VA Population Research Articles

S190 Patients Managed for Chronic Pancreatitis in a VA Population Are Done So With Low Diagnostic Confidence

S190 Patients Managed for Chronic Pancreatitis in a VA Population Are Done So With Low Diagnostic Confidence

Morphological and molecular investigation of Scolelepis agilis (Verrill, 1873) (Annelida: Spionidae) from beaches of the Atlantic coast of North America

Polychaete worms of the genus Scolelepis are one of the most abundant members of beach ecosystems worldwide. Along the Atlantic coast of North America, specimens of Scolelepis inhabiting high-energy beaches have long been erroneously identified as the European species Scolelepis squamata (O.F. Müller, 1806). In this study, we examined specimens of Scolelepis collected from Massachusetts to Virginia, finding they match Scolelepis agilis (Verrill, 1873), originally described from beaches in New Jersey. Scolelepis agilis can be most easily distinguished from S. squamata based on differences in palp ciliary pattern, morphology of neuropodial lamellae, and the quantity and start of both notopodial and neuropodial hooded hooks. Live specimens of S. agilis collected from New York were also examined to provide data on their reproduction and morphometric analyses. In addition, molecular data (18S, 28S rRNA, cytochrome c oxidase I and 16S rRNA) showed that specimens of S. agilis from the north to mid-Atlantic coast formed a monophyletic group (p-distance ≤ 0.004 for MA, RI, NY and VA populations) and were distinct from S. squamata (p-distance ≥ 0.196 (0.03 SE)). The molecular data also suggest the presence of several misidentified or undescribed species of Scolelepis, highlighting the need for additional taxonomic work on the genus from these localities as well as others (e.g. South Africa) where the worms have been incorrectly identified as S. squamata. A key to species of Scolelepis from the east coast of the United States is provided and a lectotype and paralectotypes for S. agilis are herein designated.

Comparison of concurrent care and traditional hospice at a regional VA.

e24065 Background: While hospice care offers many patients services promoting comfort and quality of life, the traditional hospice model described in Medicare policy presents numerous barriers to utilization. Notably, since hospice pays for all therapies related to a terminal illness, patients are often forced to make a difficult choice to stop disease-directed therapies in order to enroll in hospice. Poor provider understanding of hospice also contributes to the common scenario in which hospice is offered too late to make a meaningful impact for patients and their families. These issues were prominent in the VA population in 2006, when only 5% of eligible Veterans received hospice services. Consequently, the VA Comprehensive End-of-Life Care Initiative in 2009 created the concurrent care hospice model in where Veterans no longer had to stop all disease-directed therapies to enroll. Initial national VA data in lung cancer suggested that concurrent care may be better than traditional hospice by decreasing aggressive treatments, ICU hospitalizations, and medical costs. Our regional VA developed a Hospice Flag system that tagged patients in the electronic medical record who had either a concurrent or traditional hospice enrollment to better inform health care providers. This project investigates how the concurrent care hospice model may help achieve an important Veteran-centered outcome, which is to die in the home setting and improve access to hospice care. Methods: We retrospectively reviewed all Veterans with a hospice flag from October 2017 to July 2021 and cancer as the primary hospice diagnosis. Our primary aim was to establish correlation between hospice type and Veterans’ ultimate location of death with the percentage at home versus institution (e.g. care center, hospital, or hospice house). A secondary measure was median length-of-stay (LOS) in hospice. Results: 317 total Veterans were enrolled in concurrent care hospice (96) and traditional hospice (221) from Oct 2017 to July 2021. 72% of Veterans in concurrent care (69/96) died at home compared to only 57% in traditional hospice (125/221) with the remainder dying in an institution; this result was statistically significant by Chi-square analysis (p = 0.01). Median LOS in hospice was 62 days for concurrent care and 26 days for traditional hospice. Conclusions: This project demonstrates that concurrent care hospice is significantly associated with Veterans being able to die in their own home. Concurrent care was also correlated with longer median LOS in hospice, suggesting greater duration of support services provided to patients and families.

