UAB Hospital Research Articles

P-526. A Low Cost, Low Technology Intervention for Hospitalized Patients Who Inject Drugs is Feasible for Increasing Evidence-Based Addiction Care but HIV PrEP Uptake Remains Limited

Abstract Background Approximately 14% of new HIV cases in Alabama are from injection drug use, and this does not include HIV transmission from substance use related behaviors such as transactional sex. Hospitalized patients who inject drugs (PWID) present an opportunity to provide addiction treatment and HIV pre-exposure prophylaxis (PrEP). The objective of this study is to assess the feasibility and acceptability of novel, low barrier interventions aimed at increasing uptake of medications for opioid use disorders (MOUD) and PrEP in PWID. Methods In this prospective study, 60 hospitalized PWID who were HIV negative and receiving care at UAB Hospital (from October 2022 to February 2024) were randomized in a two-by-two factorial design to 4 arms: a smartphrase summary of evidence-based care added in the medical record (n=15), an outpatient peer recovery coach intervention (n=15), both (n=15), or standard of care (n=15). Patients completed standardized surveys on substance use, HIV risk behaviors, and their preferences for MOUD and PrEP at baseline. Exit surveys were conducted by phone to assess utilization of addiction treatment, PrEP services, and peer coaching. Feasibility was primarily defined by the ability to recruit hospitalized PWID and retain them in the study to determine post-discharge clinical outcomes, but feasibility was also defined by appropriate use of smartphrase and access and engagement with the peer. We assessed preliminary effectiveness by including utilization of MOUD, PrEP, and the peer coach. Results In the groups who received the smartphrase with or without the peer (n=30), 70% had documentation of the smartphrase in their provider’s consult note, and 90% had a MOUD referenced in their treatment plan. In the groups who received a peer with or without the smartphrase (n=30), 100% were contacted, and 90% had MOUD referenced in treatment plan. However, PrEP was not provided on discharge for any patients in the study. Conclusion In this pilot study of two low barrier interventions for PWID, we found that both interventions are feasible and acceptable, but HIV prevention with PrEP is still lacking. Future directions are to expand the sample size to test if these interventions will increase MOUD and PrEP uptake in a Southern cohort of PWID. Disclosures All Authors: No reported disclosures

Cerebral autoregulation metrics correlate with some major morbidity and mortality outcomes after cardiac surgery

Background: Personalized arterial blood pressure management based on cerebral autoregulation has shown clinical relevance in cardiac surgery. Here we explore the associations between lower limit of cerebral autoregulation (LLA) metrics and postoperative outcomes in a heterogenous and high-acuity population of patients undergoing high-risk cardiovascular surgery. Methods: Autoregulation parameters were determined retrospectively in 686 patients undergoing cardiac surgery at UAB Hospital. Cerebral oximetry index (COx) and hemoglobin volume reactivity index (HVx) determine a patient’s unique LLA by examining the correlation between mean arterial pressure (MAP) and near-infrared spectroscopy signals. Logistic regression analyses explored associations of area under the time-pressure curve and duration below LLA with stroke, acute kidney injury, operative mortality, low cardiac output syndrome, and mechanical ventilation lasting more than 48 hours. Any incidence of these outcomes was considered as the primary outcome of interest: major morbidity or operative mortality (MMOM). Results: We explored the association of Area under the time-pressure curve for pressures less than patient-specific Lower Limits of Autoregulation (AUCABP<LLA: and MMOM. Results are reported with odds ratio (OR) and 95% confidence intervals (CI). AUCABP<LLA was not significantly associated with MMOM incidence (HVx: Odds Ratio 1.000, 95% CI 0.970-1.030, p=0.979; COx: OR 1.006, 95% CI 0.990-1.023, p=0.456). However, for components of MMOM, specifically operative mortality (HVx: OR 1.063, 95% CI 1.013-1.115, p=0.013; COx: OR 1.027, 95% CI 1.001-1.052, p=0.038) and low cardiac output syndrome (HVx: OR 1.036, 95% CI 1.004-1.068, p=0.025), there were statistically significant relationships with AUCABP<LLA when controlling for logistic Euroscore and preoperative hemoglobin levels. Conclusions: Area under the time-pressure curve for pressures less than patient-specific LLA was not significantly associated with MMOM incidence. However, we found significant associations between components of MMOM, specifically operative mortality and low cardiac output syndrome, with an AUCABP<LLA and time under LLA. These results suggest that LLA metrics might have utility in predicting specific postoperative outcomes, but their role in predicting overall MMOM may be limited in heterogenous and high-acuity patient populations. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Menstrual Suppression in the Myelosuppressed: A Retrospective Cohort Study.

