SUNY Downstate Medical Center Research Articles

The association of race with thyroid eye disease presentation and outcomes

IntroductionClassification of thyroid eye disease (TED) is largely based on guidelines developed in Europe and North America. Few studies have investigated the presentation and treatment of TED in Black populations. The objective is to examine the manifestations of TED in secondary and tertiary care center-based populations with a significant proportion of Black patients.Materials and methodsRetrospective chart review identifying patients with a reported race/ethnicity and a presenting clinical diagnosis of TED at Kings County Hospital and SUNY Downstate Medical Center and affiliated clinics from January 1, 2010 through July 31, 2021. Main outcome measures include age of disease onset, sex, smoking status, insurance status, postal code of residence, clinical exam features, number of follow-up visits, length of follow-up, and treatments received.ResultsOf the 80 patients analyzed, 49 were Black (61.2%) and 31 were White (38.8%). Between Black and White patients, there were differences in the mean age of presentation (48.1 [range 21-76] vs 56.8 [range 28-87] years, P=0.03), insurance status (51.0% vs 77.4% private insurance, P=0.02), and mean follow up length among those with multiple visits (21.6 [range 2-88] vs 9.7 [range 1-48] months, P=0.02). The distribution of EUGOGO scores were not significantly different between Black and White patients. On initial presentation, fewer Black patients had chemosis (OR 0.21, 95% CI, 0.08 to 0.57, P=0.002), and caruncular swelling (OR 0.19, 95% CI, 0.06 to 0.59, P=0.002) compared to White patients. During the overall disease course, fewer Black patients had subjective diplopia (OR 0.20, 95% CI, 0.07 to 0.56, P=0.002), chemosis (OR 0.24, 95% CI, 0.09 to 0.63, P=0.004), and caruncular swelling (OR 0.18, 95% CI, 0.07 to 0.51, P=0.001) compared to White patients. Black patients received oral steroids (42.9% vs 67.7%, P=0.03), intravenous steroids (18.4% vs 16.1%, P=0.8), orbital decompression surgery (16.7% vs 6.5%, P=0.19), and teprotumumab (22.9% vs 22.6%, P=0.99) at similar rates.DiscussionBlack patients presented with fewer external exam findings suggestive of active TED compared to White patients, but the rate of compressive optic neuropathy and decompression surgery were similar in the two groups. These differences may be due to disease phenotypes, which warrant further study.

Intravenous magnesium as an adjunct to standard of care for treatment of atrial fibrillation with rapid ventricular response.

Academic Emergency MedicineAccepted Articles THE BRASS TACKS: CONCISE REVIEWS OF PUBLISHED EVIDENCE “Intravenous Magnesium As An Adjunct To Standard Of Care For Treatment Of Atrial Fibrillation With Rapid Ventricular Response” Pierre-Carole Tchouapi MD, Pierre-Carole Tchouapi MD New YorkSearch for more papers by this authorKevin E. Anderson, Kevin E. Anderson New YorkSearch for more papers by this authorPaul Narayan Hein MD, Corresponding Author Paul Narayan Hein MD [email protected] orcid.org/0000-0001-5016-5338 New York Correspondence Paul Narayan Hein, MD, Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, New York 11203. Email: [email protected], Tel: (858) 337-1747Search for more papers by this author Pierre-Carole Tchouapi MD, Pierre-Carole Tchouapi MD New YorkSearch for more papers by this authorKevin E. Anderson, Kevin E. Anderson New YorkSearch for more papers by this authorPaul Narayan Hein MD, Corresponding Author Paul Narayan Hein MD [email protected] orcid.org/0000-0001-5016-5338 New York Correspondence Paul Narayan Hein, MD, Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, New York 11203. Email: [email protected], Tel: (858) 337-1747Search for more papers by this author First published: 06 April 2023 https://doi.org/10.1111/acem.14734 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/acem.14734. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

MP72-15 PREOPERATIVE MEDICAL CLEARANCE: UNVEILING PRIMARY CARE NEEDS AT A PUBLIC URBAN MEDICAL CENTER USING UROLOGIC CASE CANCELATION RATES