Effect of Covid19 Pandemic on Preventive Vaccinations Among Patients with The End Stage Kidney Disease At New York Harbor VA Medical Center

Background: The COVID-19 pandemic revealed challenges and barriers in achieving high preventive vaccination rates. This study aimed to explore the effects of the pandemic on vaccination rates in patients with end stage kidney disease (kidney dialysis) patients in New York City. These patients compose a challenging cohort as their transplant optimization includes routine vaccinations including pneumococcal, flu, Hepatitis A and B, meningococcal, H flu, HPV, Tdap, RZV, and Covid. Materials and Methods: This study population consisted of 142 participants from two Veteran Affairs hospitals in New York City. Vaccination and demographic information were compiled via EMR and compared to long term US vaccination rates using exact binomial tests. Secondary analysis using generalized estimating equations was used to compare vaccination rates pre- and post-pandemic within the Brooklyn VA population controlling for demographic variables. Results: The combined vaccination rate for the post-pandemic period was found to be significantly lower than the pre-pandemic rate in the general US population for several vaccines, including Hepatitis A (CI: 0.088, 0.098; p<0.001), Influenza (CI: 0.68, 0.69, p<0.001), Meningococcal (CI: 0.34, 0.35; p<0.001), MMR (, CI: 0.51, 0.52; p=0.001), and TDAP (CI: 0.18, 0.20; p<0.001). Secondary analysis using generalized estimating equations controlling for age, race, and time on dialysis within the Brooklyn VA population revealed increases in post-pandemic vaccination rates for Shingles (subunit; B=1.03; 95% Wald CI: .178, 1.87; p=.018) and Hepatitis B (B=-.739; 95% Wald CI: .084, 1.39; p=.027), while a significant decrease was observed for Hep A (B=-2.65; 95% Wald CI: -4.4, -.90; p=.003). Conclusion: This data demonstrates that post-pandemic vaccination rates in VA dialysis patients is lower than the past 10-year US average for several vaccines including Hepatitis A, Influenza, Meningococcal, MMR, and TDAP. Mixed effects of pre- and post-pandemic vaccination rates within the Brooklyn VA were also found with a decreased vaccination rate for Hepatitis A, and increased rates for Shingles and Hepatitis B. Further study is needed to evaluate pandemic’s effect on these rates, disease prevention, and identify the reasons contributing to vaccine hesitancy vs. acceptance.

Pneumonia Related Deaths in Sleman Based on Verbal Autopsy: an Observational Study

Pneumonia has long been and remains one of the leading causes of death, especially among children and the elderly. Until this study was released, only the Jakarta province fulfilled the national target of pneumonia case findings. Thus, it is important to determine the characteristics and prevalence of pneumonia-related deaths in Sleman District based on verbal autopsy. This cross-sectional study used secondary data from Sleman HDSS cycles 1 to 7. The subject of this study was a person aged over 28 days who passed away due to pneumonia between 2015 and 2022 and met the criteria for sample inclusion. Fisher’s exact and Pearson’s chi-square tests were used to analyze the data. The number of subjects who died due to pneumonia was 65 subjects (33,3%), and the number of subjects who died due to other causes was 130 (66,7%). The prevalence of those who died due to pneumonia was lower than non-pneumonia death for all of the predetermined risk factors, including elderly age, male sex, low education level, high occupational risk, smoking history, alcohol consumption, asthma history, COPD history, stroke history, tuberculosis history, hospitalization history, and very thin or malnourished body with sex, occupational status & type, and nutritional status being statistically significant. The prevalence of pneumonia-related deaths in the Sleman HDSS VA population is 33,3%, with some risk factors that may affect it.

Bridging Total Force Fitness and Whole Health in Cardiovascular Disease Prevention.

The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.

Utility of Tumor Mutational Burden as a Biomarker for Response to Immune Checkpoint Inhibition in the VA Population.

Immune checkpoint inhibitors (ICIs) are used for an increasing number of indications across various tumor types, as well as several tumor-agnostic indications in patients with advanced cancer. Although many patients benefit from ICI therapy, others do not, highlighting a need for better predictive biomarkers. Tumor mutational burden (TMB) reflects the global number of mutations within a tumor and has been widely explored as a predictive biomarker of ICI response. The current tumor type-agnostic US Food and Drug Administration approval of pembrolizumab for metastatic solid tumors defines high TMB (TMB-H) as ≥10 mut/Mb as measured by FoundationOne CDx. This fixed cutoff may not be the ideal value across all solid tumors. We performed a retrospective analysis of the association of survival outcomes with TMB in patients treated with ICI for five major cancer types, using real-world data from the VA. Survival was measured from initiation of ICI, and Kaplan-Meier survival curves were compared by log-rank test. Overall survival (OS) was significantly longer for patients with TMB-H versus TMB low tumors in non-small-cell lung cancer (NSCLC; n = 1,593), head and neck (H&N) cancer (n = 222), and urothelial cancer (n = 332). OS was not significantly different based on TMB status in melanoma (n = 207) or esophageal/gastric cancer (n = 248). Consistent with previous studies, a predictive value of TMB ≥10 mut/Mb for ICI response was found in NSCLC and H&N, but not in esophageal/gastric cancer. Although inconclusive in the literature, significant association was found in urothelial cancer. The predictive value of TMB in melanoma was inconclusive. Our analysis does not support the use of a fixed threshold for TMB as a standalone predictive biomarker for ICI across all solid tumors.

