Title Patient Adherence to Immunosuppressive Therapy for Chronic Inflammatory Eye Disease Purpose To investigate adherence rates to immunosuppressive therapy (IMT) for treatment of noninfectious inflammatory eye disease (IED), adherence and disease control, and factors associated with nonadherence. Method Retrospective review of medical charts from 2015 to 2020 was conducted on patients with IED at 6 months, 1 and 2 years after initiation of IMT. Results Of 183 patients, adherence rates at 6 months and 1 year were 70% and 58% by 2 years. Eighty-two percent, 78%, and 65% of patients with disease quiescence were adherent at 6 months, 1 and 2 years, respectively. Adherent patients have 1.86 (95% CI 1.09, 3.20) times greater likelihood for disease control compared to nonadherent. Primary reason for nonadherence was patient self-discontinuation. No specific factors were associated with nonadherence. Conclusion Patients on IMT for IED had steady adherence rates up to 1 year, with decreased adherence at 2 years. Adherence to IMT significantly correlates with disease quiescence.

Analyzing the Difference in the Length of Stay (LOS) in Moderate to Severe COVID-19 Patients Receiving Hydroxychloroquine or Favipiravir.

Background: The coronavirus 2019 (COVID-19) disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus led to a global pandemic. HCQ and FPV were used early in the pandemic as a treatment modality for COVID-19. Various studies evaluated the HCQ and FPV effectiveness, based on the mortality endpoint and showed conflicting results. We hypothesize that analyzing the difference in the LOS as a significant endpoint would be of a major interest, especially for healthcare providers, to prevent a lengthy hospitalization and disease progression. Methods: This is a retrospective observational study, conducted via a medical chart review of COVD-19 patients who were admitted between April 2020 and March 2021 with a moderate to severe illness. The LOS endpoint was tested using the paired Wilcoxon signed-rank (WSR) model. Prior to using the WSR model, the balance between the HCQ and FPV groups, the propensity score matching, the LOS distribution, and the normality assumptions were tested. Two sensitivity statistical analyses were conducted to confirm the results (stratified log-rank test and U Welch test after transforming the LOS by the squared root values). Results: A total of 200 patients were included for the analysis: 83 patients in the HCQ group and 117 patients in the FPV group. Thirty-seven patients were matched in each group. The LOS data was positively skewed and violated the normality (Shapiro−Wilk p < 0.001) and had an unequal variance (Levene’s test, p = 0.019). The WSR test showed no statistical significance in the LOS endpoint, with a median of −0.75 days (95% confidence interval: −4.0 to 2.5, p = 0.629), in favor of the HCQ group (four days), in comparison to seven days of the FPV group. The WSR findings were further confirmed with the stratified log rank test (p = 740) and the U Welch test (p = 391). Conclusions: The study concluded that the HCQ and FPV treatments have a comparable effectiveness in terms of the LOS in the moderate to severe COVID-19 patients. This study highlights the importance of analyzing the LOS as a relevant endpoint, in order to prevent the costs of a lengthy hospitalization and disease progression. The current study also emphasizes the importance of applying the appropriate statistical testing when dealing with two-sample paired data and analyzing non-parametric data such as the LOS.