Virginia Commonwealth University Research Articles

Risk Stratified Tandem Vs Single Autologous Stem Cell Transplantation for Multiple Myeloma Yields Equivalent Survival

The standard of care for patients with newly diagnosed multiple myeloma who are transplant eligible is induction therapy followed by conditioning with high dose melphalan and autologous hematopoietic cell transplant (HCT). While the value of a single HCT (S-HCT) is established in standard-risk myeloma (SRM), there is controversy about whether tandem transplantation would improve outcomes such as progression-free survival (PFS) or overall survival (OS) in high-risk myeloma (HRM) patients. In this IRB approved retrospective study, the records of 343 multiple myeloma patients, who were referred by community oncologists and underwent HCT at Virginia Commonwealth University from 2008 to 2015, were reviewed. Patients were classified into different disease risk groups and OS and PFS determined. HRM was defined as including at least one of the following prognostic factors at diagnosis: t(4;14), t(14;16), t(14;20), del17p13, or gain of 1q by FISH; del 13 or aneuploidy by karyotyping; and ISS stage 3; patients without these features and with standard risk attributes were classified as SRM, while any patients with missing attribute information were classified as having undetermined risk myeloma (URM). In the study population, there were 135 SRM, 100 HRM, and 104 URM patients. Median age of the entire cohort was 60 years (76-34). The patients underwent hematopoietic cell mobilization and collection with filgrastim ± plerixafor and were conditioned with high-dose Melphalan (140-200 mg/m2). When possible, patients with SRM underwent single HCT (S-HCT) and those with HRM, tandem HCT (T-HCT) based on risk classification, response to prior therapy, insurance mandate and patient/physician preference. In those undergoing T-HCT, the median time to second HCT was 141 days. Evaluating the entire study population, and comparing patients who underwent a T-HCT (median follow up 82 mo.) vs. a S-HCT (85 mo.), there was no significant difference in OS (adjusted HR 1.1, 95% CI: 0.7-1.8; Cox proportional hazard model, adjusted for age, gender and risk group) (Figure 1) and PFS (HR 0.9, 95% CI: 0.6-1.2) between these two treatment groups. Of the 135 SRM patients, 20 underwent T-HCT; there was no significant difference in OS (HR = 1.2, 95% CI 0.5-2.9) and PFS (HR = 0.9, 95% CI = 0.5-1.7) in these patients compared to those undergoing S-SCT. Of the 100 HRM patients, 46 underwent T-HCT (P <0.01 c/w SRM & URM for T-HCT assignment). Again, there was no significant difference observed in OS (HR = 1.3, 95% CI = 0.7 - 2.5) (Figure 2) and PFS (HR = 1.0, 95% CI = 0.6 - 1.8) in the T-HCT recipients as compared to S-SCT amongst the HRM patients. Similar outcomes were observed in the URM patients. There were no differences observed between S-HCT and T-HCT outcomes in patients with deletion of chromosome 17p or in those with ISS stage 3 disease in OS (HR = 1.7, 95% CI = 0.8 - 3.8) and PFS (HR = 1.0, 95% CI: 0.5, 1.9). Overall, HRM patients had a trend for worse, albeit not significantly different, OS (HR 1.4, 95% CI: 0.9-2.2), as well as PFS (HR 1.1, 95% CI 0.7-1.6) compared to SRM; URM demonstrated a similar trend vis a vis SRM. This retrospective review of survival in SRM and HRM transplanted at a single center demonstrates that in the era of induction and maintenance therapy with novel agents, tandem transplantation does not improve OS or PFS in either SRM or HRM patients compared to a single transplant. Standard of care for newly diagnosed multiple myeloma patients who are transplant eligible should remain induction therapy with novel agents followed by single autologous HCT and maintenance therapy. Disclosures No relevant conflicts of interest to declare.

