Prisma Health Research Articles

The role of ethnicity, biological sex, and psychotropic agents in early and late onset Alzheimer's disease.

This study investigates differences in pharmacological and demographic factors among male and female patients with Late-onset Alzheimer's disease (LOAD) and Early-onset Alzheimer's disease (EOAD). Data are from 10,126 AD patients, 9,290 were diagnosed with LOAD, while 836 were diagnosed with EOAD. Data were collected from the Prisma Health Upstate Alzheimer's patients' registry between 2016 and 2021. The logistic regression analysis was used to assess the association between pharmacological and demographic factors in males and females with LOAD and EOAD. In the adjusted analysis for males, patients that were administered memantine [odd ratio (OR) = 1.588, 95% CI, 1.175-2.145, p = 0.003], and buspirone [OR = 1.971, 95% CI, 1.221-3.183, p = 0.006] were more likely to be associated with EOAD, while increasing age [OR = 0.816, 95% CI, 0.799-0.834, p < 0.001] was associated with LOAD. Female patients with a history of alcohol (ETOH) use were more likely to be associated with EOAD while increasing age [OR = 0.845, 95% CI, 0.834-0.857, p < 0.001], treatment with memantine [OR = 0.774, 95% CI, 0.627-0.956, p = 0.017], African Americans [OR = 0.621, 95% CI, 0.462-0.835, p = 0.002] and tobacco use [OR = 0.529, 95% CI, 0.424-0.660, p < 0.001] were associated with LOAD. Our findings identified specific demographic and pharmacological factors associated with males and females with LOAD and EOAD. These findings suggest the need to develop strategies to eliminate disparity in the care of LOAD or EOAD patients.

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure.

Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65−74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65−74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65−74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018−0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987−0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196−1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137−0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009−1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171−9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242−37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008−1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005−1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65−74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65−74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

1843. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection due to Streptococcus species

Abstract Background Effectiveness of oral antibiotics for transition of therapy in uncomplicated bloodstream infections (BSI) due to Streptococcus species remains unclear. This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in patients with uncomplicated BSI due to Streptococcus species compared to standard intravenous (IV) only therapy. Methods Adult patients with uncomplicated BSI due to Streptococcus species from April 2016 through June 2020 in 7 hospitals within Prisma Health in South Carolina were evaluated. Patients who died within 7 days of BSI were excluded to reduce the impact of survival bias. Multivariate Cox proportional hazards regression was used to examine time to treatment failure, defined as a composite of all-cause mortality and BSI recurrence within 90 days. Results A total of 222 patients with Streptococcus species BSI were included in the analysis. Overall, the median age was 62 years, and 116 (52.3%) were men. Beta-hemolytic streptococci (87; 39.2%) were the most common bloodstream isolates, followed by S. pneumoniae (76; 34.2%) and viridans group streptococci (59; 26.6%). Among this cohort, 99 patients received only IV antibiotics, and the remaining 123 received partial oral therapy. The median duration of therapy in both groups was 14 days, and median duration of IV antibiotics prior to oral transition was 4 days. Most patients in the partial oral group were transitioned to either oral beta-lactams (62; 50.4%) or fluoroquinolones (47; 38.2%). Of the IV only group, 46 (46.5%) required outpatient IV antibiotics. Treatment failure rates were 12.0% and 4.4% in the IV only and partial oral therapy groups, respectively (p=0.04). After adjustments for age, chronic comorbidities, and initial response to therapy within the first 72-96 hours, there was no difference in the risk of treatment failure in the partial oral compared to IV only group (hazards ratio 0.55, 95% CI 0.19-1.64; p=0.28). Conclusion Transitioning patients from IV to oral antibiotics may be a reasonable strategy in the management of uncomplicated BSI due to Streptococcus species. Partial oral therapy does not seem to have a higher treatment failure rate than standard IV only therapy and may spare many patients from outpatient IV antibiotics. Disclosures All Authors: No reported disclosures.

