University Of Rochester Medical Center Research Articles

Prenatal bisphenol A exposure in relation to behavioral outcomes in girls aged 4–5 and modification by socio-demographic factors in The Infant Development and Environment Study (TIDES)

Bisphenol A (BPA) is a polymer used in the production of polycarbonate plastics and epoxy resins. An estrogen mimic, prenatal BPA exposure has been associated with several behavioral outcomes in children; however, the impact of maternal demographic and economic factors on associations between BPA and child behavioral outcomes have not been examined. The objective of this study was to examine associations between prenatal maternal urinary BPA and behavior in 4–5 year old girls, and to assess whether socio-demographic factors modify this relationship. Mothers enrolled in The Infant Development and Environment Study (TIDES) provided a single spot urine at enrollment (median gestational age 11 weeks) and completed the Behavior Assessment System for Children-2 (BASC-2) and Social Responsiveness Scale-2 (SRS-2) when their daughters were 4–5 years of age. Mother-daughter pairs with complete phthalate, BASC-2, SRS-2, and covariate data were included in this analysis (N = 244). BPA was detectable in 93 % of urine samples. We used multivariable linear regression analyses to estimate associations between maternal urinary log10-transformed BPA concentration and BASC-2 subscale and composite scores and SRS-2 Total Score. To examine the role of socioeconomic and demographic factors associated with study site, we stratified by TIDES center, comparing those enrolled at University of Rochester Medical Center (URMC), a predominately lower socioeconomic population, and those enrolled elsewhere: University of Washington, University of Minnesota, and University of California San Francisco, whose populations share similar higher socioeconomic demographic characteristics. Across all centers, no associations were seen between BPA and BASC-2 or SRS-2 scores. When stratifying by center, BPA was significantly associated with greater social impairment as measured by the SRS-2 Total Score (β-coefficient [95 % confidence intervals]: 5.1 [1.0, 9.2]) in URMC participants (N = 61). In non-URMC participants (N = 183), BPA was significantly associated with lower BASC-2 Internalizing composite (−3.3 [−6.7, 0.0]) and Depression subscale scores (−3.4 [−6.7, 0.0]) while no associations were seen between BPA and SRS-2 scores. Our findings suggest that sociodemographic factors may modify the impacts of maternal prenatal BPA on developmental endpoints.

Bedside art is good medicine

“Thank you so much for doing this; I needed it,” was a sentiment I heard often on the sixth floor of Wilmot Cancer Institute (Rochester, NY, USA). As the daughter of an artist, I was overjoyed to stumble upon an opportunity to share my passion for art with patients. Started at the University of Rochester Medical Center in 2009, Art at the Bedside is a hospital visitation programme that evolved from the intersection of chaplaincy and museum education. The idea for this programme first occurred to my mentor Susan Dodge-Peters Daiss several years earlier, while she was shuttling between two positions—a chaplain at the University of Rochester Medical Center and an educator at the university's Memorial Art Gallery. She wondered whether the experience of appreciating artwork at a museum could be mirrored in the hospital, and whether a facilitated art-viewing experience could bring patients comfort and joy during a difficult time.

Circadian control of macrophages in the tumor microenvironment.