You have accessJournal of UrologyCME1 Apr 2023MP72-15 PREOPERATIVE MEDICAL CLEARANCE: UNVEILING PRIMARY CARE NEEDS AT A PUBLIC URBAN MEDICAL CENTER USING UROLOGIC CASE CANCELATION RATES Lauren Fink, Matthew Bruha, Frederick Okoye, Lauren Namkoong, Brian McNeil, and Llewellyn Hyacinthe Lauren FinkLauren Fink More articles by this author , Matthew BruhaMatthew Bruha More articles by this author , Frederick OkoyeFrederick Okoye More articles by this author , Lauren NamkoongLauren Namkoong More articles by this author , Brian McNeilBrian McNeil More articles by this author , and Llewellyn HyacintheLlewellyn Hyacinthe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elective surgical case cancelations are a common problem in healthcare, causing patient and staff dissatisfaction, and a financial burden on institutions. Underserved communities have unmet primary care needs, and case cancelations in these populations may reflect chronic disease burdens. We evaluate the role of urologic consultation in improving overall health by identifying undiagnosed or undermanaged conditions during preoperative evaluation METHODS: All canceled elective urologic procedures from two surgeons at one urban center were retrospectively analyzed from 1/2015-12/2019. Chart reviews were performed to obtain reason(s) for cancelation, demographics, medical interventions performed, and American Society of Anesthesiologists (ASA) score pre- and post-operatively. Age-adjusted odds ratio (OR) was calculated for the association between preoperative ASA and medical interventions RESULTS: 1780 total elective cases were scheduled in our review. 551 canceled elective cases were identified with a 30% overall cancelation rate. 250 of those canceled cases were due to >1 undiagnosed or under-managed medical condition(s), representing 14% of the overall cancelation rate. 91.2% of patients were over 60 years old and African American. Notes were available for 111 (44.4%) of the 250 total cases canceled due to undiagnosed or under-managed medical conditions. 83% of these patients received their intended procedures. 35.1% of cases received medication adjustments, most commonly for cardiology and diabetes. Preoperative ASA>3 was found to be significantly associated with medical interventions of any kind (OR 2.6923 [1.1188-6.4788] p=0.0271) CONCLUSIONS: Elective urologic case cancelations were frequent and often related to comorbid conditions. Most patients canceled for medical reasons received optimization and then underwent surgery. ASA scores>3 may assist urologists in underserved urban areas in identifying patients who require medical intervention before elective surgery. Urologic consultation and subsequent preoperative clearance seem to provide a safety net for patients to receive optimization of their medical conditions that otherwise might go unmanaged. Case cancellations can have economic effects, also. Procedure slots are difficult to fill in on short notice. This paired with a high cancelation rate prevents opportunities to generate revenue. Appropriate consultation can eliminate pitfalls by allowing patients to obtain preoperative clearance prior to scheduling their elective cases Source of Funding: SUNY Downstate Medical Center © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1030 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Fink More articles by this author Matthew Bruha More articles by this author Frederick Okoye More articles by this author Lauren Namkoong More articles by this author Brian McNeil More articles by this author Llewellyn Hyacinthe More articles by this author Expand All Advertisement PDF downloadLoading ...

