State University Wexner Medical Center Research Articles

PO-03-139 HIGH-RESOLUTION CARDIAC MAGNETIC RESONANCE IMAGING FOR LEFT ATRIAL APPENDAGE SIZING AND THROMBUS EXCLUSION PRIOR TO DEVICE CLOSURE

Transesophageal echocardiography and cardiac computed tomography angiography are currently utilized for left atrial appendage closure (LAAC) planning. The advent of high-resolution cardiac magnetic resonance imaging (HR-CMR) now potentially allows for adequate spatial resolution for LAAC planning. This study sought to assess preoperative HR-CMR with software-based sizing vs intraoperative TEE for LAA sizing and thrombus exclusion prior to LAAC. This retrospective study conducted at The Ohio State University Wexner Medical Center included all patients who underwent preoperative HR-CMR and intraoperative TEE for LAAC with Watchman FLX (Boston Scientific, Marlborough, MA) from May to September 2022. For HR-CMR, magnetic resonance angiography (MRA) and late gadolinium enhancement (LGE) sequences were obtained for LAA sizing and thrombus exclusion respectively. A proprietary sizing software (TruPlan, Boston Scientific) was utilized to analyze the MRA sequence to characterize LAA anatomy, predict closure device size, and estimate device compression ratio. HR-CMR was compared to TEE for assessing accuracy of LAA thrombus exclusion, maximum ostial diameter, depth, lobe count, morphology, and accuracy of predicted device size. 16 patients were included, with baseline characteristics notable for 8 (50%) females, age 73 ± 6 years, 30 ± 7 kg/m2 body mass index, 54 ± 8% left ventricular ejection fraction, and 4 ± 2 CHA2DS2-VASc. 15 (94%) cases were successfully completed. There was no significant difference in LAA thrombus exclusion (CMR 14 (88%) vs TEE 16 (100%) cases, p=0.48), maximum ostial diameter (CMR 20.9 ± 4.2 vs TEE 20.6 ± 4.2 mm, p=0.99), depth (CMR 31.1 ± 7.8 vs TEE 26.8 ± 5.6 mm, p=0.09), lobe count (CMR 1.8 ± 0.8 vs TEE 1.4 ± 0.6 lobes, p=0.25), and morphology features (p=0.44). LAA assessments are summarized in Table I. The mean devices deployed per case was 1.1 ± 0.3. In 2 (13%) cases a device downsize was required. 1 case was aborted due to inability to access a very small LAA ostium. On 45-day TEE or CCTA, no peri-device leak ≥5 mm or device-related thrombus were noted. A comparison of standard vs high-resolution contrast-enhanced (CE)-MRA of the LAA is demonstrated in Figure 1. HR-CMR is a viable modality for preoperative LAA sizing and thrombus exclusion with promising results. HR-CMR may provide utility in cases where TEE or CCTA are contraindicated or unavailable.Tabled 1Table IMeasureHR-CMR (N=16)TEE (N=16)P-valueLAA thrombus accurately excluded14 (88%)16 (100%)0.484Minimum LAA ostial diameter (mm)18.0 ± 4.216.6 ± 3.40.335Target LAA ostial diameter (mm)*20.9 ± 4.220.6 ± 4.20.987LAA depth (mm)31.1 ± 7.826.8 ± 5.60.093Number of lobes1.8 ± 0.81.4 ± 0.60.250Morphology0.437Cactus4 (25%)3 (19%)Cauliflower0 (0%)2 (13%)Chicken wing5 (31%)2 (13%)Windsock7 (44%)8 (50%)Other0 (0%)1 (6%)LAA closure device size accurately predicted12 (75%)12 (75%)1.000Values presented as mean ± 1 standard deviation for continuous variables and n (%) for categorical variables. Abbreviations: HR-CMR = high resolution cardiac magnetic resonance imaging, LAA = left atrial appendage, TEE = transesophageal echocardiography. *Based on maximum diameter measured on TEE vs area-derived diameter on HR-CMR. Open table in a new tab

PO-01-189 IMPACT OF CORONARY SINUS BALLOON UTILIZATION ON IDENTIFICATION OF THE VEIN OF MARSHALL FOR ADJUNCTIVE ETHANOL ABLATION FOR ATRIAL FIBRILLATION