Adolescent and young adult female patients receiving myelosuppressive cancer treatments are at risk of abnormal uterine bleeding (AUB). The frequency with which patients with cancer receive menstrual suppression and the agents used have not previously been well-characterized. We studied the rate of menstrual suppression, the effect of suppression on bleeding and blood product utilization, and if there were practice pattern differences between adult and pediatric oncologists. We established a retrospective cohort of 90 females with a diagnosis of Hodgkin or non-Hodgkin lymphoma (n = 25), AML (n = 46), or sarcoma (n = 19) and treated with chemotherapy between 2008 and 2019 at our institutions (University of Alabama at Birmingham [UAB] adult oncology: UAB hospital; UAB pediatric oncology: Children's of Alabama). Data were abstracted from the medical record including sociodemographics, primary oncologist specialty (pediatric v adult), cancer details (diagnosis and treatment) and gynecologic course (documented gynecologic history, menstrual suppression agents used, reported AUB outcomes, and treatments). The majority of patients (77.8%) received menstrual suppression. Compared with nonsuppressed patients, suppressed patients had similar rates of packed red blood cell transfusions but higher number of platelet transfusions. Adult oncologists were more likely to document a gynecologic history, consult gynecology, and list AUB as a problem. Among suppressed patients, there was heterogeneity in the agents used for menstrual suppression, with a predilection toward progesterone-only agents; a low rate of thrombotic events was observed. Menstrual suppression was common in our cohort with variability in agents used. Pediatric and adult oncologists demonstrated different practice patterns.

Hospital-Associated Disability Associated With Delirium Among Older Adults

Hospital-associated disability (HAD), defined as a loss of activities of daily living (ADLs) occurring during hospitalization, is a common complication among older adults. Delirium is also a common complication during hospitalization and is associated with multiple long-term sequelae. We sought to determine the effect of delirium and known covariates on the risk of incident HAD in hospitalized older adults. We examined electronic health record (EHR) data for 35,201 older adults ≥ 65 years of age admitted to the general inpatient (non-ICU) units of UAB Hospital from January 1, 2015 to December 31, 2019. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission, and HAD defined as a decline on the Katz ADL scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations for individuals with multiple admissions. We found that 21.2% of older adults developed HAD during their hospitalization and experienced higher delirium rates as compared to those not developing HAD (25.2% vs. 16.3%). Presence of delirium, medical comorbidity score, baseline cognitive status, and baseline ADL function were associated (all p <0.001) with incident HAD. Mediation analyses also showed that 8% of the effect of comorbidity on incident HAD was due to delirium (p < 0.001). Reducing rates of delirium can be one component of a comprehensive approach to reduce rates of HAD in older adults.

Inpatient Telehealth and Coronavirus Disease 2019 Outcomes: Experiences in Alabama.

Background: During the early months of the coronavirus disease 2019 (COVID-19) pandemic, hospitals were concerned about preserving personal protective equipment. UAB Hospital Medicine designed a strategy to outfit acute care patient rooms on a COVID-19 unit with telemedicine technology to allow for remote clinician rounding.Objective: To describe one hospital's experience with inpatient telehealth and compare outcomes between patients with and without inpatient telehealth visits.Design and Methods: Retrospective chart review of patients admitted to UAB Hospital Medicine with COVID-19 between March 16, 2020 and April 24, 2020. Logistic and negative binomial regression models were used to examine the relationship between telehealth visits and the likelihood of a subsequent transfer to the intensive care unit (ICU), ventilation, and number of ICU days. Clinician interviews provided additional insight into the telehealth implementation.Findings: One-quarter of the patients received a telehealth visit. Half were admitted to the ICU, and one-third received ventilation. Regression models did not identify statistically significant differences in transfer to the ICU, number of ICU days, and ventilation between patients with and without telehealth visits. Older age and increased respiratory rate were associated with higher odds of ICU admission. Patients with a cough were associated with lower odds of ventilation and fewer ICU days.Discussion: Implementation challenges included difficulties associated with assisting patients with operating the tablets. However, clinicians noted that there was a great benefit to patients being able to see an unmasked physician. Furthermore, the telehealth program proved to be a viable strategy for connecting patients in isolation with their families. Findings can inform the future development of inpatient telemedicine strategies.