Invited Commentary: From Unacceptable to Intolerable

Invited Commentary: From Unacceptable to Intolerable

1266. Effects of Rapid Initiation of Antiretroviral Therapy in an Urban Clinic Setting

Abstract Background Rapid initiation of antiretroviral therapy (ART), i.e. within 72 hours of diagnosis, in people living with HIV (PLWH) has shown improved viral suppression, medication adherence, and retention in care, compared to deferral until initial labs have resulted. More real-world experience with rapid ART programs is needed, however, particularly among clinics in resource-limited settings that serve a complex and largely uninsured or underinsured population, such as the HIV clinic at SUNY Downstate Medical Center. In 2017, the clinic implemented rapid ART in select PLWH. Methods This was a single-center retrospective chart review of patients seen at our HIV clinic between January 2015 and June 2021. Patients were included if they were ART-naïve or off ART for > 3 months. Exclusion criteria included baseline undetectable viral load (VL) and perinatal HIV infection. Patients were assigned to standard or rapid start groups based on time from intake to initiation of ART. The primary outcome was proportion of patients with VL < 50 copies/mL at week 52. Secondary outcomes were proportion of patients with VL < 200 copies/mL, retention in care, and mean weight change from baseline, all at week 52; time from intake to ART; and time to viral suppression. Results As shown in Table 1, of the 190 patients that were included, 133 were rapid start while 77 were standard start. 103 patients had baseline resistance data; only 1 had integrase stand inhibitor resistance. Median time to ART was 0 days and 2.5 weeks in the rapid and standard groups, respectively. The most common initial regimen was BIC/FTC/TAF in both groups (49.6%, 31.2%). As described in Tables 2 and 3, 62.1% and 73.7% of patients had VL < 50 and < 200 copies/mL at week 52, respectively. Nearly 73% of patients remained in care at week 52, with similar rates between groups. Time from ART to viral suppression was similar between groups. Conclusion Rapid ART was well-tolerated but resulted in similar viral suppression and retention in care at week 52 compared to standard ART. However, rapid ART resulted in quicker viral suppression, although further evaluation of the clinical impact of this finding is needed. This study highlights the need for a multifaceted approach to engaging patients with HIV throughout the care continuum to ensure retention in care. Disclosures All Authors: No reported disclosures.

Judge rules in favor of former student

Case name: Kleyman v. SUNY Downstate Medical Center, et al., No. 18‐CV‐3137 (E.D. N.Y. 09/21/20).

899. Use of Dolutegravir/Rilpivirine in Treatment of HIV in PLWH with CKD and ESRD

Abstract Background Dolutegravir and rilpivirine is a novel two-drug single-tablet regimen for human immunodeficiency virus (HIV) that does not require dose adjustment in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). Although there are no studies proving the efficacy and safety of this regimen for patients with CKD and ESRD, there are a few studies that support the use of dolutegravir in hemodialysis. Methods A retrospective chart review was performed on patients who received dolutegravir and rilpivirine from November 2017 to July 2020 in the HIV clinic at SUNY Downstate Medical Center. The primary endpoint was the viral load suppression rate (defined as viral load less than 50 copies/ml) at 6 months of therapy compared between two groups of patients with varying kidney function: chronic kidney disease (defined as creatinine clearance (CrCl) under 60 mL/min) and normal kidney function (defined as CrCl higher than or equal to 60 mL/min). Viral load suppression rate was compared using logistic regression. Secondary outcomes were any reported adverse drug events and the discontinuations of the study medication. Results Overall viral load suppression at 6 months was achieved in 31 out of 36 patients (86.1%). 13 out of 14 patients (92.9%) with CrCl greater than or equal to 60 mL/min at baseline achieved viral load suppression at 6 months, whereas 18 out of 22 patients (81.8%) with CrCl under 60 mL/min at baseline achieved viral load suppression at 6 months (p=0.367). With adjustments for age, gender, and the history of Acquired Immunodeficiency Syndrome, the result was still insignificant. One adverse event of headache was reported in the group with baseline CrCl under 60 mL/min. Three cases of discontinuation were reported in this group due to resistance, headache, and drug-drug interaction. Conclusion The use of dolutegravir and rilpivirine for the treatment of HIV infection in adults with CKD or ESRD on hemodialysis was both safe and effective in African American population. Disclosures All Authors: No reported disclosures

A Psychiatrist to Doctors Is Witness to Impact of Stigma on Physicians

A Psychiatrist to Doctors Is Witness to Impact of Stigma on Physicians

Judge rules in favor of former student

Case name: Kleyman v. SUNY Downstate Medical Center, et al., No. 18‐CV‐3137 (E.D. N.Y. 09/21/20).

Judge rules in favor of former student

Case name: Kleyman v. SUNY Downstate Medical Center, et al., No. 18‐CV‐3137 (E.D. N.Y. 09/21/20).