Retrograde ethanol infusion into the vein of Marshall (EI-VOM) as an adjunct to pulmonary vein isolation (PVI) has been reported to improve success of atrial fibrillation (AF) ablation. However, identification and cannulation of the VOM remains technically challenging. It has been proposed that balloon occlusion of the coronary sinus (CS) allows for improved contrast opacification and facilitates identification of the VOM as well as differentiation of other branching veins. This study sought to assess the impact of CS balloon use on the success rate of VOM identification and time to VOM identification during adjunctive VOM ethanol ablation for AF. All patients undergoing PVI with EI-VOM at The Ohio State University Wexner Medical Center from January 2021 to November 2022 with known use or non-use of CS balloon were included. The primary endpoint was success rate of VOM identification and time to identification of VOM. The secondary endpoints were fluoroscopy time, procedure time, successful VOM cannulation, successful scar formation as defined by development of a characteristic low voltage area around the left inferior pulmonary vein on high-density electroanatomical mapping after ethanol infusion, and procedural complications. 106 patients underwent VOM ethanol ablation, 36 (34%) with and 68 (66%) without CS balloon use respectively. There was a significantly increased success rate in identification of VOM with CS balloon use (balloon 32 (89%) vs no balloon 50 (71%) patients, p=0.042). There was no significant difference in time to VOM identification. Notably, overall procedure time was significantly longer with CS balloon use (balloon 210.4 ± 51.7 vs no balloon 181.4 ± 37.1 minutes, p=0.004). There was no significant difference with balloon use in terms of fluoroscopy time, successful VOM cannulation, or successful scar formation (Table I). Notably, there were 3 (4%) cases of CS or VOM dissection in patients without balloon use as compared to 0 (0%) cases with balloon use, but this difference did not meet statistical significance. Figure 1 demonstrates the use of CS balloon during EI-VOM to facilitate identification of the VOM as well as atrial branches. CS balloon use is associated with significantly improved success in identification of the VOM during adjunctive ethanol ablation for AF. However, this is balanced by an associated increased procedure time.Tabled 1Table I: Procedural characteristicsProcedural characteristicsCoronary Sinus Balloon Used (N=36)Coronary Sinus Balloon Not Used (N=70)Total (N=106)P valueTimingTime to VOM identification, mins43.2 ± 15.546.1 ± 14.445.1 ± 14.80.419Fluoroscopy time, mins33.4 ± 10.031.4 ± 11.532.1 ± 11.00.374Procedure time, mins210.4 ± 51.7181.4 ± 37.1191.3 ± 44.60.004Key Procedural StepsCS cannulated36 (100%)68 (97%)104 (98%)0.547VOM identified32 (89%)50 (71%)82 (77%)0.042VOM cannulated29 (81%)46 (66%)75 (71%)0.112Able to advance balloon to VOM29 (81%)46 (66%)75 (71%)0.112Ethanol infused into VOM29 (81%)46 (66%)75 (71%)0.112OutcomeSuccessful formation of characteristic scar / low voltage area on high-density EAM15 (42%)35 (50%)50 (47%)0.853ComplicationsCS or VOM dissection0 (0%)3 (4%)3 (3%)0.549Values presented as mean ± 1 standard deviation for continuous variables and n (%) for categorical variables. Abbreviations: CS = coronary sinus, EAM = electroanatomical map, VOM = Vein of Marshall. Open table in a new tab

PO-03-140 CARDIAC MAGNETIC RESONANCE IMAGING VERSUS CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR LEFT ATRIAL APPENDAGE SIZING AND THROMBUS ASSESSMENT PRIOR TO DEVICE CLOSURE

Preoperative imaging for left atrial appendage closure (LAAC) is essential for LAA sizing and thrombus assessment. Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CCTA) have been utilized to date for this purpose. During the recent global iodine contrast shortage, cardiac magnetic resonance imaging (CMR) was utilized as an alternative imaging modality. The purpose of this study was to assess CMR vs CCTA for preoperative LAA sizing and thrombus assessment prior to LAAC. This retrospective study conducted at The Ohio State University Wexner Medical Center included all patients who underwent preoperative CMR or CCTA for LAAC with Watchman FLX or Amplatzer Amulet between May 2022 and October 2022. Primary measures were accuracy of predicted device size, accuracy of thrombus detection/exclusion, and mean difference in maximum LAA ostial diameter and depth as compared to intraoperative TEE. An area-derived diameter approach was utilized with CMR and CCTA to obtain the maximum diameter in order to prevent oversizing highly elliptical ostial shapes. The radius (r) was calculated based on device design. For the octadecagonal Watchman FLX, area = r2 x 3.0782. For the circular Amulet, area = r2 x 3.1416. 75 patients underwent LAAC, and 25 (33%) vs 50 (67%) underwent preoperative CMR vs CCTA respectively. Demographics were notable for age 75 ± 7 years, 32 (43%) females, 31 ± 7 kg/m2 body mass index, 53 ± 9% left ventricular ejection fraction, and 4 ± 1 CHA2DS2-VASc. 64 (88%) and 9 (12%) patients underwent Watchman FLX and Amplatzer Amulet implantation respectively. There was no significant difference with CMR vs CCTA in accuracy of predicted device size (CMR: 16 (64%) vs CCTA: 26 (70%) patients, p=0.604) and accuracy of thrombus assessment (CMR: 22 (88%) vs CCTA: 46 (92%) patients, p=0.680). Among the 57 (76%) cases completed with intraoperative TEE guidance where LAA measurements were obtained, there was no significant difference with CMR vs CCTA in the mean difference in maximum LAA ostial diameter (CMR: 2.9 ± 2.0 vs CCTA: 2.6 ± 2.5 mm, p=0.699) and mean difference in maximum LAA depth (CMR: 9.5 ± 8.5 vs CCTA: 10.8 ± 7.5 mm, p=0.620) as compared to intraoperative TEE. Figure 1 demonstrates LAAC device sizing using multiplanar reconstruction with oblique views of the LAA on CCTA (A-C) and CMR (D-F). CMR and CCTA were comparable for LAA sizing and thrombus assessment prior to LAAC.