COVID Symptoms and COVID Anxiety in Sickle Cell Disease

BackgroundEven before the US upswing of the current COVID pandemic, the number of sickle cell disease (SCD) patients coming to hospitals and EDs appeared to fall drastically. This happened despite SCD patients having often been heavy utilizers of the ED and hospital for their iconic vaso-occlusive crises (VOC). Though ambulatory SCD clinics quick converted largely to telehealth in order to comply with stay-at-home orders designed to suppress person-to-person transmission, some SCD patients appeared to avoid care, delay care, or refuse doctors' invitations for care. Presumably patients did so out of COVID fears, but this has not been confirmed in the literature. Further, whether these patients had COVID symptoms but stayed at home has not been studied. As part of quality improvement (QI) to conduct COVID surveillance in an adult sickle cell program, we sought to explain and predict SCD health care utilization patterns we were observing, as well as to determine urgent physical and mental health needs of patients who appeared to be avoiding care.MethodsFifteen staff in the Adult Sickle Cell Medical Home at Virginia Commonwealth University, a large urban academic medical center, conducted a telephone survey (“wellness check”was used when we talked to patients) of all known adults with SCD over 19 days in 2020. A staff member confirmed the patient had SCD, asked permission to proceed, then asked about symptoms consistent with COVID-19. At the end of the telephone survey, respondents wer invited to complete an email survey of sickle cell and COVID-19 utilization attitudes (19-33 items, depending on the response pattern, either drawn from the National Health Interview Survey, from the Adult Sickle Cell Quality of Life Measurement quality of care survey, or drafted by the authors), the Sickle Cell Stress Survey-Adult (SCSS-A, a 10-item previously validated survey), and anxiety and depression (PHQ9 of the PRIME-MD).ResultsOf 622 adults approached by phone call, 353 responded to the following yes/no screening questions regarding the prior 14 days: fever over 100 F 0/353 (0.00%); cough 3/353(0.01%); difficulty breathing 0/353(0.00%); unexplained shortness of breath 2/353(0.01%); sore throat 2/353 (0.01%); unexplained muscle soreness 2/353(0.01%);contact with anyone who tested positive for COVID-19 2/353(0.01%); testing for COVID 19 6/353(0.02%). For QI purposes, we set a threshold of three or more COVID-associated symptoms or the presence of fever as criteria requiring intense telephone or in-person staff monitoring for the following week. Only three patients met criteria. A total of 219/353 had email surveys sent. Of 63 patients (28.8%) who returned email surveys by June 10, 2020, 35.9% had already managed a “pain attack” at home 4 or more times in the prior 12 months, and 45.5% of these said their bad ER experiences were very or somewhat important in that decision. In the prior 14 days, although 30/64 reported a crisis for at least one day, only 4/64 had visited the Emergency Department for pain. On a 0-10 scale, 21/61 patients endorsed “0” for worry that they would be COVID-infected by going for medical care (weighted mean 3.9), but 18/59 endorsed “10” for worry they were more at risk of COVID because of SCD (weighted mean 6.31), and 22/60 endorsed “10” for worry they would fare worse than others if COVID infected (weighted mean 6.97). Many patients forwent “needed” care (16/62) or delayed “needed” care by at least a day (36/61). Eleven patients met criteria for moderately severe to severe depression on the PHQ-9, and 28/63 somewhat or strongly agreed with the statement “death is always on the back of my mind” on the SCSS-A.ConclusionsIn adolescents and adults with SCD, many were already reticent to come to the ED for pain, but a significant portion reported delays or avoidance of needed care during the early stages of the US COVID pandemic, and few reported using the ED despite over half reporting at least one crisis day in 14. Patients nonetheless reported very few COVID-associated symptoms. Fears of COVID infection/susceptibility may limit visits for needed sickle cell care among adults.Acknowledgements: Mica Ferlis RN, FNP, Caitlin McManus, RN, FNP, Emily Sushko, RN, FNP, Justin West, RN, Kate Osborne, RN, Stefani Vaughan-Sams, Marla Brannon, BS, Nakeiya Williams, BSDisclosuresSmith:GlycoMimetics, Inc.: Consultancy; Emmaeus Pharmaceuticals, Inc.: Consultancy; Novartis, Inc.: Consultancy, Other: Investigator, Research Funding; Global Blood Therapeutics, Inc.: Consultancy, Research Funding; Shire, Inc.: Other: Investigator, Research Funding; NHLBI: Research Funding; Patient-Centered Outcomes Research Institute: Other: Investigator, Research Funding; Health Resources and Services Administration: Other: Investigator, Research Funding; Incyte: Other: Investigator; Pfizer: Consultancy; Ironwood: Consultancy; Novo Nordisk: Consultancy; Imara: Research Funding; Shire: Research Funding.