Stockout: The impact of national haloperidol tablet shortage to physician prescription pattern and patient outcomes

<h3>Introduction</h3> Drug shortages are common in the United States, and in 2019 alone there are 11 psychiatric medications out of a total of 270 drugs that are current listed as in shortage by the FDA. One of these medications is haloperidol, which has been in shortage since October 2018 for its low dosage tablet forms, only one out of two pharmaceutical companies recently restocked these forms as of September 2019. Consequently, patients are impacted due to compromised efficacy, possible medication or dosage errors, of which these lead to higher cost for substitute drug and increased risk of rehospitalization. In Canada, for example, those impacted by haloperidol decanoate shortage had higher rehospitalization rate after switching to a different long acting injectable (LAI) medication. As such, it is important for physicians to be aware of current drug shortages and be ready to address the concerns of patients and their caregivers. <h3>Methods</h3> We conducted a retrospective chart-review mirror study of the nine months before and after the shortage occurred in October 2018 in 37 patients who are on haloperidol followed in geriatric psychiatry outpatient clinic in Brooklyn, New York. <h3>Results</h3> The preponderance of subjects in this study were diagnosed with either primary psychotic disorders or dementia with behavioral disturbances. Twelve out of 37 (32%) patients who are prescribed haloperidol had to be switched to a higher dose or liquid form. All twelve patients were previously prescribed less than five milligrams of haloperidol daily. None of the patients had a psychiatric emergency visit or hospitalization in the last year prior to haloperidol shortage, but two of the 12 patients had poor medication adherence following the mandatory medication switch. For these two patients, one agreed to a switch to LAI form and the other decompensated and required a visit to the Comprehensive Psychiatric Emergency Program (CPEP). None of the 25 patients who were unaffected by the shortage had a change or decompensation. <h3>Conclusions</h3> Low dose haloperidol tablet shortage resulted in subsequent change in medication form in our cohort. Medication adherence became an issue following the switch with resultant emergency visit. These findings reflect the underreported impact of psychiatric drug shortages and specific measures should be taken to better coordinate drug supply chain to minimize negative impact to otherwise chronically stable patients. <h3>Funding</h3> This study is funded by the Department of Psychiatry, SUNY Downstate Medical Center

Abstract B059: African American pancreatic cancer microRNAs profile to identify links to drug resistance and tumor progression

Abstract Pancreatic cancer is a deadly disease with only 8% of the patients surviving 5 years (1). Recent data published for African Americans (AA) showed that this population has the highest death rate and shortest survival of any racial/ethnic group in the US for most cancers (2). The causes of this disparity are unknown; some of them may be socioeconomic as well as barriers to high-quality cancer prevention, early detection, and treatment information and services. It is clear that there is a gap between AA and Caucasian Americans (CA) concerning the development and death from pancreatic cancer. We hypothesize that there also are molecular differences in the tumors from AA and CA patients that contribute to this disparity. Importantly, The Cancer Genome Atlas (TCGA) numbers for pancreatic cancer reveals that only 7 out of 185 cases of pancreatic cancer are from African American patients. This clearly shows a prominent under-representation of tumor-related genetic information for the AA population. MicroRNAs (miRNAs) are able to regulate dozens of targets, especially those involved in cancer, making them a potential tool to study differences between populations. It is known that patients develop drug resistance against gemcitabine and one factor could be due to differential expression of miRNAs (3). The analysis of potential miRNA differences in AA and CA tumors would be a starting point to study the function(s) and mechanisms to understand the gap between these populations. We analyzed the tumor miRNAs expression of the TCGA 7 AA patients and compared the expression with 10 CA patients from TCGA to understand the main differences in expression between the two sets of samples. Using R studio, we found 26 miRNAs significantly different between CA and AA tumors. Some of them are involved in pathways related with tumor progression, cell invasion and tumor growth. We are interested in miRNAs involved in upregulating drug resistance against gemcitabine such as miR21, miR 155, or miR 196 as well as those miRNAs that dowregulate resistance to treatment like miR148, miR200 or miR34. Importantly, these miRNAs have been defined only in CA pancreatic tumor samples. We are collecting retrospective pancreatic cancer cases at SUNY Downstate Medical Center and Kings County Hospital Center to study the expression of miRNAs using Illumina technology in our AA population in Brooklyn, NY. These tissues will be matched for age, gender, body mass index, and for stage and site of disease to the best of our ability. Adjacent normal tissues will serve as standard controls. We will use CA PDAC cases from TCGA for comparison. This work is in progress. In conclusion, we found in our analysis 26 miRNAs differentially expressed between AA and CA using TCGA data. We expect to see a difference in expression of miRNAs using samples from our patient population. In addition, we are interested to see if our patients have a different expression pattern of miRNAs related to drug resistance and if this could explain the poor response often seen in AA PDAC patients. Citation Format: Maria Munoz-Sagastibelza, Mohamed Alshal, Sayed Imtiaz, Jenny E. Paredes Sanchez, Mubarak Akadri, Raavi Gupta, Maksim Agaronov, Ellen Li, Jovanny Zabaleta, Laura Martello-Rooney. African American pancreatic cancer microRNAs profile to identify links to drug resistance and tumor progression [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B059.