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia.

Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy. A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain. A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, p < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, p = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, p < 0.001). Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.

Careers in Telestroke: Toward a Virtual and Tangible Purpose.

HomeStrokeAhead of PrintCareers in Telestroke: Toward a Virtual and Tangible Purpose No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessCareers in Telestroke: Toward a Virtual and Tangible Purpose Amanda L. Jagolino-Cole, Alicia M. Zha, Navdeep Sangha, Shlee S. Song and Jennifer J. Majersik Amanda L. Jagolino-ColeAmanda L. Jagolino-Cole Correspondence to: Amanda L. Jagolino-Cole, MD, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.125, Houston, TX, 77030. Email E-mail Address: [email protected] https://orcid.org/0000-0001-8504-6224 Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (A.L.J.-C.). *A.L. Jagolino-Cole and A.M. Zha contributed equally. Search for more papers by this author , Alicia M. ZhaAlicia M. Zha https://orcid.org/0000-0002-3647-4158 Department of Neurology, The Ohio State University Wexner Medical Center, Columbus (A.M.Z.). *A.L. Jagolino-Cole and A.M. Zha contributed equally. Search for more papers by this author , Navdeep SanghaNavdeep Sangha https://orcid.org/0000-0001-9650-0488 Department of Neurology, Kaiser Permanente, Los Angeles, CA (N.S.). Search for more papers by this author , Shlee S. SongShlee S. Song https://orcid.org/0000-0002-7838-0205 Department of Neurology, Cedar Sinai Medical Center, Los Angeles CA (S.S.S.). Search for more papers by this author and Jennifer J. MajersikJennifer J. Majersik https://orcid.org/0000-0003-3191-262X Department of Neurology, University of Utah, Salt Lake City (J.J.M.). Search for more papers by this author Originally published3 Apr 2023https://doi.org/10.1161/STROKEAHA.122.039149Stroke. 2023;0Footnotes*A.L. Jagolino-Cole and A.M. Zha contributed equally.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page XXX.Correspondence to: Amanda L. Jagolino-Cole, MD, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.125, Houston, TX, 77030. Email amanda.l.[email protected]tmc.edu Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.039149PMID: 37009743 Originally publishedApril 3, 2023 Keywordsleadershiphospitalquality improvementtelemedicineneurologistPDF download Advertisement SubjectsCerebrovascular Disease/Stroke

Outcomes following a multi-disciplinary pediatric-to-adult transition and transfer clinic at a level four epilepsy center.

Transition and transfer from the pediatric to adult care model is crucial to the continued long-term health and well-being of patients impacted by life-long diseases. This project explores the impact of a novel epilepsy transition collaboration between Nationwide Children's Hospital (NCH) and Ohio State University (OSU) Wexner Medical Center. We retrospectively analyzed the characteristics and outcomes of 56 consecutive patients transferred to an adult health care system. These patients were divided into two groups. A cohort of 23 patients transferred in 2019 prior to clinic implementation were compared to a cohort of 33 consecutive patients transferred in 2019 and early 2020 using the epilepsy transition and transfer clinic model. Data points of interest included demographic information, age at transfer, epilepsy diagnosis, pharmacoresistance of epilepsy, surgical history and compliance with follow-up. Patients transferred to OSU through the transition clinic were statistically more likely to be followed at OSU (p = .037) within 6 months (p = .013). Additionally, there was improved patient retention at OSU following transition clinic implementation (p = .037). Data demonstrating statistically significant improvement in care has not been reported for an epilepsy transition clinic. This study establishes that our novelapproach improves continuity of care in this at-risk population. Our clinic model also successfully transitioned and transferred medically complex patients, including those with pharmacoresistant and/or genetically mediated epilepsy. Additionally, this work suggests that this clinic structure has potential to foster the growth of associated adult epilepsy subspecialty practices. These findings are encouraging as they offer potential for improved health care in the youth and young adult epilepsy population.