Functional B Cell Reconstitution Following Allogeneic Stem Cell Transplantation

Immune reconstitution is critical to long term survivability in recipients of allogeneic hematopoietic cell transplantation (HCT), mitigating both relapse as well as infection risk. However, both graft versus host disease (GVHD) and post HCT immunosuppression used to prevent it impair immune recovery, particularly functional B cell reconstitution which may not happen for several months post-transplant. This is relevant for post-transplant vaccination which in some centers is delayed till immune cell recovery. In this retrospective, Virginia Commonwealth University institutional review board (IRB) approved study, T helper and B cell recovery for up to two years following HCT was evaluated in 212 patients transplanted between 2015 and 2019. There were 69 HLA matched related & 143 unrelated donor transplant recipients. Median age of the patients was 56 years (range 19-74); conditioning regimens utilized were reduced intensity (RIC) in ~62% of the patients and rabbit anti-thymocyte globulin was used in ~72% of the patients. Blood stem cells were given in 183 patients and bone marrow in 29. Only patients with hematological malignancies were included in this study. Landmark analysis was carried out, with patients who did not survive the first 6 months post-transplant excluded. Of these patients, 85% are surviving. Median CD3+/4+ (Th) cell counts were 153 at 6 months, 228 at 1-year, 296 at 2 years, and corresponding B cell counts were 70, 175, & 273. Plotting Th and B cell counts over time in each individual donor-recipient pair demonstrated close correspondence between Th and B cell recovery, with synchronous recovery observed in most patients, median R 0.76 (range: 0.01-0.99). The slope of the B/Th cell curves for each patient then were compared in a subset of patients, and demonstrated a significant difference between those patients who either did not develop GVHD or only had acute GVHD as opposed to those who developed both acute and chronic GVHD (1.3±1.4 B cells/Th cells and 1.1±1.2 vs. 0.5±1, P=0.02 and 0.06 respectively), suggesting poor B cell recovery in those with chronic GVHD. Different immune recovery kinetics were observed amongst patients (Figure 1); A) rapid B cell recovery, highest absolute B cell count between 30 and 180 days post-HCT, B) intermediate B cell recovery, days 180 and 455, C) delayed B cell recovery, days 455 and 725 days, and D) minimal to no B cell recovery. A higher relative risk for developing acute + chronic GVHD was seen in the intermediate B cell recovery group when compared to those with delayed recovery, RR = 2.38 (95% CI 1.08-5.25). Functional B cell studies were performed in a subset, by measuring IgG levels and anti-pneumococcal antibody titers. Correlation was observed between Th cell count and IgG levels over time in individual patients (median R = 0.57). Pneumococcal titers were also measured at approximately 6 months, 1- and 2-years post-transplant as patients were given a series of PCV13 & PSV23 vaccinations 6 months after HCT. When the antibody titers against unique pneumococcal serotypes were analyzed in individual patients, these varied within each individual, following a declining trend in levels for antibodies against different serotypes; this decline occurred on a logarithmic scale suggesting differential immunogenicity of the pneumococcal antigens, and also mathematically ordered, rather than random Th and B cell responses (Figure 2A). When the serotypes with the highest titers in most patients were correlated with Th and B cell counts measured simultaneously, no association was observed. Further, when fold increase in pneumococcal titers beyond 1-year post transplant were compared across different groups of patients based on their GVHD status, no significant difference was observed in their antibody responses (Figure 2B). In conclusion, our data suggest synchronous Th and B cell reconstitution post allogeneic HCT, both in numeric and functional terms, and thus strategies to help promote T cell recovery, such as IL-7 administration post-transplant, are necessary to encourage optimal immune reconstitution. Vaccine responses beyond 6 months, as in the institutional practice reported here, are independent of GVHD status and numeric immune cellular recovery. These findings are consistent with the notion that immune recovery is a dynamical, rather than a stochastic process. Disclosures No relevant conflicts of interest to declare.

Improved Utilization Amongst Adult Sickle Cell Disease Patients: A Multi-Disciplinary Medical Home Approach