Abstract Introduction All leukocytes tested to date have functional circadian clocks, and nearly every arm of the immune response is subject to circadian regulation. Circadian clocks instruct the time-of-day-dependent, rhythmic expression of genes in a tissue- and cell-specific manner. In macrophages (mΦs), the circadian clock regulates several factors that are critical to executing effective immune responses. Tumor-associated mΦs are major contributors to immune suppression in the tumor microenvironment (TME). Evidence suggests that metabolically stressful factors in the TME such as acidic pH and nutrient limitation promote mΦ-mediated immune suppression, and recent data point to dysregulation of the circadian clock downstream of metabolic stress. Methods We study the effect of TME-associated metabolic stress on the circadian clock of mΦs in vitro by culturing bone marrow-derived mΦs in conditions mimicking acidic pH and nutrient limitations that have been observed in the TME. To study the impact of mΦ-intrinsic circadian rhythms on tumorigenesis in vivo, we use mice genetically engineered to have a myeloid cell-specific disruption of the circadian clock via deletion of the key clock protein BMAL1. Results Oscillation of core clock proteins is altered in mΦs subjected to TME-associated metabolic stress. Additionally, we observe increased tumor growth in mice co-injected with mΦs whose circadian clocks were disrupted compared to mice co-injected with mΦs whose circadian clocks were functional. Conclusion Our data suggests that stressful conditions associated with the TME can alter the mΦ circadian clock, and that a functional circadian clock in mΦs can suppress tumor growth in a syngeneic murine tumor model of pancreatic cancer. This research has been supported by the following fellowships and grants: 2021-Current: Wilmot Predoctoral Cancer Research Fellowship, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 2020-2021: NIH T32 Training Grant in Cellular, Biochemical & Molecular Sciences, University of Rochester Medical Center, Rochester, NY

PO-699-07 RISK OF SUDDEN CARDIAC DEATH IN PATIENTS UNDERGOING CANCER TREATMENT

The risk of sudden cardiac death (SCD) among cancer patients receiving cancer therapies in not well-defined. The identification of patients exposed to cancer treatments who are at risk of SCD may lead to preventive measures and may improve patient survival. Our study aimed to 1), evaluate the risk of SCD during the first 6 months of cancer treatment and 2), identify predictors of SCD in patients undergoing active cancer treatment. The present study population comprised 8356 patients who received any cancer treatment at the University of Rochester Medical Center from 2011-2020. The primary endpoint was occurrence of SCD during the first 6 months of cancer treatment. To identify cause of death, medical charts were reviewed for narratives including a description of the circumstances surrounding each patient’s death. Mode of death was categorized as cardiac or non-cardiac. Cardiac cause of mortality was further categorized as SCD using the modified Hinkle-Thaler classification. Mean age at the time of cancer treatment was 64 +14 years, 50% were female and 85% were White. History of smoking was reported in 45% of patients, hypertension in 57%, diabetes in 25% and coronary artery disease in 19%. Death occurred in 834 (10%) within 6 months from cancer treatment, with SCD was identified in 49 (6%) patients. At 6-month follow-up, the cumulative rate of sudden cardiac death was 0.60% as shown in Figure 1. The cumulative rate of SCD was significantly higher among patients less than 74 years of age as shown in Figure 2. Consistently cox regression analysis showed that age less than 74 years was associated with 2.6-fold higher risk of SCD (HR 2.62, 95%CI 1.04-6.60, p value 0.042). Cancer treatment may be associated with increased risk of SCD during the first 6 months of treatment and the elevated risk of SCD appears to be more pronounced in patients who are less than 74 years of age. Further prospective studies with monitoring are warranted to better understand the mode of SCD in this population and to identify measures for SCD protection in high-risk patients who receive cancer treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Utility of Select Gene Mutation Detection in Tumors by the Idylla Rapid Multiplex PCR Platform in Comparison to Next-Generation Sequencing.

Testing of tumors by next generation sequencing (NGS) is impacted by relatively long turnaround times and a need for highly trained personnel. Recently, Idylla oncology assays were introduced to test for BRAF, EGFR, KRAS, and NRAS common hotspot mutations that do not require specialized trained personnel. Moreover, the interpretation of results is fully automated, with rapid turnaround time. Though Idylla testing and NGS have been shown to have high concordance in identifying EGFR, BRAF, KRAS, and NRAS hotspot mutations, there is limited experience on optimal ways the Idylla system can be used in routine practice. We retrospectively evaluated all cases with EGFR, BRAF, KRAS, or NRAS mutations identified in clinical specimens sequenced on two different NGS panels at the University of Rochester Medical Center (URMC) molecular diagnostics laboratory between July 2020 and July 2021 and assessed if these mutations would be detected by the Idylla cartridges if used. We found that the Idylla system could accurately identify Tier 1 or 2 actionable genomic alterations in select associated disease pathologies if used. Yet, in a minority of cases, we would have been unable to detect NGS-identified pathogenic mutations due to their absence on the Idylla panels. We derived algorithmic practice guidelines for the use of the Idylla cartridges. Overall, Idylla molecular testing could be implemented either as a first-line standalone diagnostic tool in select indications or for orthogonal confirmation of uncertain results.