447: EFFICACY OF NASAL DECONTAMINATION WITH POVIDONE-IODINE COMPARED TO MUPIROCIN IN CARDIAC SURGERY

Introduction: Surgical site infections (SSIs) are considered the most common and costly healthcare-associated infection; coronary artery bypass graft (CABG) surgeries have the second highest cumulative incidence. Mupirocin is considered the gold standard intranasal decontamination treatment; however, povidone-iodine has emerged as an alternative. The objective of this study is to determine if universal nasal decontamination with povidone-iodine is as effective as targeted mupirocin in the prevention of SSIs in cardiac surgery patients. Methods: A single-center, retrospective, pre/post intervention analysis was conducted on adult patients admitted to Prisma Health–Upstate January 2017 to December 2021. Included patients received cardiac surgery for CABG and preoperative nasal decontamination with mupirocin (January 2017-December 2018) or povidone-iodine (January 2019-December 2021). The primary outcome assessed was SSI incidence. Secondary outcomes included S. aureus SSIs, non-surgical site S. aureus infection, in-hospital and 30-day mortality, hospital, and intensive care unit (ICU) length of stay (LOS), and cost. Results: Five hundred patients were screened, and 237 patients met inclusion criteria. Included patients were grouped into those receiving mupirocin (N=70) and povidone-iodine (N=167). Significant differences in baseline characteristics included the number of males and composite of past medical history. There was no difference in incidence of SSIs identified between the povidone-iodine and mupirocin (6 versus 3, p=0.726), even when stratified by SSI type (p=0.786). No differences were identified in any of the secondary outcomes between the povidone-iodine and mupirocin groups; however, evaluation of the safety outcome revealed more adverse events in the mupirocin group (p=0.025). Conclusions: This study provides evidence of efficacy and safety of povidone-iodine for preoperative nasal decontamination in cardiac surgery patients. Povidone-iodine may be considered as an alternative to mupirocin in the cardiac surgery population.

Robotic repair of non-midline hernias.

Non-midline abdominal wall hernias present unique anatomic challenges, making repair more complex. The constraints of the peritoneal cavity, pelvis, and costal margin limit the utility of intraperitoneal mesh repair, and extra-peritoneal repairs have traditionally been performed using open techniques, often resulting in higher wound morbidity. Advances in minimally invasive surgery make visualization and dissection of such complex cases feasible, with all the attendant benefits of a minimally invasive over an open approach. In this study, we examined the use of the robotic platform to repair non-midline hernias. Retrospective review of all non-midline abdominal wall hernias was performed robotically at Prisma Health, excluding parastomal hernias. Study conducted and outcomes reported according to STROBE statement. Repair was performed in the retro-rectus (n = 3) or retro-rectus + transversus abdominis release (TAR) (n = 39), pre-peritoneal (n = 22), and intraperitoneal (n = 1). Mean hernia width was 9.4cm, permanent synthetic mesh used for all repairs. Mean LOS was 1.5days. Surgical-site occurrence (SSO) occurred in 49.2%, 78% of which were simple seroma. Three patients (4.6%) developed surgical-site infection (SSI). Two recurrences were identified with a mean follow-up of 11 mos. The robotic platform facilitates complex dissection to allow minimally invasive, extra-peritoneal repair of complex non-midline hernias. This approach overcomes the anatomic constraints of intraperitoneal mesh repair and the wound morbidity of open repair.

Efficacy of virtual reality assisted guided imagery (VRAGI) in a home setting for pain management in patients with advanced cancer: protocol for a randomised controlled trial

IntroductionPatients with advanced cancer often experience high levels of debilitating pain and pain-related psychological distress. Although there is increasing evidence that non-pharmacological interventions are needed to manage their pain, pharmacologic...

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network.