Background Worldwide, Sickle Cell Disease (SCD) is the most common monogenetic disorder. SCD is costly to the American health care system: $460,151 per patient for the 100,000 affected US patients. Biological and behavioral health comorbidities with limited hospital resources contributed to a cost increase in SCD readmissions at the Virginia Commonwealth University Health System (VCUHS) from 2012-2016, after a long history of decline. With increasing census, in FY16 the 30-day SCD readmission rate was 33.7%, up from 22.5% in FY14. The average SCD length of stay was 6.7 days, compared with an expected length of 4.2 days. The number of ED visits for SCD patients in FY17 was projected to be double that of FY14. The percent of ED returns in 3 days was projected to be triple that of FY14. Method The VCU Adult SCD Medical Home (ASCMH) was funded and launched to address this issue, based on the success of a pilot that showed cost savings of $333,000 for 5 patients in 12 months. The SCD ASCMH officially began January 1,2018 with a two-year pilot funding period. The ASCMH was structured and designed using quality improvement (QI) principles and consisted of multidisciplinary teams to coordinate inpatient care, emergency care, and ambulatory care respectively. Evaluation compared utilization during CY 2017 (pre-intervention) versus CY 2019 (2 years post intervention). For all patients we compared the average 30-day readmission rate, the average length of stay (ALOS), the average 3-Day ED return rate, the number of ED discharges, the numbers of inpatient days, inpatient discharges, and outpatient visits, the number of patients who used the ED, and total VCU charges. Results Among 541 (2017) and 592 (2019) SCD adults, including 40.6% males and 59.4% females, comparing pre-intervention to intervention, average utilization and VCU charges were either numerically or statistically significantly reduced. Mean 30-day readmission rates were reduced (31.60% vs 20.40%) ALOS was reduced (5.6 days vs 4.3 days), inpatient days were reduced (5313 days vs 3340 days), and total charges were significantly reduced ($15,664,895 vs $13,939,842). Conclusion At VCU, a multi-disciplinary ASCMH that featured intensive case management (CM) reduced annual utilization and cost savings for adult SCD patients. CM program elements that were most effective should be studied in the future and next steps should include a randomized controlled trial that can demonstrate evidence of their efficacy in strengthening and improving utilization Table Disclosures Smith: Emmaeus Pharmaceuticals, Inc.: Consultancy; GlycoMimetics, Inc.: Consultancy; Novartis, Inc.: Consultancy, Other: Investigator, Research Funding; Shire, Inc.: Other: Investigator, Research Funding; Imara: Research Funding; Novo Nordisk: Consultancy; Ironwood: Consultancy; Pfizer: Consultancy; Incyte: Other: Investigator; Health Resources and Services Administration: Other: Investigator, Research Funding; NHLBI: Research Funding; Patient-Centered Outcomes Research Institute: Other: Investigator, Research Funding; Global Blood Therapeutics, Inc.: Consultancy, Research Funding; Shire: Research Funding.

Kiyan Williams

Abstract The following is an interview conducted by Che Gossett and Eva Hayward with Kiyan Williams, multidisciplinary artist and assistant professor at Virginia Commonwealth University. William's visual art—sculpture and video—on blackness and ecology, dirt and displacement, brings Black trans poetics, aesthetics, and politics to bear on questions of the afterlife of slavery and plantation geographies. Their work also engages Black trans archives and historicity. Here they discuss their work Reflections on Marlon Riggs, Jesse Harris, Black trans archives, their works Meditations on the Making of America and Trash and Treasure, and their engagement with various artistic mediums.

Developing a fidelity measure of early intervention programs for children with neuromotor disorders.

To describe the development of an intervention-specific fidelity measure and its utilization and to determine whether the newly developed Sitting Together and Reaching to Play (START-Play) intervention was implemented as intended. Also, to quantify differences between START-Play and usual early intervention (uEI) services. A fidelity measure for the START-Play intervention was developed for children with neuromotor disorders by: (1) identifying key intervention components, (2) establishing a measurement coding system, and (3) testing the reliability of instrument scores. After establishing acceptable interrater reliability, 103 intervention videos from the START-Play randomized controlled trial were coded and compared between the START-Play and uEI groups to measure five dimensions of START-Play fidelity, including adherence, dosage, quality of intervention, participant responsiveness, and program differentiation. Fifteen fidelity variables out of 17 had good to excellent interrater reliability evidence with intraclass correlation coefficients (ICCs) ranging from 0.77 to 0.95. The START-Play therapists met the criteria for acceptable fidelity of the intervention (rates of START-Play key component use ≥0.8; quality ratings ≥3 [on a scale of 1-4]). The START-Play and uEI groups differed significantly in rates of START-Play key component use and quality ratings. The START-Play fidelity measure successfully quantified key components of the START-Play intervention, serving to differentiate START-Play from uEI.