Abstract A040: Barriers to African American participation in clinical trials: A qualitative study of Central Brooklyn residents

Abstract In 2014, African-Americans made up 13% of the population, yet only comprised 5% of clinical trial participants. For diseases that are more associated with Blacks like sickle health, and other diseases with high incidence rates for Blacks like prostate, colorectal, and lung cancers, it is imperative to explore the root reasons for why Black participation in clinical trials remains so low. The study was conducted through Pfizer and with the Arthur Ashe Institute for Urban Health, a community-based nonprofit organization founded in 1992 by tennis champion and humanitarian Arthur Ashe. The Institute, located in multiethnic Brooklyn at SUNY Downstate Medical Center, utilizes a Community Health Empowerment Model, and works on health education and training with the community. This study utilized a convenience sample of 14 participants recruited in our partner barber shops and hair salons, as the Institute conducts CBPR in nontraditional settings. The participants were broken into three focus groups: men, women, and the Institute's Health and Beauty Council, which consists of barbers and stylists with whom the Institute partners for training and education. The results were tabulated by gender (9 women and 5 men) to explore the issue of low participation. Reasons differed by gender; however, some main themes were a lack of knowledge, fear of addiction, medical mistrust, patient-provider relationships, health literacy as a barrier, cultural health practices, and how to reach a targeted audience for participation. To provide a snapshot of the group, 64% had never participated in a clinical trial, 86% were between 18-60, 93% had health insurance, 33% had an associate's degree or higher, and 71% of annual household incomes were below $31,000. Central Brooklyn is an area in dire need of continuous research in health care. Disparities are pronounced given the mix of income neighborhoods and significant populations of African American, Caribbean, and Latino populations. The borough is crippled with chronic conditions such as asthma, COPD, cardiovascular conditions, diabetes, HIV, and cancers. In addition, there are a large number of immigrants, many undocumented, with barriers to health care. Year after year, in NYC's Community Health Profile of Central Brooklyn, in comparison to 41 other NYC neighborhoods, Central Brooklyn ranks below average (bottom 10) in the areas of general health, maternal and child health, infectious diseases (influenza, HIV/AIDS), chronic diseases (heart disease, diabetes, lung disease), prevention in doctors' offices (cancer screening and immunizations), and access to medical care. The participants had lower levels of income, education, and marriage (social support) rates, yet the qualitative approach captured their knowledge and sentiments towards participating in clinical trials. The results can severely impact future approaches towards increasing Black participation in clinical trials and can help tailor a more culturally aware approach to diversifying clinical trial participation. Citation Format: Cicely K. Johnson. Barriers to African American participation in clinical trials: A qualitative study of Central Brooklyn residents [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A040.

