Robert Wood Johnson University Hospital Research Articles

Predicting COVID-19 prognosis in hospitalized patients based on early status.

COVID-19 remains the fourth leading cause of death in the United States. Predicting COVID-19 patient prognosis is essential to help efficiently allocate resources, including ventilators and intensive care unit beds, particularly when hospital systems are strained. Our PLABAC and PRABLE models are unique because they accurately assess a COVID-19 patient's risk of death from only age and five commonly ordered laboratory tests. This simple design is important because it allows these models to be used by clinicians to rapidly assess a patient's risk of decompensation and serve as a real-time aid when discussing difficult, life-altering decisions for patients. Our models have also shown generalizability to external populations across the United States. In short, these models are practical, efficient tools to assess and communicate COVID-19 prognosis.

Biologic medications for asthma

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, N.J. Kavitha S. Dalal is a critical care clinical pharmacist at Virtual Hospital – Marlton Campus. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Single-Position Robot-Assisted Laparoscopic Right Ileal Ureter Interposition

Clinical History: The patient is a 45-year-old woman with a history of cervical cancer with radiation-induced pan-ureteral stricture. The patient was deemed to be essentially cancer free and was managed with stent placement for chronic duration. Upon further imaging, up-and-down-o-gram and cystoscopy demonstrated pan-ureteral stricture managed with right nephrostomy tube. Patient elected to proceed with right ureteral repair for definitive treatment with risks, benefits, and alternatives explained. Physical Examination: No abnormal physical examination findings. Diagnosis: Right pan-ureteral stricture. Data series on patients with ureteral stricture disease managed with ileal ureter robotic reconstruction at Robert Wood Johnson University Hospital: Intervention: Ports were placed similar to pelvic procedure with tilted axis, skewing the right-sided ports up and skewing the left-sided ports down to allow for better reach up towards the right ureteropelvic junction. Specific port placement used for this ileal ureter interposition allowed for the patient to remain in a single dorsal lithotomy position throughout the entire procedure. Steps for the right ileal ureter interposition procedure included isolation and division of the ileum, side-to-side bowel anastomosis, anastomosis of distal ureter to bladder and placement of a Double-J stent from distal to proximal part of ileal loop, incision of renal pelvis, and side-to-side anastomosis between ileal segments and renal pelvis. Follow-up/Outcomes: Patient's nephrostomy tube was removed intraoperatively. Estimated blood loss was 50 mL with no intraoperative complications. Patient was stable with an unremarkable postoperative course, and postoperative imaging demonstrated preserved renal function. Patient was discharged on postoperative day 2. Patient's stent was removed 4 weeks postoperatively with no restenosis. The procedure was performed effectively without postoperative complications, and patient had a follow-up mercaptuacetyltriglycine renal scan performed 3 months after surgery, which showed marked improvement of right hydroureteronephrosis. Patient was well at last follow-up, showing how robotic ileal ureteral reconstruction is a viable strategy for definitive repair of extensive ureteral defects. Source of Work: N/A, unfunded Regarding commercial associations, S.E.E. is a consultant for Intuitive Surgical. All other authors do not have any commercial associations or potential conflicts of interest. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure; attached is the patient consent statement. Runtime of video: 5 mins 46 secs

Combination inhalers for the treatment of COPD.

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, NJ. Kavitha S. Dalal is a critical care clinical pharmacist at Virtua Marlton Hospital in Marlton, NJ. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Medications for diabetes.