Infrequent intrahousehold transmission of Clostridioides difficile between pet owners and their pets.

Companion animals have been shown to carry Clostridioides difficile strains that are similar or identical to strains found in people, and a small number of studies have shown that pets carry genetically identical C. difficile isolates as their owners, suggesting inter-species transmission. However, the directionality of transmission is ultimately unknown, and the frequency with which animals acquire C. difficile following their owners' infection is unclear. The goal of this study was to assess how often pets belonging to people with C. difficile infection carry genetically related C. difficile isolates. We enrolled pet owners from two medical institutions (University of Pennsylvania Health System (UPHS) and The Ohio State University Wexner Medical Center (OSUWMC)) who had diarrhoea with or without positive C. difficile assays and tested their faeces and their pets' faeces for C. difficile using both anaerobic culture and PCR assays. When microorganisms were obtained from both the owner and pet and had the same toxin profile or ribotype, isolates underwent genomic sequencing. Faecal samples were obtained from a total of 59 humans, 72 dogs and 9 cats, representing 47 complete households (i.e. where a sample was available from the owner and at least one pet). Of these, C. difficile was detected in 30 humans, 10 dogs and 0 cats. There were only two households where C. difficile was detected in both the owner and pet. In one of these households, the C. difficile isolates were of different toxin profiles/ribotypes (A+/B+ / RT 499 from the owner, A-/B- / RT PR22386 from the dog). In the other household, the isolates were genetically identical (one SNP difference). Interestingly, the dog from this household had recently received a course of antibiotics (cefpodoxime and metronidazole). Our findings suggest that inter-species transmission of C. difficile occurs infrequently in households with human C. difficile infections.

Engaging Evidence-Based Practice, Research, and Innovation Council Members in Shared Governance Through Experiential Learning

This article aims to share the experience of a large academic medical center’s journey to build a highly engaged, strong-performing, and productive Evidence-Based Practice, Research, and Innovation Shared Governance Council. An experiential learning approach was initiated to further engage and teach staff nurse council members about evidence-based practice (EBP) and research. Using monthly council meetings, the Evidence-Based Practice, Research, and Innovation Council successfully completed 1 EBP project and 1 research project. Staff nurses appreciated the connection between research, EBP, and the development/refinement of nursing policies. This article aims to share the experience of a large academic medical center’s journey to build a highly engaged, strong-performing, and productive Evidence-Based Practice, Research, and Innovation Shared Governance Council. An experiential learning approach was initiated to further engage and teach staff nurse council members about evidence-based practice (EBP) and research. Using monthly council meetings, the Evidence-Based Practice, Research, and Innovation Council successfully completed 1 EBP project and 1 research project. Staff nurses appreciated the connection between research, EBP, and the development/refinement of nursing policies. Esther Chipps, PhD, RN, NEA-BC, FAONL, Clinical Nurse Scientist, Clinical Professor, The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing. She can be reached at [email protected]; Amy Knupp, PhD, RN, APRN-CNS, CPPS, Associate Director, Nursing CE Programming and Clinical Placement, The Ohio State University Wexner Medical Center; Jane Ginther, DNP, APRN-CNP, Nurse Practitioner, Orthopedic Trauma, The Ohio State University Wexner Medical Center; Laurel Courtney, MS, APRN-CNS, AOCN, Clinical Nurse Specialist, Nursing Informatics, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Samantha Warren, BSN, RN, PCCN, Staff Nurse, Cardiac Medical ICU, The Ohio State University Richard M. Ross Heart Hospital; Sherry Levering, DNP, RN, Staff RN, Medical-Surgical Nursing, The Ohio State University, Hospital East; Kimberly Brown, DNP, RN, NEA-BC, Director of Nursing Professional Practice and Regulatory Affairs, The Ohio State University Wexner Medical Center.

Hospital triage and skin disease: hospital outcomes are differentially associated with cutaneous morphology.