The spectrum of renal diseases with lupus-like features: a single-center study

Background A subset of patients without overt systemic lupus erythematosus (SLE) present with biopsy findings typically seen in lupus nephritis (LN). Although a minority eventually develops SLE, many do not. It remains unclear how to classify or treat these patients. Our study attempted to further understand the clinical and pathological characteristics of cases with lupus-like nephritis (LLN). Methods Among 2700 native kidney biopsies interpreted at University of Rochester Medical Center (URMC) from 2010 to 2019, we identified 27 patients with biopsies showing lupus-like features (LL-fx) and 96 with LN. Of those with LL-fx, 17 were idiopathic LLN and 10 were associated with a secondary etiology (e.g., infection/drugs). Results At the time of biopsy, the LLN-group tended to be slightly older (44 vs. 35), male (58.8 vs. 17.7%, p = .041), and Caucasian (47.0 vs. 28.1%, p = .005). Chronic kidney disease was the most common biopsy indication in LLN (21.4 vs. 2.8%, p = .001). Both LN and LLN presented with nephrotic-range proteinuria (mean 5.73 vs. 4.40 g/d), and elevated serum creatinine (mean 1.66 vs. 1.47 mg/dL). Tubuloreticular inclusions (TRIs; p < .001) and fibrous crescents (p = .04) were more often seen in LN, while more tubulointerstitial scarring was seen in LLN (p = .011). At mean follow-up of 1684 d (range: 31–4323), none of the LLN patients developed ESRD. A subset of both LN and cases with LL-fx overlapped with other autoimmune diseases. Conclusions Lupus-like pathologic features are seen in a wide array of disease processes. The findings suggest that LLN may be a manifestation of an autoimmune process that overlaps with SLE.

Editorial Comment on Considerations in the Analysis of Clinical Trial Failure. II.

No AccessJournal of UrologyEditorial1 Mar 2022Editorial Comment on Considerations in the Analysis of Clinical Trial Failure. II Timothy Campbell, Alexis R. Steinmetz, and Jathin Bandari Timothy CampbellTimothy Campbell Department of Urology, University of Rochester Medical Center, Rochester, New York More articles by this author , Alexis R. SteinmetzAlexis R. Steinmetz Department of Urology, University of Rochester Medical Center, Rochester, New York More articles by this author , and Jathin BandariJathin Bandari Department of Urology, University of Rochester Medical Center, Rochester, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002429AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment on Considerations in the Analysis of Clinical Trial Failure. II." The Journal of Urology, 207(3), p. 503

Myeloid bodies is not an uncommon ultrastructural finding

ABSTRACT The presence of myeloid bodies (MBs) is classically associated with Fabry disease (FD). However, MBs are also identified in patients without clinical evidence of FD. We attempt to further understand the clinicopathologic significance of incidental MBs in those without FD. Among the 4400 renal biopsies accessioned at the University of Rochester Medical Center from 2010 to 2021, we identified 32 cases showing MBs, 6 of which had FD. Medications were compared between a non-FG and a control-group of randomly selected cases without MBs (non-MBs). Both Fabry-group (FG) and non-Fabry-group (non-FG) were predominantly middle-aged (mean 48 years vs 56, respectively). Non-FG had slight female predominance (1:4), while all in FG were female. The majority of both non-FG and non-MBs cohort were on the same medications reported to cause phospholipidosis except sertraline and hydralazine (p = .04), which were more frequent in non-FG. Ultrastructurally, non-FG tended to show focal MBs in predominantly podocytes, while FG showed more extensive MBs in not only podocytes but also parietal, tubular, endothelial, and myocyte cells (p = .03). In addition, half of FG had another superimposed renal disease including kappa-light chain deposition disease, thin-basement membrane nephropathy, and lithium-related changes. MBs are encountered not only in FD but in other settings including CADs, toxins, and other inheritable diseases. Although secondary causes of MBs typically show less extensive involvement compared to FD, these features overlap. Given the challenges in diagnosing female carriers, the finding of MBs, though not specific to FD, may be the only clue that leads to further work-up and timely diagnosis, underscoring the importance of considering FD among other etiologies in differential diagnosis.