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, N.J. Kavitha S. Dalal is a critical care clinical pharmacist at Virtua Marlton Hospital in Marlton, N.J. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Resident Burnout Trends During COVID-19: A Retrospective Observational Study

This study was designed to assess the effects of the coronavirus disease pandemic on job satisfaction (JS) and burnout among surgical sub-specialty residents. This is a retrospective, observational, survey-based study. We administered a web-based questionnaire to surgical sub-specialty residents, and results were compared to a prior study in 2016. The questionnaire included elements on demographics, JS, burnout, and self-care habits. Basic statistical analyses were used to compare data from 2020 and 2016. This study takes place at Robert Wood Johnson University Hospital, a single mid-sized New Jersey-based academic institution. This survey was sent to all obstetrics and gynecology and general surgery residents from every postgraduate year based out of our institution. The survey was sent to a total of 50 residents across the 2 programs. Forty total residents responded to the survey, with a response rate of 80%. JS was significantly higher in 2020 than 2016 (p < 0.001). There were no differences between postgraduate years for 2020 or 2016 in emotional exhaustion (p = 0.29, p = 0.75), personal accomplishment (p = 0.88, p = 0.26), or depersonalization (p = 0.14, p = 0.59) burnout scores. A total of 0% of residents in 2020 worked fewer than 61 hours per week. Residents in 2020 exercised more (40.0% vs 21.6%), had similar alcohol usage (60%), and had similar diets to residents in 2016. Residents in 2020 were less likely to regret their specialty (7.5% vs 21.6%), consider changing residencies (30.0% vs 37.8%), or consider a career change (15.0% vs 45.9%). JS scores were significantly higher during the coronavirus disease pandemic. The cancellation of elective surgeries led to a lighter workload for surgical residents. Residents were uncertain of their role during the pandemic, however, new stressors encouraged residents to seek alternative methods for personal wellness.

Medications for Dyslipidemia

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, N.J. Kavitha S. Dalal is a critical care clinical pharmacist at Virtua Hospital – Marlton Campus. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Abstract 15016: Inferior ST Segment Depression Identifies Proximal Left Anterior Descending Culprit Lesions in Anterior ST Elevation Myocardial Infarction

Introduction: Anterior wall ST elevation myocardial infarction (STEMI) is caused by occlusion of the left anterior descending (LAD) coronary artery. Proximal LAD occlusions are associated with larger infarcts and more complications. However, there is limited data demonstrating a relationship between ECG changes and the location of the LAD culprit lesion. Objective: To determine if patterns of ST elevations (STE)/depressions (STD) on the 12 lead ECG can predict if the culprit lesion in an anterior STEMI is in the proximal LAD. Methods: We performed a retrospective chart review of ECGs obtained from a database of patients diagnosed with myocardial infarction at Robert Wood Johnson University Hospital from January 2009 to December 2016. Lesions, defined as proximal or non-proximal with respect to the first diagonal of the LAD, were assigned according to the Bypass Angioplasty Revascularization Investigation (BARI) Protocol. Each lesion was assigned to one of the 4 ECG patterns described in Table 1. An analysis of variance was used to determine if the difference in ECG characteristics between groups was significant. Results: Of 447 ECGs denoted as anterior wall STEMIs, 227 met inclusion criteria. In total, 104 lesions were defined as proximal and 123 were non-proximal. There was a difference in the ECG pattern of proximal versus non-proximal culprits category (p = 0.006). Proximal culprit lesions were more likely to have STE in the precordial leads combined with STD in the inferior leads, whereas non-culprit lesions were more likely to have STE in the precordial leads without any STE or STD in the limb leads. Conclusions: In anterior STEMIs, proximal culprit lesions were more likely to exhibit ST elevations in precordial leads and ST depressions in inferior leads, compared to non-proximal culprit lesions, which were more likely to have ST elevations in only the precordial leads. Concomitant STE in lateral leads without inferior STD did not distinguish between the 2 groups.

Medications for Gastroesophageal Reflux Disease (GERD).

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, N.J. Kavitha S. Dalal is a critical care clinical pharmacist at Virtua Hospital – Marlton Campus. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

Screening for Social Risk Factors in the ICU During the Pandemic.