Patterns of psychotropic drug use in veterans with epilepsy: Do drug interactions matter?

RationalePatients with epilepsy are likely to suffer from psychiatric comorbidities, including depression and anxiety. They often require treatment with multiple psychotropic drugs (PDs). While it is clear that CYP-inducing ASMs (EIASMs) can increase the oral clearance of multiple medications (thus lowering systemic exposure), it is less clear that all PK interactions are clinically meaningful (e.g. lower efficacy). As a first step in addressing this issue, this study sought to quantify the potential impact of ASM choice, whether EIASM or non-inducer (NIASM), on surrogate markers of suggestive of clinical use, including resultant antidepressant (AD) or antipsychotic (AP) dose, frequency of combination use of AD & AP, and number of multiple drug switches of PDs. Our hypothesis is that because of PK interactions, EIAED treatment would be associated with higher psychotropic drug doses, more frequent Rx adjustments and poly psychotropic comedication, all in order to optimize therapeutic response. MethodsUsing VA pharmacy and national encounter databases, veterans with epilepsy were identified based on having a seizure diagnosis and being prescribed concomitantly an ASM and a psychotropic drug for at least 365 days between 10/1/2010 and 9/30/2014. Patients for whom psychotropic drugs were prescribed any time between beginning and end prescriptions dates of ASMs were considered. Among those, patients receiving both an EIASM + NEIASM concomitantly were categorized with the EIASM group. Patients were evaluated for AD only, AP only and both (AD & AP). To compute average drug doses per day, averages for each patient were computed and averaged again. Multiple drug switches were defined to be for patients who had been prescribed more than three psychotropic drugs during the observation period. Pearson’s Chi-Square test was used to compare relative proportions of AD, AP and AD + AP in both groups. ResultsIn all, 16,188 patients were identified (57.0% on EIASM, 43.0% on NIASM) with a mean age of 58.7 years (91.2% male). A larger proportion of patients on EIASM received mono treatment with any psychotropic drug, as compared to NIASM (42.0% vs 36.1%). Among all, 59.6% received AD only, 6.5% received AP only, and 33.8% received both concurrently. Of EIASM, 62.5% were on AD, 5.9% on AP, and 31.7% on both AP & AD. For NIASM, 55.9% received AD, 7.4% AP, and 36.7% on AD & AP.Chi-square showed that the distribution of PD was statistically different between EIASM and NIASM groups. Z tests showed that each difference (AD, AP and both) in proportions was statistically significant (p values (4 tests, one Chi-square, 3 Z tests <0.001) between EIASM vs NIASM. Interestingly, mean doses of AD or AP did not appear to differ between ASM groups. ConclusionsConcurrent psychotropic drug use is quite common in the VA population with epilepsy, and a large number of patients still receive enzyme-inducing ASMs that may complicate other medical therapies. Interestingly, in seeming contradiction to our hypothesis, mean daily doses of either AD or AP did not appear to differ between inducers vs non-inducers. Similarly, use of polytherapy, and/or multiple trials of various psychotropic drugs did not appear increased in the CYP-induced group. In fact, combination therapy of AD + AP was higher in NIASM than EIASM. These data suggest that perhaps these types of PK interactions may not in fact result in meaningful clinical differences. Since the present analyses did not include clinical psychiatric measures, future analyses examining direct clinical outcomes are clearly warranted.

ID: 223293 Review of Trial to Permanent Outcomes and Explantation Using Spinal Cord Stimulation in VHA

The science of neuromodulation has made many great advances in the recent past. Despite a variety of improvements in technology, usability, ease of use there continues to exist a failure rate leading to surgical explantation of the device.(1) As technology has provided a clear benefit for the field , there continues to remain the elusive goal of optimal patient selection. The causes of explantation have ranged from biologic complications, hardware complications, the need for complex MRI scans , mental health reasons , loss of efficacy, complications, the need for complex MRI scans, mental health issues prior to spinal cord stimulator (SCS) trials.(2,3) It is this last reason , the lack of efficacy due to patient factors which is lacking appropriate evidence. (4) We hypothesized that in our VA population, many of which have been implanted elsewhere, explants may be related to lack of screening for symptoms and/or radiographic evidence of spinal stenosis prior to SCS trial and implant. Given the surgical risk and expense we wanted to use the best evidence to select Veteran patients who would benefit from SCS technology.