STOCKOUT: THE IMPACT OF NATIONAL HALOPERIDOL TABLET SHORTAGE TO PHYSICIAN PRESCRIPTION PATTERN AND PATIENT OUTCOMES

Introduction Drug shortages are common in the United States, and in 2019 alone there are 11 psychiatric medications out of a total of 270 drugs that are current listed as in shortage by the FDA. One of these medications is haloperidol, which has been in shortage since October 2018 for its low dosage tablet forms, only one out of two pharmaceutical companies recently restocked these forms as of September 2019. Consequently, patients are impacted due to compromised efficacy, possible medication or dosage errors, of which these lead to higher cost for substitute drug and increased risk of rehospitalization. In Canada, for example, those impacted by haloperidol decanoate shortage had higher rehospitalization rate after switching to a different long acting injectable (LAI) medication. As such, it is important for physicians to be aware of current drug shortages and be ready to address the concerns of patients and their caregivers. Methods We conducted a retrospective chart-review mirror study of the nine months before and after the shortage occurred in October 2018 in 37 patients who are on haloperidol followed in geriatric psychiatry outpatient clinic in Brooklyn, New York. Results The preponderance of subjects in this study were diagnosed with either primary psychotic disorders or dementia with behavioral disturbances. Twelve out of 37 (32%) patients who are prescribed haloperidol had to be switched to a higher dose or liquid form. All twelve patients were previously prescribed less than five milligrams of haloperidol daily. None of the patients had a psychiatric emergency visit or hospitalization in the last year prior to haloperidol shortage, but two of the 12 patients had poor medication adherence following the mandatory medication switch. For these two patients, one agreed to a switch to LAI form and the other decompensated and required a visit to the Comprehensive Psychiatric Emergency Program (CPEP). None of the 25 patients who were unaffected by the shortage had a change or decompensation. Conclusions Low dose haloperidol tablet shortage resulted in subsequent change in medication form in our cohort. Medication adherence became an issue following the switch with resultant emergency visit. These findings reflect the underreported impact of psychiatric drug shortages and specific measures should be taken to better coordinate drug supply chain to minimize negative impact to otherwise chronically stable patients. This research was funded by: This study is funded by the Department of Psychiatry, SUNY Downstate Medical Center

Annual Meeting to Offer Sessions on Suicide From Many Dimensions

Back to table of contents Previous article Next article APA & MeetingsFull AccessAnnual Meeting to Offer Sessions on Suicide From Many DimensionsMichael Myers, M.D.Michael MyersSearch for more papers by this author, M.D.Published Online:4 Feb 2020https://doi.org/10.1176/appi.pn.2020.2a34AbstractSuicide will once again be a prominent topic at APA’s Annual Meeting in response to the rising numbers of deaths by suicide.APA’s Annual Meeting is always replete with state-of-the-art updates on psychiatric dimensions of suicide. This year is no exception. What follows is a list of some of the many offerings. It is far from exhaustive, so I urge anyone attending the meeting to keep abreast of the full program. (Please note that attendees must register for courses and pay an additional fee.)“Dissemination and Implementation of an Evidence-Based Care for Suicide Attempters in Japan” with APA President Bruce Schwartz, M.D., and his expert collaborators from Japan. This Presidential Session will have great appeal to many American and international psychiatrists attending the meeting.“Responding to the Impact of Suicide in Clinicians” with Eric Plakun, M.D., and Jane Tillman, Ph.D. This is a popular and annual interactive session by two seasoned clinicians.“Therapeutic Risk Management of the Suicidal Patient” with Hal Wortzel, M.D., and Bridget Matarazzo, Psy.D., and “Evidence-Based Treatment Approaches for Suicidal Adolescents” with Michele Berk, Ph.D., and Stephanie Clarke, Ph.D. These sessions are presented by APA Publishing authors, who always draw a large attendance.“What Do I Do Now? The Development of a Clinical Pathway for Children and Adolescents With Identified Suicide Risk” with Stephen Soffer, Ph.D., Jason Lewis, Ph.D., O’Nisha Lawrence, M.D., Yesenia Marroquin, Ph.D., and Tami D. Benton, M.D. The presenters will describe the rationale and need for a clinical pathway to support a practice with children and adolescents at risk for suicide, review the process for developing a clinical pathway, and guide the audience through the flow of the clinical pathway.“Data Versus Diatribe and the Depiction of Suicide in the News Media” with Mira Zein, M.D., M.P.H., Jessica Gold, M.D., M.S., Diana Robinson, M.D., Abhisek Chandan Khandai, M.D., M.S., and Laura Pientka, D.O. Attendees will meet in small groups to discuss the relationship between psychiatrists and the media, including safe reporting guidelines and reducing contagion.“Firearms and Suicide Prevention: Why We Should Ask About Guns and How to Do It” with Marian Rain, M.D., Meagan Patricia Whitney, M.D., Theresa Raquel De Freitas Nicholson, M.D., and “Suicide and Firearms: What Do We Know and What Do We Do” with Ahmad Hameed, M.D., Kathleen Clare Dougherty, M.D., and Usman Hameed, M.D. Over 22,000 people die by firearm suicide each year in the United States—a public health crisis in which psychiatrists can play a prominent role in the effort to end it.“Dynamic Therapy With Self-Destructive Borderline Patients: An Alliance-Based Intervention for Suicide” with Eric Plakun, M.D., and Samar Habl, M.D. This session will cover nine practical principles to establish and maintain a therapeutic alliance in the psychodynamic psychotherapy of self-destructive borderline patients.“Developing a Suicide-Specific Treatment Program in Your Health Care Setting” with Kathleen Crapanzano, M.D., and Raymond Tucker, Ph.D. They will focus on the importance of integrating a comprehensive suicide-specific treatment program into mental health care settings.“The Suicidal Patient: Principles and Practice of Assessment, Treatment, and Care Management” with Kirk Strosahl, Ph.D., John Chiles, M.D., and Laura Roberts, M.D., M.A. This master course is a comprehensive, day-long course that will appeal to attendees irrespective of career stage. Participants will learn about the difficulties inherent in both predicting and preventing suicide, with the aim of refocusing their clinical attention on aspects of the patient’s presentation that are more amenable to direct intervention.“Imminent Suicide Risk Assessment in High-Risk Individuals Denying Suicidal Ideation or Intent: Introduction and Training” with Igor Galynker, M.D., Ph.D., and his expert faculty. Dr. Galynker is a prominent suicide researcher/clinician and frequent presenter at APA Annual Meetings. The course aims to train clinicians in a novel framework for the assessment of short-term suicide risk: the Modular Assessment of Risk for Imminent Suicide (MARIS) and the Narrative-Crisis Model of suicidal behavior (NCM). ■More information on these and other Annual Meeting sessions can be found using the Session Search tool on APA’s website here.Michael Myers, M.D., is a consultant to APA’s Scientific Program Committee and a professor of clinical psychiatry at SUNY-Downstate Medical Center. He is a specialist in physician health and the author of numerous books including The Physician as Patient: A Clinical Handbook for Mental Health Professionals and Touched by Suicide: Hope and Healing After Loss. ISSUES NewArchived