IMPORTANCE:Due to limitations in data collected through electronic health records, the social risk factors (SRFs) that predate severe illness and restrict access to critical care services are poorly understood.OBJECTIVES:This study explored the feasibility and utility of directly eliciting SRFs in the ICU by implementing a screening program.DESIGN, SETTING, AND PARTICIPANTS:Five hundred sixty-six critically ill patients at the medical ICU of Robert Wood Johnson University Hospital from July 1, 2019, to September 31, 2021, were interviewed for SRFs using an adapted version of the American Academy of Family Physicians’ Social Needs Screening Tool.MAIN OUTCOMES AND MEASURES:For each SRFs, we compared basic demographic factors, proxies of socioeconomic status, and severity score between those with and without the SRFs through chi-square tests and Wilcoxon rank-sum tests. Furthermore, we determined the prevalence of SRFs overall, before, and during the COVID-19 pandemic.RESULTS:Of critically ill patients, 39.58% reported at least one SRF. Age, zip-code matched median household income, and insurance type differed depending on the SRFs. Notably, patients with SRFs were admitted with a lower average severity score, indicating reduced risk in mortality. Since March 2020, the prevalence of SRFs in the ICU overall fell from 54.47% to 35.44%. Conversely, the proportion of patients unable to afford healthcare increased statistically significantly from 7.32% to 18.06%.CONCLUSIONS AND RELEVANCE:Screening for SRFs in the ICU detected the presence of disproportionally low-risk patients whose access to critical care services became restricted throughout the pandemic.

More Accessible COVID-19 Treatment Through Monoclonal Antibody Infusion in the Emergency Department.

IntroductionMonoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers. We examined characteristics of two groups of patients who received MAB infusion in the Robert Wood Johnson University Hospital (RWJUH) ED in New Brunswick, New Jersey: 1) patients who tested positive for COVID-19 in the ED and received ED infusion; and 2) patients who tested positive elsewhere and were referred to the ED for infusion. The process for the latter group was similar to the more common national model of patients testing COVID-19 positive in the community and then being referred to an infusion center for MAB therapy.MethodsWe performed a cross-sectional retrospective health record review of all adult patients presenting to the ED from November 20, 2020–March 15, 2021 who received MAB infusion at RWJUH ED (N = 486). Patients were identified through the electronic health record system by an administrative query, with manual chart review for any additional characteristics not available through the query. We compared the two groups using chi-squared tests for categorical variables and t-tests for continuous variables.ResultsWe found higher proportions of Black (18% vs 6% P < 0.001, statistically significant), Hispanic (19% vs 11% P = 0.02), Medicaid (12% vs 9% P = 0.01), and uninsured (17% vs 8% P = 0.01) patients who tested positive for COVID-19 in their ED visit and then received MAB therapy during their visit than patients tested elsewhere in the community and referred to the ED for MAB therapy.ConclusionThese findings suggest that providing MAB infusion in the ED allows increased access for patients traditionally marginalized from the healthcare system, who may be at risk of longer disease duration and complications from COVID-19.

Analysis of pediatric emergency department patient volume trends during the COVID-19 pandemic.

During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.

A Simple Scoring Tool to Predict Medical Intensive Care Unit Readmissions Based on Both Patient and Process Factors.

Although many predictive models have been developed to risk assess medical intensive care unit (MICU) readmissions, they tend to be cumbersome with complex calculations that are not efficient for a clinician planning a MICU discharge. To develop a simple scoring tool that comprehensively takes into account not only patient factors but also system and process factors in a single model to predict MICU readmissions. Retrospective chart review. We included all patients admitted to the MICU of Robert Wood Johnson University Hospital, a tertiary care center, between June 2016 and May 2017 except those who were < 18 years of age, pregnant, or planned for hospice care at discharge. Logistic regression models and a scoring tool for MICU readmissions were developed on a training set of 409 patients, and validated in an independent set of 474 patients. Readmission rate in the training and validation sets were 8.8% and 9.1% respectively. The scoring tool derived from the training dataset included the following variables: MICU admission diagnosis of sepsis, intubation during MICU stay, duration of mechanical ventilation, tracheostomy during MICU stay, non-emergency department admission source to MICU, weekend MICU discharge, and length of stay in the MICU. The area under the curve of the scoring tool on the validation dataset was 0.76 (95% CI, 0.68-0.84), and the model fit the data well (Hosmer-Lemeshow p = 0.644). Readmission rate was 3.95% among cases in the lowest scoring range and 50% in the highest scoring range. We developed a simple seven-variable scoring tool that can be used by clinicians at MICU discharge to efficiently assess a patient's risk of MICU readmission. Additionally, this is one of the first studies to show an association between MICU admission diagnosis of sepsis and MICU readmissions.