(444) Long-term Outcomes of Inflatable Penile Prosthesis in a VA Practice

Abstract Introduction Inflatable penile prostheses have favorable short-term results for men with refractory erectile dysfunction, but few studies have evaluated the long-term outcomes, including in a VA population. Objective This study aims to evaluate the outcomes and satisfaction rates using the novel validated survey, the Satisfaction Survey for Inflatable Penile Implant (SSIPI) of a long-term single-center VA practice. Methods Chart reviews were completed as a Quality Improvement project. All patients who underwent a primary inflatable penile prosthesis implantation from 1993-2021 were included. Demographics and data were collected; SSIPI was administered to men who could be reached. Statistical analyses were performed. Results 114 men were identified, 82 alive and 32 deceased. In the cohort we contacted, mean age at time of surgery was 62.6 years old and mean follow-up 78.2 months (5-234 months). Average SSIPI scores were 64.5/80 (26-80). Smokers were less satisfied with length of penis vs. non-smokers (SSIPI#8 = 2.89 vs 3.93, p=0.032). Men with diabetes were more likely to express regret about undergoing IPP surgery compared to men without (SSIPI#4 = 4.05 vs 4.38, p=0.0029). Men with an ASA score of 2 or less had higher total SSIPI scores compared to ASA score of 3+ (70.36 vs. 61.13, p=0.046). Conclusions Long-term satisfaction with IPP in a veteran population appears favorable. However, a significant number of these men still score poorly on SSIPI and/or have complications. The utility of this novel assessment instrument appears excellent. Men with smoking, diabetes, and higher overall comorbidities may find fewer positive results. Disclosure No

MP77-02 HIGH AREA DEPRIVATION INDEX IS ASSOCIATED WITH DE NOVO PROSTATE CANCER METASTASIS IN VETERANS

You have accessJournal of UrologyCME1 Apr 2023MP77-02 HIGH AREA DEPRIVATION INDEX IS ASSOCIATED WITH DE NOVO PROSTATE CANCER METASTASIS IN VETERANS Ananta Wadhwa, Lorna Kwan, Michael Lewis, Brent Rose, Jennifer Cullen, Nicholas Nickols, Kara Maxwell, Kosj Yamoah, and Isla Garraway Ananta WadhwaAnanta Wadhwa More articles by this author , Lorna KwanLorna Kwan More articles by this author , Michael LewisMichael Lewis More articles by this author , Brent RoseBrent Rose More articles by this author , Jennifer CullenJennifer Cullen More articles by this author , Nicholas NickolsNicholas Nickols More articles by this author , Kara MaxwellKara Maxwell More articles by this author , Kosj YamoahKosj Yamoah More articles by this author , and Isla GarrawayIsla Garraway More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastatic prostate cancer (PCa) is highly lethal with a 5-year survival rate of 30%. Individuals with specific germline mutations, a family or personal cancer history, and/or identifying as Black/African-American display higher risk of developing PCa, including metastatic PCa. Healthcare barriers, such as lack of insurance and/or lower socioeconomic status, also correlate with advanced stage diagnosis. We sought to determine if the Area Deprivation Index (ADI), a ranking of socioeconomic disadvantage including income, education, employment, and housing quality, was associated with de novo metastases and/or metastatic progression in a racially/ethnically diverse VA PCa cohort. METHODS: Veterans diagnosed and/or treated for PCa from 2000-2013 in the Greater Los Angeles VA Healthcare System were identified in accordance with an institutional review board approved protocol. Clinical, pathological, and demographic data were obtained from the electronic medical record and the Veterans Health Administration Corporate Data Warehouse. State ADI (decile rank of 1-10) was calculated based upon the 9-digit residential zip code. Multivariate analyses identified factors associated with de novo metastasis or metastatic progression. Kaplan-Meier (KM) analysis permitted survival comparison of de novo metastatic (M1) cases, or localized cases with metastatic progression (M0-MP). RESULTS: Of 2152 PCa cases identified, ADI could be determined in 1498 (69.6%). There were 1311 M0, 76 M1, 136 MX cases, and 57 M0 patients who experienced metastatic progression (M0-P). On multivariate analysis, state ADI decile rank ≥7 was significantly associated with de novo metastasis diagnosis (rank 7-8: OR=4.39 (1.26, 15.35); rank 9-10: OR=4.12 (1.05, 16.09)). State ADI rank was not associated with metastatic progression in M0 patients. There were no significant differences in PCa-specific survival by ADI Rank within M1 nor M0-P strata. CONCLUSIONS: Veterans residing in areas of high socioeconomic disadvantage (ADI rank ≥7) were >4 times more likely to be diagnosed with de novo metastasis, while no effects of ADI were observed on PCa-survival in M1 cases or M0-P cases. These results suggest that even in a relatively equal access healthcare system, potential social barriers indicated by high ADI may lead to delayed diagnosis. Future studies linking frequency of healthcare visits and/or screening to ADI may reveal potential strategies to mitigate this disparity in the VA population. Source of Funding: Research support for the investigators include National Institutes of Health K08CA215312, KNM; 5P50CA092131, R01 PAR-20-077, IPG); US Department of Defense (W81XWH211075, IPG; W81XWH-19-1-0435, KY); Prostate Cancer Foundation (PCF17CHAL04, IPG; 20YOUNG02, KNM; 18VALO10, KY, NGN), Burroughs Wellcome Foundation (1017184, KNM); Basser Center for BRCA at the University of Pennsylvania (KNM); Jean Perkins Foundation (IPG), STOP Cancer Foundation (IPG), and VA ORD CSR&D (NGN) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1101 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ananta Wadhwa More articles by this author Lorna Kwan More articles by this author Michael Lewis More articles by this author Brent Rose More articles by this author Jennifer Cullen More articles by this author Nicholas Nickols More articles by this author Kara Maxwell More articles by this author Kosj Yamoah More articles by this author Isla Garraway More articles by this author Expand All Advertisement PDF downloadLoading ...