Returning to Growth: One Academic Medical Center's Successful Five-Step Approach to Change Management.

The University of Alabama at Birmingham academic medical center (UAB AMC) had achieved great success and growth during the 50 years since its founding. However, the challenging and more competitive environment of the 2000s left the UAB AMC on a downward trajectory. The UAB AMC had to overcome difficult internal cultural and structural barriers that stood in the way of the transformational change needed to remain competitive. Competition rather than collaborative and strategic financial investment were the primary cultural barriers for the UAB AMC, while people were the primary structural barrier. Leadership identified 5 steps that were critical for the transformation that occurred between 2013 and 2018: alignment of leadership; creating a compelling and credible shared vision; identifying cultural and structural barriers; creating a thoughtful, data-driven intervention; and improved communication and accountability. Following these steps enabled the UAB AMC to transform its institutional structure and culture. As a result, the UAB AMC thrived, returning to substantial growth in research and clinical care. UAB AMC School of Medicine grew by $100 million in National Institutes of Health funding and moved up 10 spots in ranking. In 2018, UAB Hospital had 10 specialties ranked by U.S. News & World Report, 7 more than in 2013. This article outlines the approach taken and provides a conceptual framework for other AMCs eager to transform their structure and culture and position themselves for growth.

Empowering the People: Introducing an Advance Care Planning Conversation to Improve Cultural Sensitivity Among African American Heart Failure Patients (W215C)

1.Describe health disparities in advance care planning (ACP) engagement among African American patients with heart failure.2.Evaluate the effect of Respecting Choices, an evidence-based ACP facilitation program on ACP knowledge, contemplation, and self-efficacy.3.Identify culturally sensitive strategies to enhance ACP engagement to decrease health disparities in African American heart failure patients. Advance care planning (ACP) improves goal-concordant care and communication. African Americans (AA) are disproportionately affected by heart failure (HF) with higher morbidity and mortality supporting the need for ACP engagement in this clinical population. Yet, few AAs engage in ACP due to a lack of knowledge and culturally sensitive interventions. Assess the effect of a culturally sensitive delivery of Respecting Choices®, an evidence-based ACP facilitation program on ACP knowledge, contemplation, and self-efficacy. African American heart failure patients ≥ age 45 were recruited from the UAB Hospital Heart Failure Transitional Care Services for Adults (HRTSA) Clinic to participate in a quality improvement project aiming to improve ACP engagement. Participants received the one-on-one culturally sensitive 90-minute Respecting Choices® intervention delivered by an AA nurse clinician in local communities. ACP engagement was assessed in three domains including knowledge, contemplation, and self-efficacy using the validated ACP engagement survey by Sudore et al. at pre- and post-intervention. Thirty-three HF patients from the HRTSA clinic were approached; 28 were eligible; and 15 were enrolled from January to March 2019. Average age was 56.6 years (SD 6.7), all (n=15, 100%) were uninsured/underinsured; 80% (n=12) were male; 80% (n=12) had a high school or higher education; and 87% (n=13) identified as Christians. Participants reported improvement in knowledge (pre=3.8 vs. post=4.6), contemplation (pre=3.2 vs. post=4.4), and self-efficacy (pre=3.6 vs. post=4.4) with higher scores indicating higher engagement (range 1-5). A culturally sensitive ACP Respecting Choices® session designed for AA HF patients has shown preliminary evidence to improve ACP engagement. There is an urgent need to expand and integrate culturally sensitive ACP interventions into routine clinical care to improve health equity in the AA HF population.