In-Hospital Mortality and Prediction in an Urban U.S. Population With COVID-19.

Coronavirus disease 2019 (COVID-19) has touched every aspect of society, and as the pandemic continues around the globe, many of the clinical factors that influence the disease course remain unclear. A useful clinical decision-making tool is a risk stratification model to determine in-hospital mortality as defined in this study. The study was performed at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, New Jersey, USA. Data was extracted from our electronic medical records on 44 variables that included demographic, clinical, laboratory tests, treatments, and mortality information. We used the least absolute shrinkage and selection operator regression with corrected Akaike’s information criterion to identify a subset of variables that yielded the smallest estimated prediction error for the risk of in-hospital mortality. During the study period, 808 COVID-19 patients were admitted to RWJUH. The sample size was limited to patients with at least one confirmed in-house positive nasopharyngeal swab COVID-19 test. Pregnant patients or those who were transferred to our facility were excluded. Patients who were in observation and were discharged from the emergency room were also excluded. A total of 403 patients had complete values for all variables and were eligible for the study. We identified significant clinical, laboratory, and radiologic variables determining severe outcomes and mortality. An in-hospital mortality risk calculator was created after the identification of significant factors for the specific cohort, which were abnormal CT scan or chest X-ray, chronic kidney disease, age, white blood cell count, platelet count, alanine aminotransferase, and aspartate transaminase with a sensitivity, specificity, and negative predictive value of 82%, 72%, and 93%, respectively. While numerous reports from around the globe have helped outline the pandemic, demographic factors vary widely. This study is more applicable to an urban, highly diverse population in the United States.

Reduction of Clostridium Difficile Infection in an Academic Medical Center Blood and Marrow Transplant Population

Background/Aim: Clostridium difficile infection (CDI) is the leading cause of infectious diarrhea among hospitalized patients. Blood and Marrow Transplant patients appear to be one of the most vulnerable populations due to previous antimicrobial exposure, graft vs. host disease and prolonged hospitalizations. CDI in cancer patients is associated with higher mortality rates and prolonged hospitalization. CDI affects the course of the disease by delaying treatments such as chemotherapy. Furthermore, the estimated CDI infection-related costs are 4.8 billion dollars for acute care facilities alone. Methods: In 2015, an increase in house-wide CDI at Robert Wood Johnson University Hospital occurred and triggered an extensive analysis of these cases with Blood and Marrow Transplant and leukemic patients totaling 30% of all CDI in the hospital in 2019. This increase occurred despite the previous implementation of Tru D ultraviolet radiation for all CDI rooms and all Blood and Marrow Transplant unit rooms. Several other initiatives including decreased use of proton pump inhibitors, decreased utilization of piperacillin-tazobactam and house-wide monitoring of hand hygiene did not significantly decrease the percentage of CDI comprised by Oncology patients. In 2018, various other CDI prevention initiatives included: daily Chlorhexidine bathing for adults, implementation of a nursing specimen collection sheet with CDI Criteria; cleaning with OxyCide sporicidal hospital disinfectant, and ongoing hand hygiene champion training with the implementation of an electronic hand hygiene system. Although this resulted in a house-wide CDI SIR &amp;lt; 1 for 3 out of 4 Quarters of 2018, which was a 13% decrease from 2017, there was still no change in the rates in oncology population comprising 25% of all CDI cases. In 2019, CDI orders were updated to increase the denial of testing if patients received laxatives within the last 48 hours and work began with nursing to startscreening upon admission for diarrhea within the past 48 triggering a CDI order. Again, the 2019 house-wide CDI SIR decreased (0.903) but Blood and Marrow Transplant and leukemic patients CDI increased, making up 30% of all CDI cases. A retrospective review of all oncology CDI cases was conducted, noting that all tested PCR positive. A Blood and Marrow Transplant- specific action plan was developed which included the initiation of prophylactic oral Vancomycin on admission for all allogeneic and autologous patients. Results: After implementation of prophylactic oral vancomycin, there have been 9 CDI in the first 7 months of 2020 in the oncology population and only 1 CDI in the Blood and Marrow Transplant and leukemic population during this timeframe. This is an 89% decrease from the same period of 2019 for the Blood and Marrow/leukemic population. In addition, only 3.7% of the house-wide CDI is from the Blood and Marrow Transplant and leukemic population; 23% of the house-wide CDI is from the Oncology population. As of yet, np untoward effects have been seen after this implementation. The incidence of documented bacteremia has remained constant at approximately 1.5 patients/ quarter; acute GVHD in allogeneic patients has remained constant at approximately 4 patients/ quarter. Conclusions: The utilization of vancomycin prophylactically upon admission for all autologous and allogeneic patients may have a significant impact on CDI rates in the oncology population. More time is needed to evaluate the effects of this at Robert Wood Johnson University Hospital but this is the first and only intervention that has helped to decrease the CDI rates in Oncology in 5 years. Next steps include participating in a national collaborative on CDI prevention with several other similar institutions to drive actions for improvement. Goals of this collaboration include strengthening our antibiotic stewardship committee, to have a dedicated staff person to coordinate CDI prevention activities including nurse and physician champions and to increase adherence to use of hand hygiene/ gowns/ gloves for families and visitors. Disclosures No relevant conflicts of interest to declare.