72 Establishing a histologically defined NAFLD cohort in the Million Veteran Program for further genetic analyses

OBJECTIVES/GOALS: Research in Non Alcoholic Fatty Liver Disease Genetics is ongoing. In this project, we aim to: 1.Identify and describe a histological NAFLD Cohort in the MVP Biobank by extracting liver biopsy proven NAFLD patients using natural language processing (NLP) 2.Confirm previously defined NALFD genetic loci (via look up-GWAS) in the histological NLP cohort METHODS/STUDY POPULATION: We will utilize the Million Veteran Program Biobank where a total of 10,959 subjects have been identified using liver biopsy reports in the EMR via CPT codes. Cases will be based on i) steatosis, steatohepatitis, inflammation or fibrosis in liver biopsy reports with ii) exclusion of other causes of liver disease. Controls will be comprised of the general VA population. In collaboration with the Applied NLP and Precision Medicine groups at the VA Informatics and Computing Infrastructure(VINCI); we will attempt to create and validate a histological cohort of NAFLD in the MVP database by: 1)Annotation of biopsy reports for the NLP algorithm 2)Automation/training of the NLP algorithm We will then perform a multi-ancestry genetic lookup of previously established genetic loci among the cases identified. RESULTS/ANTICIPATED RESULTS: Recently published data: the MVP NAFLD research led by Dr. Chang and Dr. Vujkovic had first validated a proxy NAFLD phenotype based on chronic alanine aminotransferase elevation (cALT). A GWAS was then performed using this phenotype which revealed 77 loci of genome-wide significance including 10 established NAFLD- and 52 ALT-associated SNPs were identified. Replication in external Liver Biopsy and Imaging Cohorts validated 17 SNPs of which 9 were novel. Preliminary data on Liver Biopsy reports: Using CPT codes for Liver Biopsy we estimated a total of 10,959 unique patients and 18,812 notes in the MVP biobank. We anticipate 2,000-3,000 NAFLD cases (based on the prevalence of NAFLD in the general population). Initial review reveals 90% concordance between analysts for the purposes of developing an NLP. DISCUSSION/SIGNIFICANCE: NAFLD is a major cause for morbidity and mortality in liver disease. Gold standard for diagnosis is based on biopsy. GWAS studies with biopsy proven phenotypes are limited. The study will aim to isolate a histologically defined NAFLD cohort in MVP to conduct further GWAS that can provide new clinically relevant knowledge for future research.Contemporary Research Challenges

Is Hand Surgery in the Procedure Room Setting Associated With Increased Surgical Site Infection? A Cohort Study of 2,717 Patients in the Veterans Affairs Population