Background: The relationship between diastolic blood pressure (DBP), risk factors, and stroke severity in acute ischemic stroke (AIS) patients treated in a telestroke network is not fully understood. The present study aims to determine the effect of risk factors on stroke severity in AIS patients with a history of elevated DBP. Material and Methods: We retrospectively analyzed data on stroke severity for AIS patients treated between January 2014 and June 2016 treated in the PRISMA Health telestroke network. Data on the severity of stroke on admission were evaluated using NIHSS scores ≤7 for reduced, and >7 for increased, stroke severity. DBP was stratified as ≤80 mmHg for reduced DBP and >80 mmHg for elevated DBP. The study’s primary outcomes were risk factors associated with improving neurologic functions or reduced stroke severity and deteriorating neurologic functions or increased stroke severity. The associations between risk factors and stroke severity for AIS with elevated DBP were determined using multi-level logistic and regression models. Results: In the adjusted analysis, AIS patients with a DBP ≤ 80 mmHg, obesity (OR = 0.388, 95% Cl, 0.182–0.828, p = 0.014) was associated with reduced stroke severity, while an increased heart rate (OR = 1.025, 95% Cl, 1.001–1.050, p = 0.042) was associated with higher stroke severity. For AIS patients with a DBP > 80 mmHg, hypertension (OR = 3.453, 95% Cl, 1.137–10.491, p = 0.029), history of smoking (OR = 2.55, 95% Cl, 1.06–6.132, p = 0.037), and heart rate (OR = 1.036, 95% Cl, 1.009–1.064, p = 0.009) were associated with higher stroke severity. Caucasians (OR = 0.294, 95% Cl, 0.090–0.964, p = 0.002) and obesity (OR = 0.455, 95% Cl, 0.207–1.002, p = 0.05) were more likely to be associated with reduced stroke severity. Conclusions: Our findings reveal specific risk factors that can be managed to improve the care of AIS patients with elevated DBP treated in the telestroke network.

Curating a knowledge base for individuals with coinfection of HIV and SARS-CoV-2: a study protocol of EHR-based data mining and clinical implementation

IntroductionDespite a higher risk of severe COVID-19 disease in individuals with HIV, the interactions between SARS-CoV-2 and HIV infections remain unclear. To delineate these interactions, multicentre Electronic Health Records (EHR)...

Abstract 5028: Integration of molecular data into cancer patient database

Abstract Background: Precision medicine holds promise of being a more effective method for treating complex diseases such as cancer. Nuanced care is needed, as the development and clinical course of cancer is multifactorial with influences from the general health status of the patient, germline and neoplastic mutations, co-morbidities, and environment including "lifestyle". To tailor an individualized treatment to the patient, such multifactorial data must be presented in an easy-to-use, easy-to-analyze fashion for providers to use effectively. Purpose: To address the need, we have built a searchable database integrating cancer-critical gene mutation status, serum galectin protein markers, serum and tumor glycomic profiles, with clinical, demographic, and lifestyle data points of individual patients. Methods: The initial data was acquired from breast, colon, and lung cancer patients’ serum and biopsy samples from the Prisma Health Cancer Institute Biorepository. The acquired data contains the status of 2,800 COSMIC cancer-critical gene mutations, individual patient profiles of five serum galectins, and serum and biopsy glycan structures from each patient’s glycomic profile. DNA from tumor cells was used to screen the regions frequently mutated in human cancer genes. Multiplex PCR using Ion AmpliSeq࣪ Cancer Hotspot panel v2 was performed by Precision Genetics. Enzyme-linked immunosorbent assay was employed to perform galectin profiling of cancer patient serum samples. Glycomic profiling of serum and biopsy samples was performed by the Emory Comprehensive Glycomic Core. In addition, healthy control values for galectin and glycomic profiles were obtained and added to the patient database for reference. The data is being stored using Microsoft SQL servers and is fed into an interactive web application using RStudio. Results: Our interactive database allows care providers to amalgamate cohorts from these groups to find correlations between different data types with the possibility of finding a "stage signature" based upon a combination of genetic mutations, galectin serum levels, glycan signatures, and patient clinical data and lifestyle choices. Conclusion: Our project provides a framework for an integrated interactive database to analyze molecular and clinical patterns across cancer stages and provides opportunities for increased diagnostic and prognostic power. Citation Format: Basil H. Chaballout, Avery T. Funkhouser, Bailey B. Blair, Jane L. Goodwin, Alexander M. Strigenz, Connie M. Arthur, Julie C. Martin, W. Jeffery Edenfield, Anna V. Blenda. Integration of molecular data into cancer patient database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5028.