Rapid Processing and Drug Evaluation in Glioblastoma Patient-Derived Organoid Models with 4D Bioprinted Arrays

SummaryGlioblastoma is the most common and deadly primary brain malignancy. Despite advances in precision medicine oncology (PMO) allowing the identification of molecular vulnerabilities in glioblastoma, treatment options remain limited, and molecular assays guided by genomic and expression profiling to inform patient enrollment in life-saving trials are lacking. Here, we generate four-dimensional (4D) cell-culture arrays for rapid assessment of drug responses in glioblastoma patient-derived models. The arrays are 3D printed with thermo-responsive shape memory polymer (SMP). Upon heating, the SMP arrays self-transform in time from 3D cell-culture inserts into histological cassettes. We assess the utility of these arrays with glioblastoma cells, gliospheres, and patient derived organoid-like (PDO) models and demonstrate their use with glioblastoma PDOs for assessing drug sensitivity, on-target activity, and synergy in drug combinations. When including genomic and drug testing assays, this platform is poised to offer rapid functional drug assessments for future selection of therapies in PMO.

Physostigmine for Antimuscarinic Toxicity

Raghad Saadi is an Emergency Medicine Clinical Pharmacist at Robert Wood Johnson University Hospital, New Brunswick, NJ, and Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ. Kristin Bohnenberger is a Clinical Assistant Professor and a Clinical Pharmacist/Toxicologist at Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, and Penn Medicine Princeton Medical Center, Plainsboro Township, NJ.