S2243 Reversal Obstructive Lung Disease in Ulcerative Colitis: A Rare Extraintestinal Manifestation

INTRODUCTION: Ulcerative colitis (UC) is associated with several extraintestinal manifestations that may affect various organ systems, lungs involvement are relatively rare. Our case highlights a patient presenting with symptoms of reversible obstructive airway disease associated with UC disease activity. CASE DESCRIPTION/METHODS: A 23 YO male with history of Ulcerative pancolitis presented to Virginia Commonwealth University (VCU)-IBD Center with unresolving cough, wheezing, diarrhea, fecal urgency and abdominal pain. Physical exam was notable for moderate abdominal tenderness and minimal lung wheeze. Lab data reveled elevated CRP of 14 mg/dL and fecal calprotectin of 1285 µg/gm. CT abdomen/pelvis revealed active inflammation with diffuse colonic wall thickening. UC Treated initially with Mesalamine after diagnosis at age of 22 YO, combination therapy with Adalimumab and Methotrexate started few weeks prior to presentation.Pulmonary symptoms were manifested in cough and wheezing. These symptoms were exacerbated with worsening UC activity and more responsive to steroids courses. CT chest was negative for interstitial lung disease. Prior pulmonary function test (PFT) showed mild obstructive airway disease requiring albuterol and corticosteroids inhalers. He was found to have infectious colitis causing UC flare. GI and pulmonary symptoms improved with therapy optimization, steroids and methotrexate were stopped. Clinical remission were maintained with Adalimumab monotherapy. He remained off respiratory inhalers. Subsequent PFT with improved lung volumes and function. DISCUSSION: The prevalence and pathogenesis of lung involvement in IBD is poorly understood but it may be related to the underlying inflammatory process. Respiratory manifestations of ulcerative colitis are rare, they can be broadly categorized into airway disease and interstitial lung disease. These manifestations usually follow the IBD disease activity and often exacerbate during relapses. Patients with airway disease can have significant airway inflammation, which could potentially lead to airway narrowing. The most common presenting symptoms include cough and wheezing. Chest radiographs are often non-specific and pulmonary function testing may reveal obstruction pattern. CT scan of the chest may not show remarkable findings.This case report highlights that it is imperative to maintain a high index of suspicion for the development of pulmonary disease in the setting of IBD in order to institute appropriate treatment early and avoid complications.

Accuracy of the NHSN Central-Line–Associated Bloodstream Infections (CLABSIs) Definition: The Experience of Two Geographically Proximal Hospitals

Background: Central-line–associated blood stream infections (CLABSIs) are linked with significant morbidity and mortality. A NHSN laboratory-confirmed bloodstream infection (LCBSI) has specific criteria to ascribe an infection to the central line or not. The criteria used to associate the pathogen to another site are restrictive. This objective to better classify CLABSIs using enhanced criteria to gain a comprehensive understanding of the error so that appropriate reduction efforts are utilized. Methods: We conducted a retrospective review of medical records with NHSN-identified CLABSI from July 2017 to December 2018 at 2 geographically proximate hospitals. Trained infectious diseases personnel from tertiary-care academic medical centers, the University of Virginia Health System, a 600-bed medical center in Charlottesville, Virginia, and Virginia Commonwealth University Health System with 865 beds in Richmond, Virginia, reviewed charts. We defined “overcaptured” or O-CLABSI into different categories: O-CLABSI-1 is bacteremia attributable to a primary infectious source; O-CLABSI-2 is bacteremia attributable to neutropenia with gastrointestinal translocation not meeting mucosal barrier injury criteria; O-CLABSI-3 is a positive blood culture attributable to a contaminant; and O-CLABSI-4 is a patient injecting line, though not officially documented. Descriptive analyses were performed using the χ2 and the Fisher exact tests. Results: We found a large number of O-CLABSIs on chart review (79 of 192, 41%). Overall, 56 of 192 (29%) LCBSIs were attributable to a primary infectious source not meeting NHSN definition. O-CLABSI proportions between the 2 hospitals were statistically different; hospital A identified 34 of 59 (58%) of their NHSN-identified CLABSIs as O-CLABSIs, and hospital B identified a 45 of 133 (34%) as O-CLABSIs (P = .0020) (Table 1). When comparing O-CLABSI types, hospital B had a higher percentage of O-CLABSI-1 compared to hospital B: 76% versus 64%. Hospital A had a higher proportion of O-CLABSI-2: 21 versus 7%. Hospitals A and B had similar proportion of O-CLABSI-3: 15% versus 18%. These values were all statistically significant (P < .0001). Discussions: The results of these 2 geographically proximate systems indicate that O-CLABSIs are common. Attribution can vary significantly between institutions, likely depending on differences in incidence of true CLABSI, patient populations, protocols, and protocol compliance. These findings have implications for interfacility comparisons of publicly reported data. Most importantly, erroneous attribution can result in missed opportunity to direct patient safety efforts to the root cause of the bacteremia and could lead to inappropriate treatment.Funding: NoneDisclosures: Michelle Doll, Research Grant from Molnlycke Healthcare

Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit

Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

Author Biographies

Author Biographies

Virginia Commonwealth University School of Medicine.