Ultrasound-Guided Compared With Non–Ultrasound-Guided Placement of Immediate Postpartum Intrauterine Contraceptive Devices

Immediate postpartum placement of intrauterine devices (IUDs) can help reduce unintended short-interval pregnancy; however, the rate of spontaneous device expulsion is increased. The objective of this study is to evaluate the risk of expulsion with ultrasound-guided placement of immediate postpartum IUDs. Retrospective review of all patients receiving immediate postpartum IUDs after vaginal delivery at Prisma Health Richland Hospital from 2018 to 2020 was performed. Outcomes were available for 78 patients in the ultrasound-guided cohort and for 226 in the control cohort. The expulsion rate was 15.4% (95% CI 8.2-25.3%) for the ultrasound-guided cohort and 14.2% (95% CI 9.9-19.4%) for the control cohort. Our data suggest that using ultrasonography to guide placement of IUDs immediately after vaginal delivery is not associated with the risk of expulsion.

0240 Investigating the Potential for Actigraphy as a Complementary Clinical Tool for Evaluation of Sleep in Patients with Rheumatoid Arthritis

Abstract Introduction Poor sleep is a common complaint among patients with rheumatoid arthritis (RA), but few actively recognize the problem or discuss it with their rheumatologist during the clinical visit. Challenges to identification of sleep issues include a lack of standardized sleep measures used within clinical care and lack of confidence on the part of patients’ articulating how sleep is affected by RA. Clinical management is further complicated by insufficient evidence between sleep quality and disease symptomology. The objective of this study was to identify correlations between sleep measures assessed through self-report and actigraphy with disease activity for patients with RA. Methods In a prospective, cross-sectional study, a sample of 15 participants diagnosed with RA were recruited through convenience sampling. Consenting participants self-reported sleep quality and disease activity using Pittsburgh Sleep Quality Index (PSQI) and Routine Assessment of Patient Index Data 3 (RAPID-3). Participants’ sleep quality was also measured using actigraphy which monitors wrist movement by wearing a watch. Daily actigraphy measures of sleep efficiency, latency, and fragmentation were averaged over 6 nights. Actigraphy measures were correlated to the PSQI and RAPID-3 through Spearman correlations. Results The sample was mostly Caucasian women with an average age of 55 years, generally reflective of the population with RA. The results demonstrated weak, nonsignificant correlations between self-reported measures of sleep and average sleep efficiency (0.12, p=0.66), latency (0.10, p=0.72), and fragmentation (-0.13, p=10). Additionally, weak, nonsignificant correlations existed between disease activity and average sleep efficiency (0.09, p=0.75), latency (0.35, p=0.19), and fragmentation (-0.12, p=65). Conclusion This study’s implications suggest actigraphy may provide complementary information to self-reported measures of sleep. Such information may support patients’ articulation of sleep issues to the rheumatologist. Further research is necessary to understand how actigraphy measures can be effectively summarized for use by the patient and rheumatologist to discuss sleep issues during the clinical encounter as well as their ability to support clinical diagnosis of sleep disorders. Support (If Any) Support: Prisma Health Upstate Seed Grant 2019-2020. University of South Carolina Magellan Scholar &amp; Apprentice Programs funding Shelby Rader. Furman University Center for Engaged Learning for summer internship funding for Ava Cox.