Procedure rooms (PRs) are increasingly used for hand surgeries, but few studies have directly compared surgical site infection (SSI) rates between the PR and operating room. We tested the hypothesis that procedure setting is not associated with an increased SSI incidence in the VA population. We identified carpal tunnel, trigger finger, and first dorsal compartment releases performed at our VA institution from 1999 to 2021 of which 717 were performed in the main operating room and 2,000 were performed in the PR. The incidence of SSI, defined as signs of wound infection within 60 days of the index procedure, which was treated with oral antibiotics, intravenous antibiotics, and/or operating room irrigation and debridement, was compared. We constructed a multivariable logistic regression analysis to assess the association between procedure setting and SSI incidence, adjusting for age, sex, procedure type, and comorbidities. Surgical site infection incidence was 55/2,000 (2.8%) in the PR cohort and 20/717 (2.8%) in the operating room cohort. In the PR cohort, five (0.3%) cases required hospitalization for intravenous antibiotics of which two (0.1%) cases required operating room irrigation and debridement. In the operating room cohort, two (0.3%) cases required hospitalization for intravenous antibiotics of which one (0.1%) case required operating room irrigation and debridement. All other SSIs were treated with oral antibiotics alone. The procedure setting was not independently associated with SSI (adjusted odds ratio, 0.84 [95% confidence interval, 0.49, 1.48]). The only risk factor for SSI was trigger finger release (odds ratio, 2.13 [95% confidence interval, 1.32, 3.48] compared with carpal tunnel release), which was independent of setting. Minor hand surgeries can be performed safely in the PR without an increased rate of SSI. Prognostic II.

Genetic analysis of 23 Y-STR loci in the Va population from Yunnan Province, Southwest China

Background Y-chromosomal short tandem repeat (Y-STR) polymorphisms are widely used in forensic DNA analysis. However, there is a lack of information about the Chinese Va population in the Y-STR Haplotype Reference Database. Aim To establish the Y-chromosome Haplotype Reference Database of the Yunnan Va population and investigate the population genetic relationships with other geographically adjacent groups. Subjects and methods In total, 23 Y-STR loci were genotyped with the PowerPlex Y23 Kit in 368 unrelated healthy Va males from Yunnan Province, Southwest China. Genetic polymorphism was analysed using the YHRD’s AMOVA tools and the MEGA 6.0 software. Results The gene diversity (GD) of the 23 Y-STR loci ranged from 0.3092 (DYS19) to 0.7868 (DYS385a/b). According to haplotype analysis, 204 different haplotypes were obtained, out of which 144 were unique. The haplotype diversity (HD) and discrimination capacity (DC) were 0.9852 and 0.5543, respectively. By comparing the Yunnan Va group with the other 22 referential groups, the results revealed that Yunnan Va was isolated from other groups. Conclusions The 23 Y-STR loci were highly polymorphic and informative in the Yunnan Va population, and the results enriched the basic genetic information for forensic investigation and population genetic studies.

Cognitive Impairment is Common in a Veterans Affairs Population with Peripheral Arterial Disease

Despite the shared pathogenesis of peripheral arterial disease (PAD) and vascular dementia, there is little data on cognitive impairment in PAD patients. We hypothesized that cognitive impairment will be common and previously unrecognized. Cognitive impairment screening was prospectively performed for Veterans presenting to a single Veterans Affairs outpatient vascular surgery clinic from 2020-2021 for PAD consultation or disease surveillance. Overall, 125 Veterans were screened. Cognitive impairment was defined as a score of <26 on the Montreal Cognitive Assessment (MoCA) survey. A multivariable logistic regression assessed for independent risk factors for cognitive impairment. Overall, 77 (61%) had cognitive impairment, 92% was previously unrecognized. Cognitive impairment was associated with increased age (74.4 vs. 71.8 years, p=0.03), Black vs. White race (94% vs. 54%, p<0.01), hypertension (66% vs. 31%, p=0.01), prior stroke/TIA (79% vs. 58%, p=0.03), diabetes treated with insulin (79% vs. 58%, p=0.05), and post-traumatic stress disorder (PTSD) (80% vs. 57%, p=0.04). On multivariable analysis, risk factors for newly diagnosed cognitive impairment included age ≥ 70 years, diabetes treated with insulin, PTSD, and Black race. Many Veterans with PAD have evidence of cognitive impairment and is overwhelmingly underdiagnosed. This study suggests cognitive impairment is an unrecognized issue in a VA population with PAD, requiring more study to determine cognitive impairment's impact on surgical outcomes, and how it can be mitigated and incorporated into clinical care.