808 Racial disparities in reliable contraception use in women with heart disease

Reliable contraception (RC) is encouraged for women with maternal cardiac disease (MCD) to allow for counseling and medical optimization before pregnancy. Since MCD is a leading cause of pregnancy-related deaths and unduly affects Black women, we sought to investigate differences in RC use between Black and White women with MCD. Retrospective cohort of women with MCD managed by the UAB Comprehensive Pregnancy & Heart Program (CPHP). Women were included if they attended ≥ 1 prenatal visit at the UAB CPHP and delivered at UAB Hospital between March 2015 and June 2019. The primary outcome was RC use within 2 months postpartum (PP) by receipt of long acting reversible contraception (e.g. intrauterine device or etonogestrel implant) or PP sterilization (immediately PP or up to 2 months PP). Secondary outcomes included RC use in women with modified World Health Organization maternal cardiovascular risk classification (mWHO Class) III/IV, non-RC choices, and PP follow-up. All outcomes were compared based on self-reported race. One hundred forty-nine women met inclusion criteria (Table 1). Black women were more likely than White women to use RC (65% vs 43%, p=0.008) (Table 2). There was no difference in RC use between Black and White women with mWHO Class III/IV (37% vs 28%, p=0.42). Black women were less likely than White women to be undecided or decline contraception at the time of admission (13% vs 27%, p=0.037). Tubal ligation performed before hospital discharge was the most common form of contraception for all women (p=0.41). There was no difference in PP follow-up attendance (p=0.42). Black women with MCD were more likely than White women to receive RC. However, over 25% of women with mWHO Class III/IV did not receive RC PP. Interventions designed to address disparities in unintended pregnancy in patients with MCD should focus on improving RC use among all women, especially those with mWHO III/IV. Increasing use of RC in women with MCD may mitigate maternal morbidity and mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effectiveness of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for Reduction of Vancomycin Use for Pneumonia

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been a well-established risk for developing MRSA pneumonia. In previous studies, the MRSA nasal screening test has shown an excellent negative predictive value (NPV) for MRSA pneumonia in patients without exclusion criteria such as mechanical ventilation, hemodynamic instability, cavitary lesions, and underlying pulmonary disease. MRSA nasal screening can be used as a stewardship tool to de-escalate broad antibiotic coverage, such as vancomycin. Objective: The purpose of this study was to determine whether implementation of a MRSA nasal screening questionnaire improves de-escalation of vancomycin for patients with pneumonia. Methods: A retrospective review was performed on 250 patients from October 2018 to January 2019 who received MRSA nasal screening due to their prescriber choosing only “respiratory” on the vancomycin dosing consult form. Data obtained included demographics and clinical outcomes. Statistical analyses were performed, and P &lt; .05 was considered significant. Results: Of the 250 patients screened, only 19 patients (8%) were positive for MRSA. Moreover, 40% of patients met exclusion criteria. In 149 patients without exclusion criteria, the MRSA nasal swab had a 98% NPV. Although not statistically significant, vancomycin days of therapy (DOT) based on MRSA nasal swab result was 1 day shorter in those with negative swabs (3.49 days negative vs 4.58 days positive; P = .22). Vancomycin DOT was significantly reduced in pneumonia patients without exclusion criteria (3.17 days “no” vs 4.17 days “yes”; P = .037). Conclusions: The implementation of an electronic MRSA nasal screening questionnaire resulted in reduced vancomycin DOT in pneumonia patients at UAB Hospital. The MRSA nasal swab is an effective screening tool for antibiotic de-escalation based on its 98% NPV for MRSA pneumonia if utilized in the correct patient population.Funding: NoneDisclosures: Rachael Anne Lee reports a speaker honoraria from Prime Education, LLC.