Abstract 47: Project TURNIP: Teleproctoring Of Rural Stroke Patients With Advanced Nurse Practitioner

Introduction: Prisma Health Tuomey (PHT) is a rural-based spoke hospital, with advanced Nurse Practitioners (ANP). Prisma Health Richland (PHR) is an urban-based hub hospital with access to vascular neurologists. In this ongoing project we evaluated the effectiveness of Zeriscope, a web-based, HIPAA compliant, teleproctoring platform, for ANP evaluation of etiology of ischemic stroke. Methods: PHT uses a web-based, HIPAA compliant, telemedicine platform, Zeriscope, to provide a live interactive video stream to PHR, a certified Comprehensive Stroke Center 45 miles away. Zeriscope uses a mobile exam headset, comprised of a camera attached to a cellphone and an audio headset, to provide two-way audio and visual communication between an APP and a board-certified vascular neurologist (Figure). The care was provided in inpatient setting with full access to neuroimaging, vascular imaging, cardiac imaging, and long-term monitoring. Patients evaluated directly by teleneurology platform in the PHT emergency room for TPA and thrombectomy were transferred to PHR and excluded from the teleproctoring assessment. Results: Fifty-two ischemic stroke and TIA patients (age 67.8 ± 12.7, 52 % African American, 69 % Males) were evaluated and treated in 4-month period from April to August 2021. Patients underwent a standardized stroke work-up to determine stroke etiology, which was classified by TOAST criteria (11.8% LAA, 19.6% Cardioembolic, 27.5% Lacunar, 39.2% Cryptogenic and 1.9% Undetermined). All patients received best medical management based on the secondary stroke prevention guidelines. To date, no patients experienced complications or were readmitted or needed transfer to a stroke center. Conclusion: Tele-proctoring is a feasible method of delivering stroke care that has not been previously implemented in a rural hospital. The use of Zeriscope was practical and effective in determination of ischemic stroke etiology and implementation of best practice guidelines.

Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection.

Early clinical failure criteria (ECFC) were recently introduced to predict unfavorable outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC include hypotension, tachycardia, tachypnea or mechanical ventilation, altered mental status, and leukocytosis evaluated at 72-96h after BSI. The aim of this retrospective cohort study was to assess performance of ECFC in predicting 28-day mortality in Enterococcus species BSI. Hospitalized adults with Enterococcus species BSI at Prisma Health hospitals from 1 January 2015 to 31 July 2018 were identified. Multivariate logistic regression was used to determine the association between ECFC and 28-day mortality. Area under the receiver operating characteristic (AUROC) curve was used to measure model discrimination. Among 157 patients, 28 (18%) died within 28days of BSI. After adjustments in multivariate model, the risk of 28-day mortality increased in the presence of each additional ECFC (OR 1.6, 95% CI 1.2-2.3, p = 0.005). Infective endocarditis (OR 3.9, 95% CI 1.4-10.7, p = 0.01) was independently associated with 28-day mortality. AUROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best breakpoint. Mortality was 8% in patients with ECFC < 2 compared to 33% in those with ECFC ≥ 2 (p < 0.001). ECFC had good discrimination in predicting 28-day mortality in patients with Enterococcus species BSI. These criteria may have utility in future clinical investigations.

Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score

ObjectivesThe quick Pitt bacteremia score (qPitt) predicts mortality in patients with serious infections due to gram-negative bacteria. This retrospective cohort study examines utility of qPitt to predict mortality in patients with Staphylococcus aureus bloodstream infection (SAB). MethodsMultivariate logistic regression was used to examine risk factors for 28-day mortality in hospitalized adults with SAB at four Prisma Health hospitals in South Carolina, USA from January 2015 to December 2017. Area under receiver operating characteristic curve (AUROC) was used to examine model discrimination. ResultsAmong 692 patients with SAB, 305 (44%) had methicillin-resistant S. aureus (MRSA), and 129 (19%) died within 28 days. After adjustment for age, comorbidities, and MRSA, each component of the qPitt was associated with 28-day mortality. There was a 3-fold increase in the risk of 28-day mortality for each one-point increase in qPitt. Predicted 28-day mortality was 3%, 9%, 22%, 45%, and 70% for qPitt of 0, 1, 2, 3, and ≥4, respectively. AUROC of the qPitt in predicting 28-day, 14-day, and in-hospital mortality were 0.80, 0.81, and 0.80, respectively. ConclusionsThe qPitt predicts mortality with good discrimination in SAB. These results support using qPitt as a measure of acute severity of illness in future studies.

P067 Immune Checkpoint Inhibitor Colitis in a Community-Based Hospital System.