Virginia Commonwealth University School of Medicine.

A pilot survey of personality traits of dental students in the United States.

Introduction The training of dental students and eventual practice of dentistry involves multiple components of the 'person'; therefore, understanding the personality of dental students is critical for creating a supportive student culture.Aims Our objective was to examine the personality traits of students attending Virginia Commonwealth University School of Dentistry.Methods We collected qualitative descriptive research through an anonymous survey sent to all pre-doctoral students, which included the 50-item International Personality Item Pool of the Big Five Markers (IPIP-BFM). Fifty-three dental students completed the survey.Results Analysis indicated that two of the personality traits were significantly different for both gender and academic year. The most significant deviation in scores between genders occurred for 'agreeableness and emotional stability'.Discussion The results demonstrate there may be a degree of commonality of traits shared between dental students and other professionally trained students. Nevertheless, gender-related deviations were the most remarkable findings.Conclusion Studies of personality traits have been used to consider and implement needs-based student services in other professions. The results of surveys of this kind could be considered instrumental in structuring evidence-based student services throughout the dental training curriculum, as they have been helpful for training of other professions.

The NAI Chapter Spotlight: Virginia Commonwealth University

The NAI Chapter Spotlight: Virginia Commonwealth University

Automatic Incident Triage in Radiation Oncology Incident Learning System.

The Radiotherapy Incident Reporting and Analysis System (RIRAS) receives incident reports from Radiation Oncology facilities across the US Veterans Health Affairs (VHA) enterprise and Virginia Commonwealth University (VCU). In this work, we propose a computational pipeline for analysis of radiation oncology incident reports. Our pipeline uses machine learning (ML) and natural language processing (NLP) based methods to predict the severity of the incidents reported in the RIRAS platform using the textual description of the reported incidents. These incidents in RIRAS are reviewed by a radiation oncology subject matter expert (SME), who initially triages some incidents based on the salient elements in the incident report. To automate the triage process, we used the data from the VHA treatment centers and the VCU radiation oncology department. We used NLP combined with traditional ML algorithms, including support vector machine (SVM) with linear kernel, and compared it against the transfer learning approach with the universal language model fine-tuning (ULMFiT) algorithm. In RIRAS, severities are divided into four categories; A, B, C, and D, with A being the most severe to D being the least. In this work, we built models to predict High (A & B) vs. Low (C & D) severity instead of all the four categories. Models were evaluated with macro-averaged precision, recall, and F1-Score. The Traditional ML machine learning (SVM-linear) approach did well on the VHA dataset with 0.78 F1-Score but performed poorly on the VCU dataset with 0.5 F1-Score. The transfer learning approach did well on both datasets with 0.81 F1-Score on VHA dataset and 0.68 F1-Score on the VCU dataset. Overall, our methods show promise in automating the triage and severity determination process from radiotherapy incident reports.

Real-time measurement for effectiveness of novel educational endeavors during the COVID-19 pandemic.