Reply by Authors.

No AccessUrology PracticeBusiness of Urology1 Jan 2022Reply by Authorsis a reply to letterEditorial Commentary Alexis R. Steinmetz, Jacob Gantz, Kevin Fiscella, and Edward M. Messing Alexis R. SteinmetzAlexis R. Steinmetz http://orcid.org/0000-0002-5833-851X Department of Urology, University of Rochester Medical Center, Rochester, New York Supported in part by Urology Care Foundation Residency Research Award and Kahlert Foundation. Equal study contribution. More articles by this author , Jacob GantzJacob Gantz Department of Urology, University of Rochester Medical Center, Rochester, New York Equal study contribution. More articles by this author , Kevin FiscellaKevin Fiscella Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York More articles by this author , and Edward M. MessingEdward M. Messing ‡Correspondence: Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, New York telephone: 585-275-9273; FAX: 585-273-1068; E-mail Address: [email protected] http://orcid.org/0000-0002-0985-7065 Department of Urology, University of Rochester Medical Center, Rochester, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000268.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." Urology Practice, 9(1), pp. 54–55 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology PracticeOct 5, 2021, 12:00:00 AMEditorial Commentary Volume 9Issue 1January 2022Page: 54-55 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexis R. Steinmetz Department of Urology, University of Rochester Medical Center, Rochester, New York Supported in part by Urology Care Foundation Residency Research Award and Kahlert Foundation. Equal study contribution. More articles by this author Jacob Gantz Department of Urology, University of Rochester Medical Center, Rochester, New York Equal study contribution. More articles by this author Kevin Fiscella Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York More articles by this author Edward M. Messing Department of Urology, University of Rochester Medical Center, Rochester, New York ‡Correspondence: Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, New York telephone: 585-275-9273; FAX: 585-273-1068; E-mail Address: [email protected] More articles by this author Expand All Advertisement PDF DownloadLoading ...

Anesthetic Considerations for Minimally Invasive, Off-Pump, HeartMate III Implantation

The authors developed and utilized an anesthetic protocol for the management of an off-pump approach for minimally invasive Heartmate III (HM3) implantation. Their goal was to determine if this method was safe and feasible for patients with in-situ mechanical support. The authors performed a retrospective study of consecutive patients undergoing off-pump HM3 implantation via bilateral minithoracotomies. This was a single-institution study at the University of Rochester Medical Center, using the same cardiac anesthesiologist and cardiac surgeon pair. The authors studied 8 consecutive patients undergoing off-pump HM3 implantation from June 2019 to July 2020. The authors developed an anesthetic management protocol for off-pump HM3 implantation via bilateral minithoracotomies. As a result, the authors evaluated 88% of men with a mean age of 55.0 ±13.0 years. The median time to extubation was 19.7 hours, with a median intensive care unit length of stay of 6.5 days. Fifty percent of patients required blood transfusions during the first 24 hours after surgery (postoperative), and 63% of patients were free from all postoperative complications. No patients required a right ventricular assist device. The mean hospital stay was 26.3 ± 11.3 days, with an 88% survival to discharge. In this single-center study, the authors have described the anesthetic consideration for the implantation of the HM3 left ventricular assist device using a complete sternal-sparing technique without the use of cardiopulmonary bypass. Their results have shown, in a case series of 8 patients, that this is a safe and feasible alternative to traditional techniques in patients with existing mechanical support.