Immune checkpoint inhibitors (ICIs) have significantly changed the oncologic treatment landscape for a wide array of cancers over the past few decades. While these medications can produce a durable remission for patients they also come with a risk of inflammatory toxicities. With the widespread use of immune checkpoint inhibitors there have been increased reports of immune-related adverse events (irAEs) including severe gastrointestinal toxicities such as colitis. While multiple studies have assessed ICI colitis in tertiary care settings little is reported on the characteristics and treatment outcomes of ICI colitis in a community-based population. Additionally, the utility of gastroenterologists in the diagnosis and management of ICI colitis is poorly defined. The aim of this study is to report the characteristics and treatment outcomes of ICI colitis in a community-based hospital system. This is a single-center retrospective case-series of patients with ICI colitis. Charts were reviewed from patients in the Prisma Health Upstate Network from 2/1/2016 to 12/31/2020. Potential cases of ICI colitis were identified using a diagnosis code of "toxic colitis", "indeterminate colitis", "unspecified colitis", and "noninfective gastroenteritis and colitis" (ICD-10 K52.1, K 52.3, K 52.89 and K52.9) as well as a prior infusion (within 12 months) of pembrolizumab, nivolumab, cemiplimab, atezolizumab, avelumab, durvalumab, or ipilimumab. Charts were abstracted for demographics, tumor type, checkpoint inhibitor used, mode of colitis diagnosis, endoscopic severity of inflammation, and treatments used. Study was approved by the Institutional Review Board at Prisma Health Upstate. The mean (±SD) age for the 37 patients was 64.1 ± 13.2 years. The patient population was predominantly male (62%) and Caucasian (100%). The cancer type in the patient population were melanoma (43.2%), non-small cell lung cancer (18.9%), renal cell carcinoma (10.8%), and other (27%). Patients with ICI colitis were most-commonly treated with ipilimumab (35.1%), nivolumab (35%), pembrolizumab (10.8%), and other (13.5%). The mean time to colitis onset was 25.7 ± 29.7 weeks. Over 56% of the patient population reported abdominal pain and 45.9% were hospitalized. Only 64.8% were evaluated by a gastroenterologist. Cross sectional abdominal imaging by computed tomography (CT) was obtained in 20 (54.0%) and showed colitis in 13. 54% obtained a colonoscopy with inflammation severity stratified into normal (25.0%), mild (40.0%), moderate (20.0%) and severe (15.0%). Endoscopic extent showed proctitis (0%), left-sided disease (5.0%), right-sided disease (5.0%), pancolitis (55.0%), and isolated ileal disease (25%). Histology showed 90.0% with active inflammation and 10.0% with microscopic colitis. Outcomes were resolution with steroids (64.8%), antibiotics (5.4%), biologic (10.8%), surgery (5.4%), hospice (8.1%). Of those that received biologic therapy, 6 received infliximab and 1 received vedolizumab. As immune checkpoint inhibitors gain approval in more cancer treatment ICI-colitis is being seen in a community-based setting. The most common treatment were steroids and often required a prolonged course. Biologic use in our series (18.9%) was much lower than prior reports from academic tertiary referral centers (>50%). Only 64.8% of patients saw a gastroenterologist for ICI-colitis symptoms. Early gastroenterology referral in the community setting could help to identify more severe disease and patients necessitating escalation to biologic therapy.

Abstract 1122‐000035: Is Age Critical in Determining Stroke Severity Within the Telestroke Network?