Standard Processing of Apheresis Products for HSCT Provides Significant Cost Savings over Automated Processing without Impact on Time or Product Quality

Introduction: Automated cell manufacturing is becoming increasingly common in advanced manufacturing protocols in order to provide more linearity and quality control. However, most of the manufacturing performed within full-service cell therapy laboratories consists of routine processing for HSCT. Automated systems are also employed for basic cell processing although the value of these systems is not routinely assessed. We compared our standard method for cell washing and concentration using the Terumo 2991® to manual centrifuge-based processing autologous apheresis products, testing the hypothesis that manual centrifuge-based processing would decrease cost and staff time for processing of apheresis HSCT products.Methods: A total of 10 products were compared (9 myeloma and 1NHL). Using the Terumo 2991®, the collection bag was rinsed x2 with a Plamalyte A®/Sodium Citrate prior to automated centrifugation and the centrifuge module was rinsed in a similar manner following concentration and expression of the cell product. For centrifuge-based manual processing, the product was transferred from the collection bag to a transfer bag, centrifuged, and excess plasma expressed. Each product was diluted to 10% within 5 x 108WBC/ml with autologous plasma. Samples were obtained for cell counting, viability, and CD34 enumeration by flow cytometry at the beginning and end of processing and following cryopreservation/thawing and 7d storage. Hands-on time was assessed by an observer and materials cost was based on standard pricing for UAB Hospital. Statistical determinations consisted of mean, SD, and student's t-test.Results: The WBC/kg dose recovery was not significantly different between automated processing (x̅=0.894±0659) and manual centrifuge-based processing (x̅=0.938±0.0696, p=0.163). The CD34+/kg dose recovery also did not show a significant difference between automated (x̅=0.875±0.0920) and centrifuge-based processing (x̅=0.937±0.0897, p=0.302). Post processing total viability, however, was significantly improved for the manual centrifuge-based processing (x̅=0.940±0.0260 vs. x̅=0.890±0.0390 p=0.031). Post thaw and wash CD34+ viability showed no difference between automated processing (x̅=0.8260, SD=0.0840) and manual centrifuge-based processing (x̅=0.810, SD=0.0260, p=0.592). Patients that were transplanted the manual centrifuge-based processed products engrafted between days 11 and 13. The institution engraftment benchmark is 15 days with an average of 11.3 days. Hands-on time for processing was also not significantly different between the two methods (x̅=27.89±7.897min for automated vs x̅=34.88±9.975min for standard, p=0.169). The combined cost for labor and supplies for automated Terumo® 2991 is $174.01 per product processed and $63.58 for manual centrifuge-based product processed. This produces a cost saving of $110.43 per product processed.Conclusions: Taken together, these findings show that manual centrifuge-based processing creates significant cost savings and improved product viability for the same hands-on processing time and with no significant total or CD34+ cell loss. With the current financial trends in healthcare, significant savings in standard care is important for the laboratory and hospital providing care. DisclosuresLamb:Incysus Therapeutics Inc.: Consultancy, Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Improvement of Gram-negative Susceptibility to Fluoroquinolones After Implementation of a Pre-Authorization Policy for Fluoroquinolone Use: A Decade-Long Experience

BackgroundAntibiotic use is a well-known risk factor for acquisition of drug-resistant bacteria and community antibiotic prescribing can drive high rates of resistance within the hospital setting. Owing to concerns over increasing fluoroquinolone (FQ) resistance among Gram-negative organisms at UAB Hospital, our stewardship program implemented a pre-authorization policy. The goal of this study was to assess the relationship between hospital fluoroquinolone use and antibiotic resistance.MethodsIn 2006, the inpatient formulary was consolidated to only ciprofloxacin and moxifloxacin with implementation of guidelines for use to limit inpatient prescribing. Any use outside of these guidelines required approval from an infectious diseases physician. Organism-specific data were obtained from the clinical microbiology database and FQ use was obtained from the hospital database. Correlations were calculated using Pearson’s coefficient.ResultsFrom 1998 to 2004, FQ use peaked at 173 days of therapy (DOT)/1,000 patient-days, but has remained below 60 DOT/1,000 patient-days since restriction implementation (Figure 1). FQ susceptibility was documented for five common Gram-negative isolates, P. aeruginosa, Acinetobacter spp., Enterobacter cloacae, E. coli, and K. pneumoniae, over an 18-year period (1998–2016). Common hospital acquired pathogens, including Pseudomonas aeruginosa, Acinetobacter spp. and Enterobacter cloacae improved in their susceptibilities to fluoroquinolones. Acinetobacter went from 35% to over 50% susceptible in the preceding 10 years after the policy. Pseudomonas improved from 50% susceptible to over 70% and Enterobacter improved from less than 50% to over 90% susceptible. Interestingly this improvement was not seen for E. coli which continued to show a decline in susceptibility from over 90% to near 60% in 2016.ConclusionIn a large academic hospital setting, FQ susceptibility for common hospital-acquired GNRS improved significantly with the introduction of a restricted use program. A continued decline in E. coli FQ susceptibility suggests resistance rates may be driven by outpatient and community antibiotic use and thus, outpatient stewardship programs are necessary to prevent further spread of FQ resistance.Disclosures All authors: No reported disclosures.