Novel Strategies to Reach and Engage Older Veterans During COVID-19

The COVID-19 pandemic and associated public health measures to prevent its spread have important implications for the health and wellbeing of older Veterans. Prior to the pandemic, social isolation was already recognized as a risk for older adults, contributing to increased risk of depression, physical inactivity, and mortality. Stay-at-home orders, social distancing, and transitions to new ways of delivering care have meant that many of the ways in which older Veterans connect with VA and others have changed. Older Veterans and Veterans with serious mental illness (SMI) are especially vulnerable to experience negative impacts from social isolation and loneliness. This symposium will present on four novel and adapted strategies for engaging with older Veterans during the COVID-19 pandemic and beyond: 1) VA Connection Plans, a whole health intervention to promote social connections for older Veterans with and without SMI (Peeples); 2) telehealth adaptations to PEER, an in-person, peer-delivered exercise intervention for older Veterans with SMI (Muralidharan); 3) VA Compassionate Contact Corps, a VA Voluntary Service program to connect older Veterans with friendly volunteers via telephone (Sullivan); and 4) group telehealth interventions to foster social connection among older Veterans and their families (Weiskittle). Kim Van Orden, geropsychologist and director of the Hope Lab (Helping Older People Engage) at the University of Rochester Medical Center, will serve as discussant.

Current Research on Suicide in Older Adults

Rates of suicide are elevated in middle- and late-life, yet studies focusing on suicidal ideation and behavior in older adults are limited compared to research in younger adults. The studies included in the present symposium offer valuable findings on suicide in older adults across the span of late-life. Owsiany et al. focus on age differences between older and younger adults in the association between anxiety symptoms and suicide risk. In Heisel et al., an online intervention is assessed for improving the outcomes of psychological well-being and suicide risk in older adult men who are transitioning into retirement during the COVID-19 pandemic. Crnek-Georgeson and Wilson reviewed the link between retirement patterns and psychological effects, including suicidal behaviors, among older adults. Additionally, this review includes recommendations for policy makers and employers in an effort to assist older adults with the transition into retirement. Utilizing baseline data from the Helping Older Adults Engage study, Fenstermacher et al. research the association between volunteering and suicidal ideation in a predominantly lonely older adult sample across the span of late-life. Together, these studies provide foundation for future research on suicide in late-life to build upon. Future studies should continue to focus on risk and protective factors for suicide in older adults and aim to improve screening and intervention for suicidal thoughts and behaviors in this population. Yeates Conwell, M.D., Director of Geriatric Psychiatry and Co-Director of the Center for the Study and Prevention of Suicide at the University of Rochester Medical Center, will serve as discussant.

Using Real World Data (RWD) to Identify Care Needs in an Adolescent and Young Adult (AYA) Lymphoma Population: A Match Cohort Study