Introduction : Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people &gt;65 years of age. In addition, adults &gt;75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages &gt;65 and &lt;75 as well as those ≥75 is not known. In this study, we aim to investigate how age, coupled with various clinical risk factors, affects AIS severity within these two age categories. Methods : This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages &gt;65 and &lt;75 as well as those ≥75 was analyzed using univariate analysis. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to examine the association of specific baseline risk factors or comorbidities associated with worsening or improving neurologic functions. The primary functions were risk factors associated with improving or worsening neurologic outcome in each age category. Results : Adjusted multivariate analysis showed that AIS population of patients &gt;65 and &lt;75 experiencing heart failure (OR = 4.398, 95% CI, 3.912 – 494.613, P = 0.002) and elevated HDL levels (OR = 1.066, 95% CI, 1.009 – 1.126, P = 0.024) trended towards worsening neurologic functions while patients experiencing obesity (OR = 0.177, 95% CI, 0.041 – 0.760, P = 0.020) exhibited improving neurologic functions. For the patients ≥75 years of age, direct admission (OR = 0.270, 95% CI, 0.085 – 0.856, P = 0.026) was associated with improvement of patients treated in the telestroke. Conclusions : Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for &gt;65 and &lt;75 and ≥75 age categories. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions among AIS for patients aged &gt;65 and &lt;75. Obese patients and individuals ≥75 years who were directly admitted were most likely to exhibit improving neurologic functions. Most importantly, findings from this study reveal specific risk factors that can be managed to improve the care in older stroke patients treated in the telestroke network.

Trainee Poster Competition Abstracts Presented at the 122nd Virtual Annual Meeting of the American Association of Colleges of Pharmacy, July 19-22, 2021

### "Alohomora!" Unlocking Student Engagement in an Elective Course Through Themed Competition Abigail M. Alexander, University of South Carolina College of Pharmacy , Caitlin M. Musgrave Mardis, University of South Carolina College of Pharmacy , Andrew Mardis, Prisma Health Richland, University of

After the Match

After the Match

Nurses’ Aesthetic Responses and Emotional Judgments to Senior Leaders’ Use of Language, Action, and Behavior

Mergers can cause high anxiety for nurses. The purpose of this qualitative study was to examine nurses’ emotional responses and experiences with senior leaders’ use of language, action, and behavior during a time of intense organizational change. Branding, allocations of resources, restructuring maneuvers, and leader connection wrapped in contextual fabrics were surfaced by interviews with clinical nurses. Fostering aesthetic responses and emotional judgments may help nurses feel something and to act. Mergers can cause high anxiety for nurses. The purpose of this qualitative study was to examine nurses’ emotional responses and experiences with senior leaders’ use of language, action, and behavior during a time of intense organizational change. Branding, allocations of resources, restructuring maneuvers, and leader connection wrapped in contextual fabrics were surfaced by interviews with clinical nurses. Fostering aesthetic responses and emotional judgments may help nurses feel something and to act. Lucinda Easler, PhD, NEA-BC, is Director of Behavioral Care Services at Prisma Health in Columbia, South Carolina. She can be reached at [ [email protected] ].

Morbidity and Mortality in the Obese Trauma Intensive Care Unit Patient.

Obesity is an epidemic in the United States, known to be associated with comorbidities. However, some data show that obesity may be a protective factor in some instances. The purpose of this study is to determine if there are differences in morbidity and mortality when comparing the obese and non-obese critically ill trauma patient populations. This was a retrospective study conducted at Prisma Health Upstate in Greenville, South Carolina, an Adult Level 1 Trauma Center. Patients over the age of 18years admitted due to trauma from February 6, 2016 to February 28, 2019 were included in this study. Burn patients were excluded. An online trauma database was used to obtain age, sex, body mass index, Glasgow coma score (GCS), injury severity score (ISS), revised trauma score (RTS), days on mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. There were 2365 critically ill trauma patients who met inclusion criteria for this study. 1570 patients were men (66.38%) and mean age was 53.2 ± 20.9. Of the patients, 2166 patients had blunt trauma (91.59%). Median GCS was 15 (interquartilerange [IQR]: 12, 15), median RTS was 12 (IQR: 11, 12), and median ISS was 17 (IQR: 9, 22). Obese critically ill trauma patients had significantly lower odds of mortality than nonobese (OR .686, CI 0.473-.977). Penetrating traumas (OR: 4.206, CI: 2.478, 6.990), increased ISS (OR: 1.095, CI: .473, 1.112), and increased age (OR: 1.036, CI: 1.038, 1.045) were associated with significantly increased odds of mortality. The obesity paradox is observed in the obese critically ill trauma patient population.