Cryoprecipitate Usage and Cost at a Tertiary Care Hospital Between 2010 and 2017

Abstract Introduction Cryoprecipitate (CRYO), a blood product prepared from FFP, is rich in fibrinogen, von Willebrand’s factor, and factors VIII and XIII. ​The major indication for CRYO transfusion is fibrinogen deficiency with increased risk of bleeding when fibrinogen is &lt;100 mg/dL, a transfusion trigger rarely followed by the house staff or other clinicians. To limit wastage, Transfusion Services issue them as pools of five individual CRYO units. The use of CRYO at Robert Wood Johnson University Hospital (RWJUH) has significantly risen since 2010, so we conducted a study to identify the factors leading to increased CRYO transfusions. Methods Data on CRYO transfusions from 2010 to 2017 were obtained and analyzed for trends in overall usage and by nursing unit/departments. Cost-analysis was performed to determine the cost of CRYO usage. Conclusion Overall, CRYO usage has risen since 2010, with a sharp increase between 2015 and 2017 attributed to increased transfusions in the operating room (OR), surgical intensive care unit, and hematology-oncology units. There was a sixfold rise in transfusions in the hematology-oncology units. During this time, the lower limit of the fibrinogen reference range decreased from 234 to 190 mg/dL along with a drop in the number of trauma alerts. Values less than the lower reference range were used as the transfusion trigger by some overzealous hematology fellows. Cost-analysis showed that RWJUH lost 75% revenue per patient based on Medicare reimbursement despite efforts to limit wastage and lowering purchasing cost per unit by changing to a new blood supplier. The major determinants of intensified CRYO transfusions at RWJUH are (1) changes in the fibrinogen reference range concomitant with enhanced awareness, monitoring, and early treatment of hypofibrinogenemia, particularly in hematology-oncology units and (2) the complexity of surgical procedures (ie, VAD procedures) requiring more CRYO transfusions rather than the number of trauma alerts.

Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha.

Purpose To compare the initial clinical features, laboratory values, and bone mineral density among patients with primary hyperparathyroidism (PHPT) in Changsha (China) and New Brunswick (USA). Methods In this retrospective study, we reviewed 169 PHPT patients who presented at Robert Wood Johnson University Hospital and 133 PHPT patients who presented at the Second Xiangya Hospital of Central South University in the same time period. The following characteristics were compared between the groups: age, gender, BMI, serum calcium, alkaline phosphatase (AKP), albumin, intact PTH (iPTH), 25-hydroxyvitamin D (25 (OH) D), fasting blood glucose levels, and bone mineral density (BMD). All these parameters were also compared according to gender and menopausal status. iPTH associations were also assessed along with several other parameters. Results PHPT patients from Changsha had higher serum calcium, iPTH, and AKP levels but lower 25 (OH) D levels than the patients from New Brunswick (p < 0.05). Patients in Changsha had lower T-scores and Z-scores in both the lumbar spine and hip regions than those in New Brunswick (p < 0.05). Patients in New Brunswick had lower percentages of parathyroid adenoma and kidney stones. Serum iPTH level was positively correlated with serum calcium and serum AKP levels in both Changsha and New Brunswick (p < 0.05). Conclusions There are distinct biochemical and clinical differences between patients with PHPT in China and the United States. Our study revealed that Asian PHPT patients from Changsha presented more severe PHPT profiles, lower bone mineral density, and higher incidence of renal stones.

Publish or perish: Success with publication in pharmacy residency training

Background and purposePharmacy residency training standards require development of medical writing skills. These skills are fundamental to pharmacy clinicians and scholars alike. Despite this requirement, new practitioners and seasoned clinicians frequently struggle with scholarly development and manuscript generation for a variety of reasons, ranging from lack of experience or familiarity with the process of peer-review submission to time constraints. Educational activity and settingWe describe a process for fostering pharmacy resident scholarship and publication utilized at Robert Wood Johnson University Hospital, including the stages of the project development process and corresponding responsibilities during each phase of the manuscript submission process. From identification of interest, to project and manuscript development, review, submission, revision, and reflection, our postgraduate pharmacy residents receive guidance and structure from a preceptor mentor to usher them through this experience for the first time. FindingsThe program has had success utilizing this structured approach to supporting residency publication efforts, with the preparation of 23 manuscripts that have resulted in peer-reviewed publications from 28 residents graduating between 2013 and 2017. This results in a resident authorship rate of 82%. SummaryAlthough medical writing and manuscript development may not be an intuitive process, it is imperative that preceptors and individuals interacting with postgraduate pharmacy trainees consider exposing their trainees to this process, with foresight into thinking about a structured approach to publication at the onset of project development.