Adolescent and young adult (AYA) patients with malignancies are a unique population within oncology with differences in survivorship outcomes as compared to adult and pediatric counterparts. The National Comprehensive Cancer Network (NCCN) identified eight critical domains in AYA care: mental health, cognitive function, physical exercise, fatigue, immunizations/infection prevention, pain, sexual function and sleep disorders. However, it can be difficult to establish a clinical benchmark of these domains at an institutional level without time-consuming chart review. With the advent of real-world data generated from the electronic medical record (EMR), feasible large scale data assessment can be used to identify care needs and direct future prospective studies and interventions.Here we demonstrate the feasibility of a match cohort study using EMR comparing metrics in the above NCCN domains in AYA lymphoma patients within the University of Rochester Medical Center. We identified 172 AYA lymphoma patients diagnosed between 2013 and 2019 and compared them to 516 controls over that time period using 3:1 control matching, both at time of diagnosis and one year post-diagnosis. Controls were identified within the EMR with exclusion criteria of no cancer diagnoses and fewer than an average of ten medical visits per year over the study period to control for other chronic disorders.Demographic characteristics for both groups were matched for age at diagnosis date, sex, and race. The resultant populations had an average age of 29 (SD 6), male predominance (58.72%), and Caucasian predominance (82.56%). The lymphoma group had a slightly higher rate of federally funded insurance as compared to controls (25% vs. 20%).In mental health domains, lymphoma group had a higher rate of depression at baseline (19.77% vs. 1.16%; p <0.0001) but anxiety was at comparable rates (8.72% vs. 10.85% p <0.46) with similar rates of antidepressant medication prescriptions (27.33% vs. 25.97% p < 0.75). At one year post-diagnosis, anxiety and depression rates were near identical but rates of antidepressant prescriptions had increased in the lymphoma group (30.81% vs. 22.65% p < 0.03.)In physical health domains, lymphoma group had similar rates of BMI in the overweight and obese range as compared to controls and less than five percent of the group had a sleep medicine, nutrition, or cognitive assessment at baseline or one year post-diagnosis. Vaccination rates, as measured by influenza and pneumovax adherence, were low both at diagnosis and at one year post- diagnosis in the lymphoma group (18.6% and 21.5%, respectively).In the pain domain, the lymphoma group had similarly low rates of alcohol abuse, opiate abuse and chronic pain diagnoses as compared to controls (between 1 and 4% without statistically significant differences). Interestingly, pain scores recorded at visits on the 0 to 10 scale were noticeably lower for the lymphoma group both at diagnosis and one year post-diagnosis (4.65% vs 11.24% p=0.009; 5.23% vs 11.43% p=0.02) however prescription of any analgesic medication was higher in the lymphoma group (76.16% vs. 40.98% p<0.0001; 63.95% vs. 30.62 p<0.0001).Lastly, in the reproductive and sexual health domain, the lymphoma group had high rates of consultation with reproductive endocrinology at diagnosis as compared to controls (31.40% vs. 1.74% p<0.0001) suggestive of early referral between initial suspicion of cancer and tissue diagnosis. The overall use of the services however were still at relatively low rates. Additionally, long-acting removable contraception rates, while higher in the lymphoma population (11.27% vs. 4.23 p<0.02) were still relatively low. Finally, rates of erectile dysfunction diagnoses were similar in lymphoma cases as compared to controls (0.99 vs. 0.66 p< 0.7128) without significant differences in tadalafil/sildenafil prescriptions at one year post-diagnosis (2.97% vs. 1.32% p<0.15)These data support the feasibility of using the electronic medical record to track institutional level ancillary markers of care for prospective study and population-specific interventions. Future studies will be directed at collaborations to address these care gaps and a prospective survey of AYA patients to identify patient-centered interventions improving care for this critical population. DisclosuresCasulo: Genentech: Research Funding; BMS: Research Funding; Gilead: Research Funding; Verastem: Research Funding.

An untapped resource: characteristics of thrombus recovered from intermediate or high risk pulmonary embolus patients

IntroductionResponse to anticoagulation varies during management of acute hospitalized pulmonary embolism. We aimed to study thrombus histology in pulmonary embolism samples removed during acute surgical embolectomy to evaluate whether thrombus morphology was similar between patients and whether there was an association with duration of symptoms and/or resolution on follow up imaging. MethodsThis was a retrospective observational single center study at the University of Rochester Medical Center. We evaluated patients that underwent acute surgical embolectomy and followed up in our clinic 2 – 4 months after the event with Ventilation/Perfusion (V/Q) scan obtained for all regardless of symptoms. Thromboemboli were formalin fixed and processed for light microscopy in the hospital histopathology laboratory. Four-micron thick sections were stained with hematoxylin and eosin, Masson trichrome, and Verhoeff elastic tissue stains. Immunohistochemistry was performed using anti-CD31 and anti-CD68. Slides were independently evaluated for time-dependent microscopic changes using Irniger's classification by two blinded pathologists. ResultsSixteen patients underwent embolectomy with fifteen having V/Q imaging at follow up. The majority of patients were female. Samples showed a generally similar overall architecture that included a central core composed primarily of red blood cells and fibrin and an outer layer of platelets and monocytes. Two samples had evidence of fibrosis and recanalization. ConclusionsWe found heterogeneous histopathology in samples obtained during acute embolectomy. Further prospective studies should systematically characterize clot morphology and evaluate treatment response and outcomes. Careful thrombus specimen measurement and consistent sampling for sections will be required to draw firm conclusions.