Determining the exact dermatologic diagnosis is difficult in the inpatient setting. Determine whether morphologic classification rather than specific diagnosis is associated with hospital outcomes. Retrospective single-center study. Information from 1798 inpatient dermatology consults at The Ohio State University Wexner Medical Center from 2012 to 2014 was queried. Dermatologic diseases were categorized into 16 groups based on appearance. Logistic regression was performed comparing mortality rate vs morphology. Linear regression was performed comparing the length of stay (LOS) vs morphology. Morphology was associated with a mortality rate (P=0.038). The morphologic subgroups acneiform/follicular/occlusion (P=0.011), blistering disorders (P=0.009), retiform purpura (P=0.011), and vasculitis/vascular (P=0.007) were associated with increased mortality. Morphology was associated with LOS (P=0.004), and the morbilliform subgroup was associated with increased LOS (P < 0.001). This study demonstrated the importance of morphologic diagnosis and its association with mortality rate and LOS. This information may help triage cutaneous disorders in the inpatient setting and determine the relative risk of dermatologic conditions when assessing the need for hospital transfers and more aggressive therapies.

Transdural Thoracic Discectomy and Dorsal Arachnoid Web Fenestration: 2-Dimensional Operative Video.

*Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; ‡The Ohio State University College of Medicine, Columbus, Ohio, USA; §Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA Correspondence: David S. Xu, MD, Department of Neurological Surgery, The Ohio State University College of Medicine, 410 West 10th Ave, Columbus, OH43210, USA. Email: [email protected]

Commentary: Two Practices to Improve Informed Consent for Intraoperative Brain Research.

*Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA; ‡Moritz College of Law and College of Public Health, The Ohio State University, Columbus, OH, USA Correspondence: Ryan Eaton, MD, Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, 410 W. 10th Ave Doan Hall N1019, Columbus, OH43210, USA. Email: [email protected], Twitter: @ryeaton1992; Russell Lonser, MD, Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave Doan Hall N1047, Columbus, OH43210, USA. Email: [email protected], Twitter: @RussellLonser

2213. Increased Early Syphilis Detection and Treatment in an Urban Emergency Department During the COVID-19 Pandemic

Abstract Background Many people at risk for sexually transmitted infections (STIs) utilize the emergency department (ED) for evaluation and treatment of STI-related complaints. Syphilis testing rates in the ED have historically been low. Following the implementation of a joint ED and Infectious Disease (ID) multidisciplinary quality improvement initiative designed to increase syphilis testing in this setting, we sought to evaluate the demographics and clinical outcomes for patients diagnosed with early syphilis in the ED. Methods A retrospective chart review of patients with positive syphilis test results from ED encounters at the Ohio State University Wexner Medical Center East Hospital between 1 January 2019 and 31 December 2021 was performed. Demographic and clinical information was obtained for patients diagnosed with early syphilis (primary, secondary or early latent syphilis). Results Since 2019, we have observed a significant increase early syphilis cases identified in our ED despite stable rates of testing (Figure 1). There were 55 cases of early syphilis, 3 with neurosyphilis (NS) at the time of diagnosis (Figure 2). Most cases were men (38/55; 69%), Black/African American (44/55; 80%), and symptomatic (48/55; 87%). Nine of 55 patients (16%) had HIV co-infection, 2 were new diagnoses at time of syphilis diagnosis. Most patients (44/55; 80%) completed appropriate treatment. Of the symptomatic patients, 17/45 (37%) received presumptive treatment in the ED (3 cases of NS excluded). Of those who received treatment after discharge from the ED, the median time to treatment completion was 3 days (range 0-30), with 11/24 (46%) returning to the ED for treatment. Figure 1.Figure 2. Conclusion As a result of a collaborative ED/ID STI testing initiative established at our institution, we have observed a significant increase in the number of symptomatic early syphilis cases identified in our ED between 2019 and 2021, with most patients completing treatment in a timely manner. This data show that the ED is an important and feasible setting for syphilis diagnosis and treatment when appropriate support systems are in place, including established communications with ID colleagues. Disclosures Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant Susan L. Koletar, MD, Gilead Sciences: Grant/Research Support.

Impact of concomitant fluconazole on direct oral anticoagulant bleeding risk.