Case 3: Rapidly Expanding Neck Mass Leading to Cardiopulmonary Arrest in a 14-year-old Boy.

1. Stanley Lee, MD* 2. Ahmed Aly, MBBS* 3. Paayal Bhakta, MD* 4. Karthikeyan Parameswaran, MBBS* 5. Valeriy Chorny, MD* 6. Rohit Pinto, MD* 7. Jianying Zeng, MD† 8. Richard Hong, MD‡ 9. Melvyn Braiman, MD* 1. *Department of Pediatrics, 2. †Department of Pathology, and 3. ‡Department of Radiology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY A 14-year-old boy is transferred from an outside hospital with a 1-day history of severe left upper neck swelling and pain without any known precipitating factors. Three years ago the patient had a similar episode: a painful left neck mass was diagnosed as lymphadenitis and treated with amoxicillin without sequelae. In the emergency department, vital signs and a complete blood count are within normal limits. The mass is soft and tender to palpation, measuring 1.0 × 1.5 cm. A computed tomographic (CT) scan with contrast reveals an expansile lesion stemming from the left aspect of the hyoid bone compressing the trachea (Fig 1). The ENT team performs a bedside laryngoscopy and confirms a rightward tracheal deviation and compression. Figure 1. Expansile lesion of the hyoid bone causing a rightward tracheal deviation. A computed tomographic scan of the neck revealing a 1.3-cm lesion from the left hyoid bone (blue arrow) with an associated 11.2-cm soft tissue mass expanding through the thoracic outlet. The lesion led to a rightward tracheal deviation and compression (red arrow). On admission to the inpatient unit, the patient is alert, oriented, and in mild distress due to pain, but his vital signs remain within normal limits. The neck mass remains very tender to palpation and has expanded to 4.0 × 5.0 cm on physical examination, a few hours after the initial measurement. His neck has limited movement, and there are no signs of respiratory distress, stridor, drooling, or retractions. He is able to speak in full sentences. He has some difficulty in swallowing solids but is tolerating liquids. He is started on …

Prognostic significant of osteoclast-like giant cells in undifferentiated carcinoma of pancreas