Removable Denture Wearing as a Risk Predictor for Pneumonia Incidence and Time to Event in Older Adults.

Older adults are more susceptible to a common respiratory infection: pneumonia. Nearly 1 million older adults per year are hospitalized for community-acquired pneumonia in the United States. To examine whether wearing removable dentures are associated with an increased risk of pneumonia incidence in a geriatric population. We conducted a retrospective cohort study among patients >65 y of age within a large academic health system (University of Rochester Medical Center). The medical and dental electronic records from 2010 to 2018 were reviewed and used for data collection. The exposure was removable denture wearing. The main outcome variables were the incidence of pneumonia and time to event of pneumonia. A Cox proportional hazards regression was used to examine the association between pneumonia onset and wearing removable dentures, adjusting for demographics, socioeconomic status, and medical and dental conditions. A total of 2,364 patients were included, with 1,189 (50.29%) in the denture-wearing group and 1,175 (49.70%) in the non-denture wearing group. The annual pneumonia incidence rate per 100,000 persons was 1,191 in the denture-wearing group and 128 per 100,000 persons in the non-denture wearing group, with a crude incidence rate ratio of 9.33 (95% CI, 5.41 to 18.81; P < 0.0001). The mean ± SD age of the pneumonia onset was 78.0 ± 10.0 and 78.6 ± 9.0 y among denture-wearing and nonwearing groups (P = 0.84). The time to event of pneumonia was associated with removable denture wearing (yes/no; hazard ratio, 7.68 [95% CI, 3.91 to 15.08]; P < 0.001) after adjusting for covariates. Wearing removable dentures was found to be a risk predictor for pneumonia incidence among the geriatric population even after accounting for other risk factors. Wearing removable dentures was found to be a risk predictor of pneumonia incidence among older adults. Although the current study does not imply a causal relationship between denture wearing and pneumonia, clinicians and older patients could reference the study results when choosing dental prostheses to restore missing teeth.

85: Antibiotic prescribing practice in pediatric cystic fibrosis patients at University of Rochester Medical Center: A quality improvement initiative

85: Antibiotic prescribing practice in pediatric cystic fibrosis patients at University of Rochester Medical Center: A quality improvement initiative