The aim of this study was to evaluate the effect on bleeding risk when fluconazole is administered concomitantly with direct oral anticoagulants (DOACs). This was a retrospective cohort study including hospitalized adult patients prescribed a DOAC with or without fluconazole. The Ohio State University Wexner Medical Center, a tertiary care academic medical center with more than 1800 beds. Hospitalized patients ages 18-89 years who received apixaban or rivaroxaban with or without fluconazole from October 1, 2016, to September 30, 2021, were included. The minimum duration of DOAC or DOAC with fluconazole therapy was 48h. Patients were excluded if they received fluconazole <400 mg daily or a DOAC at doses outside those recommended for atrial fibrillation or venous thromboembolism treatment or prophylaxis. Patients were matched based on DOAC received. Patients who received a DOAC with fluconazole were compared with those receiving a DOAC alone. The primary outcome was a composite of major, clinically relevant nonmajor, and minor bleeding events at 30 days. There were 216 patients included, 108 in the DOAC with fluconazole group and 108 in the DOAC alone group. More patients in the DOAC with fluconazole group experienced bleeding at 30 days compared with the DOAC alone group [35/108 (32%) vs. 21/108 (19%), respectively; p=0.03]; however, after adjusting for proven confounding variables (hemoglobin and concomitant carvedilol) this was found not to be statistically significant [adjusted odds ratio 1.71, 95% confidence interval 0.85-3.40]. Patients receiving a DOAC with fluconazole were not at significantly increased risk for bleeding at 30 days compared with those receiving a DOAC alone after controlling for confounding variables. As an increasing number of patients are prescribed DOACs, the results of this study may inform clinical decision-making on the safety of concomitant DOAC and fluconazole use.

Exploration of Differences between Women Who Do and Do Not Disclose Their Marijuana Use during Pregnancy.

This study aimed to explore demographic and health-related factors that may differentiate women who do and do not disclose their marijuana use during pregnancy. The current study is a secondary analysis of data from a prospective cohort of pregnant women identified as using marijuana during pregnancy via a variety of assessment tools including self-report, urine screen, and obstetrics record abstraction. The cohort included a convenience sample of women recruited from several antenatal clinics at The Ohio State University Wexner Medical Center (OSUWMC). To be eligible, women needed to be within the first or second trimester of their pregnancy, 16 to 50 years of age, able to communicate in English, and intended to deliver at OSUWMC. Chi-square, independent samples t-tests, and logistic regression analyses were used to explore differences between those who did and did not disclose their use in relation to physical and mental health diagnoses, adverse experiences, use of other substances, and demographics. Women who used marijuana during their pregnancy and had mental/physical health data available comprised the current sample (n = 109). Women who attended college were more likely to disclose their marijuana use compared with women who did not attend college (p < 0.001). Women who experienced homelessness (p < 0.01) or self-reported alcohol use during pregnancy (p < 0.001) were significantly more likely to disclose their marijuana use. Findings, suggesting disclosure of other substance use and adverse experiences, such as homelessness, may increase the likelihood that pregnant women will voluntarily disclose their marijuana use to providers. Findings did not reflect racial differences nor significant differences in mental/physical health status among women based on their disclosure. Future research with larger datasets is needed to build on these findings by confirming results, as well as exploring additional factors, that may more effectively differentiate women who are unlikely to disclose their prenatal marijuana use from those who do disclose their use. · Women with higher education were more likely to self-disclose their prenatal marijuana use.. · Women who experienced homelessness were more likely to self-disclose their prenatal marijuana use.. · Self-disclosure of prenatal alcohol use was related to self-disclosure of prenatal marijuana use.

Defining, capturing, and validating pharmacists' patient profile reviews in the electronic medical record.

To describe the implementation and validation of a novel patient profile review tool in the electronic medical record (EMR) at an academic medical center. Pharmacy leaders at The Ohio State University Wexner Medical Center aspired to develop a data-driven approach to clinical pharmacy services. The initial phase of this vision highlighted a need to define the clinical activities of a pharmacist and leverage use of the EMR to seamlessly capture data. A comprehensive list of clinical activities was developed and analyzed to determine which activities were currently uncaptured. Patient profile review was prioritized and determined to be variable among staff and undefined. A profile review tool was developed and implemented across the medical center while requiring minimal additional documentation through the EMR. Phase II determined what user audit trail data in the EMR were automatically recorded based on performing various levels of pharmacist-recorded profile review and validated the consistency in utilization of this tool. The information gathered as a result of this study identified interactions within the patient chart that matched profile reviews that were not captured during manual documentation. The department of pharmacy will utilize the data generated from this tool to better make decisions and build a comprehensive clinical productivity model. The implementation of a pharmacist patient profile review tool built within the EMR successfully defined, stratified, validated time spent on, and captured a clinical activity.