The UAB Informatics Institute and 2016 CEGS N-GRID de-identification shared task challenge

Clinical narratives (the text notes found in patients’ medical records) are important information sources for secondary use in research. However, in order to protect patient privacy, they must be de-identified prior to use. Manual de-identification is considered to be the gold standard approach but is tedious, expensive, slow, and impractical for use with large-scale clinical data. Automated or semi-automated de-identification using computer algorithms is a potentially promising alternative. The Informatics Institute of the University of Alabama at Birmingham is applying de-identification to clinical data drawn from the UAB hospital’s electronic medical records system before releasing them for research. We participated in a shared task challenge by the Centers of Excellence in Genomic Science (CEGS) Neuropsychiatric Genome-Scale and RDoC Individualized Domains (N-GRID) at the de-identification regular track to gain experience developing our own automatic de-identification tool. We focused on the popular and successful methods from previous challenges: rule-based, dictionary-matching, and machine-learning approaches. We also explored new techniques such as disambiguation rules, term ambiguity measurement, and used multi-pass sieve framework at a micro level. For the challenge’s primary measure (strict entity), our submissions achieved competitive results (f-measures: 87.3%, 87.1%, and 86.7%). For our preferred measure (binary token HIPAA), our submissions achieved superior results (f-measures: 93.7%, 93.6%, and 93%). With those encouraging results, we gain the confidence to improve and use the tool for the real de-identification task at the UAB Informatics Institute.

Abstract 151: Obesity is independently associated with mTORC1 pathway activation in the progression of endometrial cancer.

Abstract Background: Obesity is a major risk factor for endometrial cancer (EC) yet, with the exception of estrogen, the mechanisms underlying this association remain unclear. The mammalian target of rapamycin complex 1 (mTORC1) cascade links energy balance to cell proliferation via the PI3K/Akt pathway. Phosphorylation of Akt by hormone and growth factor signaling activates mTORC1 and results in the downstream phosphorylation of 4EBP1. Activated 4EBP1 positively regulates cap-dependent translation and cell growth, and correlates with EC progression. Thus, we explored the associations between obesity and pAkt and p4EBP1 expression, and cell proliferation rates (Ki67) in benign and malignant endometrial tissues. Methods: Medical records were reviewed to identify women who underwent endometrial biopsy at UAB Hospital from 2008-2010. Women who had recurrent EC or diagnoses of any other cancer were excluded. Data on diagnosis, height, weight, race, age, menopausal status, number of children, medications, and comorbid conditions were extracted from medical records. Height and weight were used to calculate body mass index (BMI: kg/m2). A gynecologic pathologist reviewed H&amp;E slides for concordance with the pathology report, and additional sections were obtained from formalin-fixed paraffin-embedded tissue blocks. Immunohistochemistry was used to assess p4EBP1, pAkt, and Ki67. The pathologist employed a semiquantitative scoring system based on percent positive and staining intensity for p4EBP1 and pAkt, and scored on percent positive for Ki67. Wilcoxon rank-sum tests were used to compare marker activity between women with and without EC in the overall and BMI-stratified sample. Results: Immunohistochemical data were available for 18 benign and 25 type 1 endometrioid EC cases, of which 29 were obese (BMI &amp;gt; 29.9) and 14 were non-obese (BMI ≤ 29.9); the overall mean BMI was 35.5 (SD=11.6). Mean age was 56.7 (12.2). Women with vs. without EC had significantly elevated median [interquartile range] expression of cytoplasmic p4EBP1 (95 [30-180] vs. 0 [0-20], p=0.001), nuclear p4EBP1 (170 [95-195] vs. 70 [20-100], p=0.003), and Ki67 (50 [40-80] vs. 10 [5-20], p&amp;lt;0.0001). EC was not associated with pAKT activity. While obese women with vs. without EC had significantly higher expression of cytoplasmic p4EBP1 (100 [80-180] vs. 0 [0-10], p=0.002) and nuclear p4EBP1 (180 [100-200] vs. 65 [20-100], p=0.002), neither cytoplasmic nor nuclear p4EBP1 activity differed by EC status among non-obese women. No associations between obesity and Ki67 or pAKT were detected. Conclusions: Results from this exploratory study suggest that p4EBP1 expression is elevated in obese women with EC. These preliminary findings suggest that obesity may play a role in EC-related activation of the mTORC1 pathway and 4EBP1, a biomarker for EC outcomes. Citation Format: Emily Falk Libby, Maria Azrad, Lea Novak, Wendy Demark-Wahnefried. Obesity is independently associated with mTORC1 pathway activation in the progression of endometrial cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 151. doi:10.1158/1538-7445.AM2013-151