MP34-04 BURNOUT AND DOCUMENTATION BURDEN AMONG UROLOGY RESIDENTS AND ATTENDINGS AT THE UNIVERSITY OF ROCHESTER

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-04 BURNOUT AND DOCUMENTATION BURDEN AMONG UROLOGY RESIDENTS AND ATTENDINGS AT THE UNIVERSITY OF ROCHESTER Thomas Osinski, Gareth Warren, Edward Messing, and Jeanne O'Brien Thomas OsinskiThomas Osinski More articles by this author , Gareth WarrenGareth Warren More articles by this author , Edward MessingEdward Messing More articles by this author , and Jeanne O'BrienJeanne O'Brien More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For the past several years Urology has consistently had among the highest rates of physician burnout when compared with other medical and surgical specialties. Physician burnout has been associated with significant personal consequences (such as higher levels of substance abuse, depression, and motor vehicle incidents). Physician burnout can also have negative patient care outcomes as burnout has been linked to increased rates of medical error. It is well known that the electronic medical record (EMR) has increased clinical documentation demands. We thus sought to determine the prevalence of burnout among urologic residents and attendings at our institution and how medical documentation may play a role in physician burnout. METHODS: An anonymous survey tool was created through Redcap. The survey included the Maslach Burnout Inventory (MBI), to assess burnout, and several questions pertaining to documentation. The Redcap survey was sent via email to urology residents and attendings at the University of Rochester Medical Center with data collected from January to March of 2020. RESULTS: Overall, 11/19 (58%) attendings and 7/13 (54%) residents responded to the survey. 46% of attendings and 71% of residents were found to have a high-risk of burnout in at least 1 component of the MBI. All respondents with a high-risk of burnout in 1 or more component of the MBI had a high-risk of burnout in the depersonalization component of the MBI. Furthermore, 91% of attendings and 100% of residents responded that they ‘sometimes’ or ‘often’ document on patients at home with 64% of attendings and 29% of residents spending 7 hours or more in a typical week documenting outside of ‘normal’ clinic and hospital hours. Critically, 73% of attendings and 72% of residents ‘sometimes’ or ‘often’ felt stress due to documentation requirements not being complete. When asked ‘Has documentation interfered with planned activities out of work?’, 100% of attendings and 86% residents replied ‘sometimes’ or ‘often’. Lastly, 91% of attendings and 86% of residents thought that documentation accurately reflected the care provided to patients less than 75% of the time. CONCLUSIONS: EMR documentation demands are likely disrupting activities outside of work more than is currently appreciated and contributing to burnout. Additionally, despite all the effort, many think documentation often does not reflect the actual care provided to patients. Finding ways to reduce the burden of documentation and making documentation more clinically focused for providers may help reduce burnout within urology. Finally, asking questions to better understand how specific clinical activities are perceived and impact life outside of work may help identify the stressors that have the biggest impact on burnout. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e617-e617 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Osinski More articles by this author Gareth Warren More articles by this author Edward Messing More articles by this author Jeanne O'Brien More articles by this author Expand All Advertisement Loading ...

Abstracts and Case Studies for the College of American Pathologists 2021 (CAP21) Annual Meeting

Abstracts and Case Studies for the College of American Pathologists 2021 (CAP21) Annual Meeting

Resting heart rate as a surrogate for improvement in intermediate risk pulmonary embolus patients?

BackgroundPulmonary embolism (PE) response teams (PERT) have been developed to improve in-hospital mortality. Identifying intermediate risk PE patients that will progress despite anticoagulation is difficult, especially because outcomes with modern anticoagulation are quite good. ObjectiveThe primary aim of this study was to evaluate the rate of anticoagulation failure (new deep vein thrombosis or PE, right ventricular failure resulting in shock, cardiac arrest, or PE-attributable death) in intermediate risk PE patients managed by PERT. The secondary objective was to determine whether there was a significant decrease in heart rate 24 h after initiation of anticoagulation in intermediate risk PE. MethodsThis was a retrospective observational study of patients treated for acute intermediate risk PE at the University of Rochester Medical Center who also had outpatient followup between November 2016–June 2019. ResultsNinety-two patients presented as intermediate-risk PE and had outpatient followup. Seventy-four patients were initially treated with anticoagulation. None of these patients failed anticoagulation. Of the eighteen intermediate risk patients that underwent advanced intervention, none failed anticoagulation first. There was significant decrease in resting heart rate 24 h after starting therapeutic anticoagulation, 107 beats/min vs 89 beats/min, p = 0.0001. ConclusionWe did not observe anticoagulation failure in the management of acute, intermediate risk PE. Reductions in heart rate may reflect improvements in right ventricular function; we hypothesize that those whose heart rate does not fall may be optimal candidates for advanced intervention.

Seamless Introduction of a Purely Laparoscopic Full-Lobe Living Donor Hepatectomy Program in a North American Center.

Laparoscopic liver resection (LLR) has significantly evolved over the last two decades through improvements in approach, technique, and instrumentation and offers benefits over open liver surgery in terms of quicker recovery, early return to normal life, and cosmesis.1 However, the associated technical complexity of LLR coupled with overarching emphasis on donor safety have been the primary reasons for its delayed introduction into the domain of living liver donation.