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

Genomic Study on Blood Culture Isolates From Patients With Staphylococcus Infection-associated Glomerulonephritis

IntroductionStaphylococcus infection-associated glomerulonephritis (SAGN), is an autoimmune sequela of infection affecting a subset of infected patients without specific predictive factors, frequently presenting with acute nephritic syndrome and propensity for chronic kidney disease. We performed a comparative genotypic and phenotypic analysis of S. aureus isolates from patients that did and those that did not develop SAGN.MethodsWe had 22 culture-proven cases of SAGN from Ohio State University Wexner Medical Center (OSUWMC) from 2004 to 2016, 9 of 22 being blood cultures, with archived isolates. These, along with blood culture isolates from 12 patients with no clinical evidence of SAGN (between ages 40 to 80 years) over the same period were used for genotyping. For host demographic comparison, we used all available SAGN cases (n = 85, including those with positive cultures other than blood; and patients with kidney biopsies received from referring hospitals) and all OSUWMC patients with positive Staphylococcus cultures without glomerulonephritis (GN) (n = 23,496).ResultsMultiple sequence types (STs) suggesting strain diversity was seen in the GN isolates with mainly clonal complexes (CC) 5 and 59. Mutations in the agr operon were identified in significantly higher number of the GN isolates (83%) than non-GN isolates (16%). Significant differences in β-hemolysis and biofilm formation was also observed between the groups.ConclusionThe functionality of these agr mutants remains to be seen, but the presently known effects of reduced agr function, namely increased surface adhesins, biofilm formation, and persistent bacteremia could be important microbial factors predisposing to SAGN and testing for them early during infection could help to predict its development.

O08 A Mixed Method Study of Whether Appalachian Ohioans Conceptualize Food Security in Alignment with the Prevailing Measure

<h3>Background</h3> In the US, food security is monitored annually via the Household Food Security Survey Module (HFSSM). The measure focuses primarily on a household's monetary means. There is heightened interest in developing food security measures that embody more nuanced conceptualizations of household food security. <h3>Objective</h3> To explore whether current conceptualizations of food insecurity among a rural Appalachian sample diverge from HFSSM constructs. <h3>Study Design, Setting, Participants</h3> A study recruitment postcard was mailed to all residential addresses in the Athens County region of Appalachian Ohio in late June 2020. Adult recipients were first invited to complete quarterly surveys, containing a demographic questionnaire and the HFSSM, for one year. Based on HFSSM-based food security categorizations, a purposively selected sub-sample of respondents were invited for in-depth semi-structured interviews (n = 16, May-June 2021). Our maximal variation sample included households demonstrating consistent food security (n = 7, 44%), transient insecurity (n = 5, 31%), and persistent insecurity (n = 4, 25%). Interviewees reflected on whether the HFSSM-based status aligned with how they would characterize their household's food security status. <h3>Measurable Outcome/Analysis</h3> Verbatim transcripts were coded in NVivo and themes identified via template analysis, a process that leveraged both a priori codes (based on HFSSM constructs) and emergent codes reflecting measure-diverging constructs. <h3>Results</h3> While individuals characterized their food insecurity experiences in partial convergence with the HFSSM measure (e.g., noting insufficient money for food), there were several diverging themes. Food security was primarily discussed through a communal, and notably non-monetary, lens in which food reciprocity (e.g., bartering), collective responsibility (i.e., thinking beyond one's own household), and resourcefulness (e.g., gardening) defined their food (in)security experience. <h3>Conclusion</h3> This study demonstrates that food security may be conceptualized in ways that account for non-monetary assets and embody a communal ideology. The development and testing of a food security measure containing items in line with these constructs may be warranted for – and help to capture food insecurity more accurately in – rural regions where traditions of resourcefulness and reciprocity persist. <h3>Funding</h3> NIH; The Ohio State University's Initiative for Food and AgriCultural Transformation; National Center for Advancing Translational Sciences; The Ohio State University's Office of Outreach and Engagement; Clinical Research Center/Center for Clinical Research Management of The Ohio State University Wexner Medical Center.

Impact of a pharmacist-led tacrolimus management protocol in the outpatient setting