Genetic diversity of 15 STR loci in Yunnan Va ethnic minority and the phylogenetic relationships with 26 other populations

Background The Va (also called “Wa”) people are an ethnic minority living mainly in the southwest of Yunnan Province Aim This study was conducted to obtain the genetic information and forensic statistical parameters of 15 autosomal short tandem repeat (STR) loci included in the AmpFlSTR®Identifiler™ kit (Applied Biosystems, Foster City, CA) in the Yunnan Va population, with a view to enriching the genetic databases of the Chinese Va population. Subjects and methods A total of 508 unrelated Chinese Va individuals were genotyped with this 15 STR kit, the genetic polymorphisms and associated forensic parameters were calculated. The genetic relationships between Chinese Va and 26 other Chinese populations were also evaluated. Results All of the STR loci reached the Hardy–Weinberg equilibrium after Bonferroni correction. A total of 159 alleles were observed with allele frequencies ranging from 0.000984 to 0.606299. The combined discrimination power (CDP) and the cumulative probability of excluding (CPE) of the 15 STR loci were 0.999 999 999 999 999 988 126 and 0.999 995 734, respectively. Our results indicated that the geographically adjacent or ethnically close populations showed a higher genetic affinity. Conclusions The results of this study will enrich the forensic databases of the Chinese Va population and could be applied in forensic analysis.

PSUN181 Diabetes-related outcomes following use of basal-bolus insulin vs. premixed insulin in a VA population with Type 2 diabetes: A retrospective chart review.

Abstract Background Treatment of diabetes mellitus (DM) with basal bolus insulin analogs (BB) requires up to five injections a day. The complexity of BB therapy may adversely influence patient compliance. A simpler and cheaper regimen with premixed insulin (PM) typically involves two injections a day but is perceived to be less effective in managing DM. The purpose of this research project was to compare DM-related outcomes between BB regimens (insulin detemir or glargine plus aspart, lispro or regular insulin) and PM insulin regimens (70/30 insulin NPH/regular) among our veteran population with type 2 DM. Research design and Methods This is a retrospective chart review that included 140 veterans (70 in BB group and 70 in PM group) with type2 DM. Subjects aged 18 years or above and those having A1C level ≥ 8% were included. Subjects with type 1 diabetes or who switched their insulin regimen during the follow-up period were excluded. The included subjects were followed for a year, after the start of respective insulin therapies to examine change in A1c (primary outcome) levels across groups. Data were analyzed using Chi-square/Fisher exact tests and logistic regression. All analyses were conducted using SPSS version 27 and SAS9.4. Results Out of 140 enrolled subjects, 94% were males with average age of 65.7 ± 10.1 years and DM duration of 12.9±9 years. There was no significant difference in age, gender, baseline A1c, BMI or duration of DM between the two groups. Following treatment initiation, there was no statistically significant difference between the BB and PM insulin groups for change in A1c (-1.9±1.8 vs -2.1±1.9%, p = 0.3) or for the rate of hypoglycemia (30% vs 21.4%, p = 0.3) respectively. Although the average BMI increased in both groups, the change was similar for both BB and PM groups (0.84±3.1 vs 0.4±2.2 kg/m2 respectively, p = 0.2). A logistic regression controlling for the confounders of hypoglycemia, found that the type of insulin used did not predict the development of hypoglycemia [OR 0.594, (0.251, 1.404)]. Conclusion There were no significant differences in A1c change, rate of hypoglycemia, and change in body mass index in patients treated with either BB or PM insulin among our study population. These results suggest that PM insulin is equally effective as the BB and its use can potentially improve patient compliance and reduce the cost of care. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Specialist Care, Metabolic Testing, and Testing Completeness Among U.S. Veterans with Urinary Stone Disease.