Journal of Dental EducationVolume 85, Issue S1 p. 1020-1021 ADVANCING THROUGH INNOVATION Real-time measurement for effectiveness of novel educational endeavors during the COVID-19 pandemic Kimberly K. Patterson DDS MS, Corresponding Author Kimberly K. Patterson DDS MS Pattersonk8@vcu.edu Department of Pediatric Dentistry, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, USA Correspondence Kimberly K. Patterson, DDS, MS, Associate Professor, 521 N 11th Street, Room 317, Richmond, VA 23298, USA. Email: Pattersonk8@vcu.eduSearch for more papers by this authorPriyanshi Ritwik DDS MS, Priyanshi Ritwik DDS MS orcid.org/0000-0003-0114-9619 School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USASearch for more papers by this authorCarolyn A. Kerins DDS PhD, Carolyn A. Kerins DDS PhD Department of Pediatric Dentistry, Texas A&M University College of Dentistry, Dallas, Texas, USASearch for more papers by this authorAbimbola Adewumi BDS FDSRCS(Eng), Abimbola Adewumi BDS FDSRCS(Eng) Pediatric Dentistry, University of Florida College of Dentistry, Gainesville, Florida, USASearch for more papers by this author Kimberly K. Patterson DDS MS, Corresponding Author Kimberly K. Patterson DDS MS Pattersonk8@vcu.edu Department of Pediatric Dentistry, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, USA Correspondence Kimberly K. Patterson, DDS, MS, Associate Professor, 521 N 11th Street, Room 317, Richmond, VA 23298, USA. Email: Pattersonk8@vcu.eduSearch for more papers by this authorPriyanshi Ritwik DDS MS, Priyanshi Ritwik DDS MS orcid.org/0000-0003-0114-9619 School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USASearch for more papers by this authorCarolyn A. Kerins DDS PhD, Carolyn A. Kerins DDS PhD Department of Pediatric Dentistry, Texas A&M University College of Dentistry, Dallas, Texas, USASearch for more papers by this authorAbimbola Adewumi BDS FDSRCS(Eng), Abimbola Adewumi BDS FDSRCS(Eng) Pediatric Dentistry, University of Florida College of Dentistry, Gainesville, Florida, USASearch for more papers by this author First published: 04 August 2020 https://doi.org/10.1002/jdd.12363Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume85, IssueS1Supplement: Advancing Through Innovation in a Challenging TimeJune 2021Pages 1020-1021 This article also appears in:Advancing Through Innovation in a Challenging Time RelatedInformation

Abstract 807: Predictive biomarkers for Bevacizumab activity in recurrent glioblastoma: A single institution study

Abstract Glioblastoma Multiforme (GBM) is an aggressive type of astrocytoma and the most common malignant brain tumor in adults. Bevacizumab is a recombinant monoclonal antibody that targets VEGF-A. VEGF is regulated by the hypoxia-inducible-factor (HIF-1α) pathway, with the tumor suppressor gene TP53 as one of the key regulating factors. Our study examines the relevance of various genetic mutations of the HIF-1α pathway and their predictive significance in patients diagnosed with recurrent GBM and treated with bevacizumab. A total of 41 patients diagnosed with recurrent GBM and treated with Bevacizumab at Virginia Commonwealth University from January 1990 through November 2018 were included in our study. Our study cohort consists of 56.1% males and 43.9% females, with an average age of 59.9 (SD 12.1), and 68.3% were Caucasian. The majority (90%) of the cohort were classified as de novo cases of GBM. The overall survival (OS) was 172.5 days (95% CI: 122.0, 218.5), with a minimum of 11 days and maximum of 904 days measured from the date of the first bevacizumab treatment to the date of death. The majority of patients (70.7%) responded to treatment, with 61% exhibiting a partial response and 9.8% exhibiting a complete response. The median first response to treatment (FRT) was 34 days (95% CI: 21, 40), with a minimum of 2 days and maximum of 76. All patients died during the follow-up period. Survival analyses for OS, along with FRT, were both performed with Kaplan-Meier curves generated individually. We have examined the clinical characteristics of our study cohort and are currently examining the genetic characteristics of the tumors in our cohort. At the time of the conference we will have updated genomic and radiographic data in addition to the current detailed clinical data. Citation Format: Marcin Dragan, Matthew Carli, Mark Malkin, Victor Yazbeck. Predictive biomarkers for Bevacizumab activity in recurrent glioblastoma: A single institution study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 807.

The One Note System: Implementation and Initial Perceptions of Student Documentation in the Electronic Health Records Under the New Centers for Medicare and Medicaid Services Guidelines.

IntroductionMedical students have been documenting notes in the electronic health records (EHR) for many years but often wrote separate notes from housestaff and faculty because licensed providers (LPs) could not bill the Centers for Medicare and Medicaid Services (CMS) for Evaluation and Management (E/M) services. However, in 2018, CMS updated its policy to allow LPs to simply verify any component of an E/M service under appropriate supervision, allowing LPs to bill a full medical student note.MethodsAt Virginia Commonwealth University Health Systems (VCUHS), a task force was formed to develop and pilot the One Note System (ONS), a system that incorporates the new CMS guidelines for certain note types. In June 2019, or 10 months after implementation of the ONS, the authors developed and distributed a survey that explored perceptions regarding the ONS among medical students, housestaff (residents and fellows), and faculty.ResultsThe results showed that most participants were aware of the ONS and preferred email as the form of training. Overall, the ONS had a positive impact on faculty and housestaff workflow, improved self-reported faculty wellbeing, and increased meaning in student work. Only a minority reported barriers to implementing the ONS.ConclusionsThe One Note System was successfully implemented at VCUHS and positively received. Other outcomes to measure include impact of the ONS on student and trainee education, compliance and billing, quality and quantity of documentation, and faculty and housestaff burnout rates.