Smoking and diabetes mellitus type 2 reduce skin graft take; the use of fibrin glue might restore graft take to optimal levels

Efficacy has been demonstrated in some uses of fibrin glue associated with graft loss. Smoking and hyperglycemia significantly decrease the success of skin graft survival in specific injuries. This retrospective study aimed to verify the association with decreased skin graft survival and whether fibrin glue is useful in reversing the influence of these factors. This bicentric, retrospective, cross sectional case control study was carried out on 1881 medical patients. Patients who met inclusion criteria were admitted to the Plastic Surgery Service of Reina Sofia University Hospital (Spain) and the Trauma/Burn intensive Care Unit of UAB Hospital at Birmingham (USA) between January 2000 and December 2009. The successful graft take for each group and its control were analyzed by a Chi-square test; the confidence interval was 95%. Smoking and DM type 2 decrease skin graft survival when compared with their control groups. There was a statistically significant improvement in skin graft take when fibrin glue was used. The percentage improvement in the control groups was approximately 10%, whereas in the study groups it was 2-3 times higher. We conclude that graft loss is associated with smoking and DM type 2, but fibrin glue might restore graft adherence to almost normal levels.

Preventing False Positive Blood Cultures On The Bone Marrow Transplant Unit At UAB Hospital

Preventing False Positive Blood Cultures On The Bone Marrow Transplant Unit At UAB Hospital

How UAB Hospital'S BMT Unit Used Collaborative Partnerships to Answer the Call Of An Increased Need for House ICU Beds While Addressing Issues Of A Fluctuating Bmt Specialty Census

How UAB Hospital'S BMT Unit Used Collaborative Partnerships to Answer the Call Of An Increased Need for House ICU Beds While Addressing Issues Of A Fluctuating Bmt Specialty Census

NUMBER OF TRANSFUSIONS (TX) BY GESTATIONAL AGE (GA) AND LENGTH OF STAY (LOS).1700

To reduce blood product Tx and donor exposures, a number of methods have been proposed, including rhEpo, reduced sampling, sterile docking devices, and dedicated units. To assess the impact of different methods, the frequency of blood product Tx must be predicted for a given GA. Data were prospectively collected on PRBC, plasma (FFP) and platelet Tx, GA and LOS for 6248 infants admitted to UAB Hospital's newborn ICU 1989-1995. The mean Tx per baby and number of Tx per 100 days of stay were calculated. The relationship of PRBC Tx to GA and LOS was significant (p< 0.0001, mult. logistic regression). PRBC Tx/baby peaked at 24 wks and showed a nadir at 33wks(Table). Platelet Tx/baby and Tx/100 days were not significantly related to GA (0.07 ± 0.01, 0.7 ± 0.1 respectively). FFP Tx were related to GA (p <0.01) with Tx/100days peaking at 24 and 38wks (3.7 ± 1.9, 2.8 ± 1.6) with a nadir at 34wks(0.2 ± 0.1). Together with data on timing of Tx, these data should facilitate choosing which infants would benefit and the most effective method(s) of reducing donor exposure for a given GA so that appropriate strategies may be initiated at admission.