Recent observational studies reporting a lack of benefit from 24-hour urine testing for urinary stone disease (USD) prevention assumed testing included all components recommended from clinical guidelines. We sought to assess the completeness of 24-hour urine testing in the VA population. From the VHA Corporate Data Warehouse (2012-2019), we identified patients with USD (n=198,621) and determined those who saw a urologist and/or nephrologist, and received 24-hour urine testing within 12 months of their index USD encounter. Through Logical Observation Identifiers Names and Codes, we evaluated each collection's completeness, defined as including all of urine volume, calcium, oxalate, citrate, uric acid, and creatinine. We then fit a multilevel logistic regression model with random effects for VHA facility to evaluate factors associated with specialist follow-up, testing, and testing completeness. Specialist follow-up occurred in 54.3% and was stable over time. Testing occurred in 8.4%, declining from 9.3% in 2012 to 7.2% in 2019. Of tests performed, 54.6% were complete (43.7% increasing to 62.7% from 2012-2019). In adjusted analysis, there was high between-facility variation in specialist follow-up (median OR 2.0; 95% CI 1.7-2.0), testing (median OR 2.2, 95% CI 1.9-2.4), and testing completeness (median OR, 6.0, 95% CI 4.5-7.3). Individual facilities contributed 52% (intraclass correlation coefficient, 0.52; 95% CI, 0.44-0.57) towards the observed variation in testing completeness. Approximately 1 in 12 U.S. Veterans with USD receive metabolic testing and half of these tests are complete. Addressing facility level variation in testing completeness may improve USD care.

Integrating Medical Genetics Into Precision Oncology Practice in the Veterans Health Administration: The Time Is Now.

Increased access and utilization of tumor profiling of cancers in our veteran population uncovered a modest number of potentially pathogenic germline variants (PPGVs) that require genetics referral for follow-up evaluation and germline sequencing. Challenges identified specific to the veteran population include paucity of genetics providers, either at a veteran's VA facility or nearby non-VA facilities. We sought to investigate the number of veterans who would benefit from having such resources at both local and national levels. Annotated clinical reports of mutations identified by tumor-only profiling and medical records of veterans with solid tumors at the Veterans Administration Ann Arbor Healthcare System (VA AAHS) between 2015 and 2020 were reviewed. PPGVs were identified according to society recommendations (such as ESMO and American Board of Medical Genetics and Genomics), expert review, and/or previously published criteria. After the analysis of our local VA population, these same criteria were then applied to veterans in the National Precision Oncology Program (NPOP). Two hundred eight veterans underwent tumor profiling at the VA AAHS over the defined time period. This included 20 different primary tumor sites with over half (n = 130) being advanced cancer at diagnosis. Of these, 18 veterans (8.5%) had mutations suggestive of a PPGV. Applying these criteria to the larger NPOP database (n = 20,014), a similar percentage (6%) of PPGVs were identified. These results indicate a PPGV frequency (6%-9% of veterans) consistent with the prevalence of inherited cancer predisposition syndromes in the general population, underscoring the need for medical genetics as part of standard oncologic care for veterans. We explore current and future care delivery models to optimize incorporation of medical genetics and genetic counseling to best serve veterans needing such services.

Unrecognized Cognitive Impairment Is Common In A VA Population With Peripheral Arterial Disease

<h3>INTRODUCTION AND OBJECTIVES</h3> Despite the shared pathogenesis of peripheral artery disease (PAD) and vascular-related Cognitive Impairment (CI), there is little data on CI in PAD patients. We hypothesized that CI would be common and associated with worsening clinical status in PAD patients. <h3>METHODS</h3> CI screening was prospectively performed for PAD patients undergoing surveillance at a single Veterans Affairs outpatient clinic from 2020-2021. Overall, 125 PAD patients were screened. CI was defined with a validated cut-off of <26 on the Montreal Cognitive Assessment (MOCA) survey. Worsening clinical status was defined as requiring a revascularization and/or worsening wound status within three months from MOCA assessment. Multivariable logistic regression assessed independent risk factors for CI. <h3>RESULTS</h3> Overall, 77 (61%) had CI, 92% representing new diagnoses. CI was associated with increased age (74.4 vs. 71.8 years, p=0.03), Black race (88% vs. 57%, p=0.02), hypertension (66% vs. 31%, p=0.01), prior stroke/TIA (79% vs. 58%,p=0.03), insulin-dependent diabetes (76% vs. 58%,p=0.05), and post-traumatic stress disorder (PTSD) (80% vs. 57%, p=0.04). Overall, 65 (52%) had a worsening clinical status, which was more common in those with CI (61% vs. 38, p=0.01). On multivariable analysis, major risk factors for newly diagnosed CI included worsening clinical status and Black race (Table).Image, table 8 <h3>CONCLUSIONS</h3> Cognitive Impairment is present in most VA-based patients living with PAD and is overwhelmingly underdiagnosed. Patients with worsening clinical status are at high risk, and disparities were noted, as Black race was a significant risk factor. This pilot study suggests CI is a major unrecognized issue in a VA population with PAD, requiring more study to determine its impact on surgical outcomes and how it can be mitigated and incorporated into clinical care.