Presenter: Ryosuke Misawa MD, PhD | SUNY Downstate Medical Center Brooklyn Background: Undifferentiated carcinoma of the pancreas (UDC) is defined as containing large eosinophilic pleomorphic cells and/or ovoid-to-spindle-shaped cells and has a poor prognosis. On the other hand, undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOG) comprises osteoclast-like giant cells (OGCs) is suggested to have a better prognosis. However, the number of cases are limited and only case reports and their reviews are available in English literature. The aim of this study was to evaluate the prognostic significance of OGCs using the national cancer database. Methods: A retrospective analysis investigated the US National Cancer Data Base and evaluated patients who were diagnosed with UDC or UCOG from 2004 to 2014. Prognosis, demographic, and clinical features were compared between the two groups. Results: The study identified 1681 patients, 255 were in the UCOG group and 1426 were in the UDC group. The two groups were well matched in demographic profile including age ( 67.3 year-old vs 66.3 year-old, p = 0.146 ), sex ( male 56.9 % vs 57.4 %, p = 0.834 ), race distribution, and co-morbidities ( Charlson/Deyo Score ). The location of the UCOG group tumor were more common in the body and tail of the pancreas compared to the UDG group ( 32.0% vs 24.9%, p = 0.045 ), and as a consequence, more distal pancreatectomies were performed in the UCOG group ( 13.7% vs 7.2%, p = 0.011 ). Institution of chemotherapy ( 32.6% vs 29.3%, p = 0.12 ) and radiotherapy ( 20.0% vs 20.4%, p = 0.678 ) were similar in both groups. The size of the tumor at the time of diagnosis was larger in the UDC group ( 18.7 cm vs 19.7, p = 0.018 ). Lymph node metastasis were far more evident in the UDC group ( 61.7% vs 28.2%, p < 0.01 ). Kaplan-Meier analysis demonstrated superior survival for the UCOG group when compared to the UDC group ( mean OS 16.15 months vs 31.95 months, p = < 0.01 ). Conclusion: The clear prognostic significance of OGC is evident in undifferentiated carcinoma of the pancreas. Continual accumulation of UDC and UCOG cases in a database would clarify the effectiveness of surgical and neoadjuvant/adjuvant treatments in the future.

Numerous Sessions to Address One of Psychiatry’s Most Difficult Topics

Numerous Sessions to Address One of Psychiatry’s Most Difficult Topics

Commentary on Assessing Skin Biopsy Rates for Histologic Findings Indicative of Nonpathological Cutaneous Disease.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York The authors have indicated no significant interest with commercial supporters.

608. The Effect of Prenatal Screening for Chlamydia trachomatis (CT) on Chlamydial Conjunctivitis in Infants

BackgroundCT was the most common identifiable infectious cause of neonatal conjunctivitis in the USA during the 20th century, accounting for 20–40% of cases. Infection is transmitted to newborns via exposure to infected mothers during passage through the birth canal. The transmission risk for an infant born vaginally to a woman with CT has been reported to be as high as 70%, including newborns with asymptomatic respiratory infection; 8–44% will develop conjunctivitis. The CDC recommended routine screening and treatment of pregnant women for CT infection in the United States in 1993. The aim of this study was to determine the impact of screening and treatment during pregnancy on chlamydial conjunctivitis in infants in our population.MethodsA retrospective, observational study of all infant eye samples submitted to the Chlamydia Research Laboratory at SUNY Downstate Medical Center for CT culture from 1986 to 2002. Culture results were divided into two groups by time period: pre-screening (1986–1993) and post-screening (1994–2002).ResultsA total of 880 samples obtained from infants with signs and symptoms of conjunctivitis were submitted for CT culture, 103 (11.7%) were positive. The number of submitted samples and positive cultures both declined over time. The positivity rate for eye cultures was 15.6% during the pre-screening period (1986–1993) and was 1.8% during post-screening period (1994–2002) (P < 0.0001). A separate hospital audit confirmed >95% of pregnant women were screened during the post-screening period.ConclusionThe prevalence of neonatal chlamydial conjunctivitis decreased significantly in our population after the implementation of routine screening and treatment of pregnant women in the United States in 1993.These results also confirm that the most effective way to prevent perinatal chlamydial infection is prenatal screening and treatment of pregnant women. These data have important implications for maternal and infant health globally.Disclosures All authors: No reported disclosures.