BackgroundClinical pharmacists are often used to make recommendations regarding tacrolimus therapy in the post transplant setting.Therapeutic drug monitoring (TDM) of tacrolimus after transplant is based on trough levels in the setting of predetermined institutional immunosuppression goals. To evaluate time within therapeutic range (TTR) of tacrolimus the Rosendaal method can be utilized. ObjectiveOur study aimed to compare objective therapeutic drug monitoring outcomes after the implementation of a pharmacist driven tacrolimus management protocol (postprotocol initiation) with previous management by providers (preprotocol initiation). Practice descriptionThe Ohio State University Wexner Medical Center (OSUWMC) is a 700-bed academic medical center in Columbus, OH. On average, OSUWMC completes more than 300 kidney transplants each year. There are 6 abdominal transplant pharmacists (including one postgraduate year 2 transplant pharmacy resident) that rotate through the inpatient and outpatient setting. Practice innovationA pharmacist-led tacrolimus management protocol in kidney transplant recipients was initiated in October 2018 at our institution, which enabled pharmacists to dose and adjust tacrolimus in the outpatient setting in accordance with prespecified goals. Evaluation methodsThis single-center retrospective analysis included adult kidney transplant recipients on de novo tacrolimus. Patient’s tacrolimus levels were evaluated for 6 months after transplant. The mean tacrolimus percent TTR and the median coefficient of variation (CV) were calculated and compared in postprotocol initiation group (n = 85) with preprotocol initiation group (n = 39). TTR was calculated using the Rosendaal method. ResultsThere was no statistically significant difference between the preprotocol initiation and postprotocol initiation group mean TTR (59.6% vs. 60.5%, P = 0.723), mean CV from 0-3 months after transplant (36.3 vs. 36.0, P = 0.900), and mean CV from at least 3-6 months after transplant (24.5 vs. 22.7, P = 0.351). Rejection rates, development of donor-specific antibodies, and renal function were similar between groups. ConclusionBased on our findings, transplant pharmacists were equally as effective at maintaining tacrolimus percent TTR and CV in the designated kidney transplant recipients included in the management protocol compared with primary management by other transplant providers. The delegation of tacrolimus management to clinical pharmacists is a viable alternative to primary management by outpatient practitioners.

Abstract 2522: Pathway and immune profile analysis of cyst-derived versus PanIN-derived pancreatic ductal adenocarcinomas

Abstract Introduction: Pancreatic cystic lesions (PCL) are common and a subset of mucinous cysts will transform into pancreatic ductal adenocarcinoma (PDAC). However, predicting which of these mucinous PCL may progress to PDAC and warrant surgery remains a clinical challenge. Moreover, identifying those clinically emergent mucinous PCL for which a surveillance approach is best is a dire clinical need. Therefore, we aimed to identify molecular signatures that distinguished between PDAC with and without clinical evidence of a PCL to identify novel biomarkers. Methods: We leveraged data from the Oncology Research Information Exchange Network (ORIEN) multi-institute sequencing project and analyzed 66 PDAC cases recruited to ORIEN from The Ohio State University Wexner Medical Center and Moffitt Cancer Center for which tumor whole transcriptome sequencing datasets were generated. We separated the cases based on whether a tumor had originated from a cystic lesion (n=16) or presumably through the pancreatic intraepithelial neoplasia (PanIN) pathway (n=50). We then performed differential expression and pathway analysis using both Gene-Set Enrichment Analysis (GSEA) and Pathway Analysis with Down-weighted Genes (PADOG) algorithms. Based on the emerging importance of the immune landscape in PDAC development, we also analyzed immune profiles using a novel tool, Tumor-immune Microenvironment Deconvolution Web-portal for Bulk Transcriptomics (TIMEx). Results: When grouped by tumor origin, cyst-derived PDAC gene expression sets are enriched in immune signaling pathways, specifically NOTCH signaling (p=0.04), and demonstrate significant downregulation in amino acid metabolism, mitochondrial import and Gsα signaling pathways. Furthermore, GSEA based on TIMEx signatures indicated that multiple immune cell-specific profiles had significant enrichment scores in either the cyst-derived (for example, plasma cell: normalized enrichment score=-1.53; p=0.007) or non-cyst-derived (for example, neutrophil: normalized enrichment score=2.24; p=0.0001) PDAC cohorts. Conclusions: Our data suggest that cyst-derived and non-cyst-derived PDACs differ by immune profile, enhanced NOTCH pathway usage and in the metabolic processing of multiple amino acids. These initial findings support future studies to assess the accuracy of risk stratifying PCLs based on their amino acid, metabolic, or immune profiles, and exploration into mechanisms to explain these findings. Citation Format: Margaret A. Park, Somashekar G. Krishna, Maria C. Genilo-Delgado, Kristyn Gumpper-Fedus, Darwin L. Conwell, Phil A. Hart, Mary E. Dillhoff, Maria F. Gomez, Toni L. Basinski, Aamir N. Dam, Jason B. Klapman, Jason B. Fleming, Mokenge Malafa, Amir Mohammadi, Barbara A. Centeno, Kun Jiang, Daniel Jeong, Dung-Tsa Chen, Mengyu Xie, Aik Choon Tan, Brooke L. Fridley, Jamie K. Teer, Zobeida Cruz-Monserrate, Jennifer B. Permuth. Pathway and immune profile analysis of cyst-derived versus PanIN-derived pancreatic ductal adenocarcinomas [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 2522.