Collaboration, Collegiality, and Sharing of Resources: Benefits of a Visiting Professor Exchange Program in Breast Imaging.

The role of a visiting professor (VP) has long been used as a model to share medical knowledge and new advances between different teaching institutions. As with all subspecialties, breast imaging has institution-specific differences in resources and faculty. Sharing of resources between programs can have a profound impact on enriching educational experiences for learners. Our conceptual design of a VP lecture exchange program was between two academic medical centers, Virginia Commonwealth University Health System (VCU) and MedStar Georgetown University Hospital University (MGUH), in the subspecialty of breast imaging. The program was designed to supplement potential areas of weakness in the breast imaging educational curriculum at each respective institution. The program also sought to create opportunities for long-term mentorship and collaboration between institutions. Three faculty members from VCU and three faculty members from MGUH participated for a total of six lectures (three lectures at each site). Participating residents and faculty completed anonymous surveys following each lecture regarding the lecture exchange program experience. The survey responses showed that the VP exchange was well received at both institutions. The VP exchange process was relatively easy to arrange, benefits both institutions, and could even be expanded to the virtual environment.

Cross-cultural differences in Parkinson's disease caregiving and burden between the United States and Mexico.

IntroductionGiven the rapidly aging population in both the United States and Mexico, rates of Parkinson's disease (PD) are likely to rise in both countries, suggesting that the number of individuals providing informal care will also increase, and the healthcare system will have to consider the burden this places upon caregivers. Therefore, the purpose of the current study was to examine differences in PD caregiving and burden between the United States and Mexico.MethodsData were collected from PD caregivers in the Parkinson's Clinic at the Hospital Civil Fray Antonio Alcalde in Guadalajara, Mexico (N = 148) and the Parkinson's and Movement Disorders Center at Virginia Commonwealth University in Richmond, Virginia (N = 105) regarding caregiver demographics and self‐reported burden.ResultsDespite considerably more time spent in caregiving duties, higher rates in unemployment or underemployment, and lower education levels, Mexican PD caregivers reported significantly less personal strain and role strain than did their United States counterparts. Even after controlling for these and other demographic differences between the two sites, the differences in caregiver burden remained.ConclusionsLatino cultural values in Mexico encouraging the importance of caring for family members with PD and respecting elders may promote caregiving and even make it a point of cultural pride, helping to overcome potential negative effects on caregivers seen in the United States. The scientific and medical communities should view caregiving as a culturally embedded and potentially positive role, rather than predominantly as burdensome as frequently conceptualized in Western or Eurocentric cultures.

Surgery Resident Perceptions of the Clicker Evaluation System: A Novel Approach to Collecting and Utilizing Clinical Faculty Performance Data

Medical trainees often have a process in place to receive feedback from clinical faculty regarding overall performance. While there is guidance on effective methodologies for faculty to provide feedback for learners, there is a dearth of literature analyzing trainees' evaluation of faculty performance. We sought to identify an effective and anonymous method for surgery residents to evaluate clinical faculty. The Department of Orthopedic Surgery at Virginia Commonwealth University (VCU) Health implemented a novel process to gather annual clinical faculty performance data from residents for the purpose of program improvement starting in 2012. Specifically, residents used a web-based audience response system, also known as a "clicker" system, to evaluate faculty performance over the academic year. During the June 2018 evaluation session, residents also completed an anonymous, 9 question survey to assess the residents' perceptions regarding this clicker evaluation process. VCU Health System, a tertiary care hospital in Richmond, Virginia. All 24 orthopaedic surgery residents at VCU Health participated in the evaluation process and completed the perception survey in 2018. Ninety-six percent (n = 23) of the residents agreed that they are able to accurately rate their attendings' performance, felt confident that their responses remained anonymous, and that their departmental chair values their opinion when evaluating their attendings' performance through the clicker process. Qualitative responses identified anonymity as a strength of the clicker process, while opportunities for improvement included refinement of questions. The clicker evaluation system is an effective and anonymous method for resident evaluation of clinical faculty performance in academic settings. Future steps include refinement of questions based on departmental goals for education, adoption of the clicker evaluation system by other specialties, as well as research into ways to optimize the clicker evaluation process. Additional research should be done to see if and how the clicker evaluation feedback translates into change in clinical faculty behavior.