Objective This study’s purpose was to determine if an early amniotomy increased the risk of maternal and neonatal infectious morbidity when compared with late amniotomy. Study design This was a single-center retrospective cohort study performed between 1/1/2010 and 3/31/2018. It assessed the relationship between eligible term women undergoing labor induction with early amniotomy, defined as artificial rupture of membranes (AROM) performed less than 12 h from start of cervical ripening, compared with women who do not have an early amniotomy. The primary outcome was a composite of chorioamnionitis and/or neonatal sepsis. Secondary outcomes included isolated maternal fever, composite maternal morbidity, cesarean delivery, amnioinfusion, any transfusion, length of labor induction, cord prolapse, NICU admission, and Apgar score. Results Among the 1200 patients, the rate of chorioamnionitis or neonatal sepsis was lowest at 0.4 % for patients with early amniotomy <12 h, increased to 3.5 % in both the interval to AROM 12 to <18 h and 18 to <24 h, and further increased to 5.9 % when AROM occurred after 24 h from start of cervical ripening (p = 0). For the secondary outcomes, the rate of cesarean was significantly lower in the early AROM group <12 h at 13.9 % compared to all other later periods of AROM, with the highest rate in the >24 h group (34.9 %, p = 0). The mean time from amniotomy to delivery was increased across each time interval, lowest at 11.5 in the <12-hour interval and highest at 44.6 h for the interval with AROM at 24 h and beyond (p = 0). Composite maternal morbidity also increased across each time interval, lowest in the <12-hour group at 17.6 % and highest in the group that had AROM occur after 24 h at 31.2 % (p = 0). There were no significant differences in neonatal secondary outcomes. Conclusion When amniotomy is performed <12 h after initiation of cervical ripening, there does not appear to be an increased rate of infectious morbidity. When performing amniotomy in a closer time interval to end of cervical ripening, it appears infectious morbidity may be reduced with shorter duration from amniotomy to delivery while decreasing cesarean and maternal morbidity rates.

Background:Diabetes mellitus type 1 (DM1) and type 2 (DM2) are well-established risk factors for cardiovascular disease but differ pathophysiologically in that DM1 results from insulin deficiency, whereas DM2 results from insulin insensitivity. The association between DM1 and DM2 and cardiovascular events remains undetermined. Methods:For DM1 or DM2 patients aged 46 to 75 years receiving care at outpatient facilities with primary care and/or endocrinology enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017-2022, we compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization. Results:The study population included 5823 DM1 patients (3.59%) and 156,204 DM2 patients (95.41%) with a total of 758,643 visits. DM1 patients were younger and had fewer comorbidities. A total of 11,096 incident cardiovascular events occurred with a prevalence ratio (PR) of 0.63 (95% CI, 0.55-0.71) for fewer events associated with DM1 than DM2. After adjustment for age, the PR was 0.66 (95% CI, 0.58-0.74). When analyzed by separate cardiovascular events, DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2. Overall cardiovascular event probability was lower in DM1 than in DM2 across all 10-year age categories, in both female and male patients, before and during/after the coronavirus disease 2019 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine. Conclusions:DM1 was associated with a lower probability of incident cardiovascular events than DM2. Although DM1 may carry a lower risk of incident cardiovascular events than DM2, the pathophysiology, prevention, and treatment of cardiovascular disease in DM1 remain poorly understood.

Background: In the US, opioid treatment providers (OTPs) have wide latitude to perform urine drug screening (UDS) and discharge clients for positive results. OTP clients have identified randomized and directly observed UDS as potentially stigmatizing, but little research has examined the association between UDS modality and retention in OTPs. Methods: This cross-sectional study uses the 2016-2017 NDATSS wave among OTPs that administered methadone. The exposure was a 4-level variable based on whether OTPs had a high percentage (> 90% of clients) who experienced randomized, observed, both, or neither modality of UDS. The outcome was the proportion of clients retained in treatment 1 year or longer (long-term retention). Analyses were conducted using fractional logit regression with survey weighting and presented as percentages and 95% confidence intervals. We also present how policies for involuntary clinic discharge modify these effects. Results: 150 OTPs were eligible with a median of 310 clients. 40 (27%) OTPs did not highly utilize either randomized or observed UDS, 22 (15%) only highly utilized observed UDS, 42 (28%) only highly utilized randomized UDS and 46 (31%) utilized both practices on > 90% of clients. Adjusted estimates for long-term retention ranged from 57.7% in OTPs that conducted both randomized and observed UDS on > 90% of clients and 70.4% in OTPs that did not highly utilize these practices. Involuntary discharge may moderate this relationship. Conclusion: Findings showed an association between high utilization of randomized and observed UDS and decreased long-term retention, suggesting that UDS modality may impact long-term OTP retention.

Introduction: No association regarding classification of social vulnerability and outcomes of patients with gunshot injury have been described. Our goal was to assess whether the socioeconomic vulnerability index (SVI), is associated with an increased risk of hospital readmission following gunshot wounds. Methods: We conducted an exploratory retrospective cohort study on Massachusetts patients with trauma following gunshot wounds from January 1, 2012 to December 31, 2020 using the institutional trauma registry. We estimated the association between high social vulnerability (defined by the Centers for Disease Control and Prevention as >= 90th percentile) and incidence of all-cause readmission at 30, 60, and 90 d (overall and stratified over sex, race, and age groups). Estimates from unadjusted log-binomial regression were reported using relative risks (RRs) and 95% confidence intervals. Time-to-event (readmission) was assessed using Kaplan-Meier plots. Results: A total of 386 patients were included for analysis: 211 (55%) with SVI <0.90 and 175 (45%) with SVI >= 0.90. The mean (standard deviation) age was 29 (13) y, with majority being male (89%). There was no strong risk of readmission associated with SVI >= 0.90; the interval with the greatest risk was at 60 d (RR = 1.34; 95% confidence interval [0.73, 2.45]). Among stratified analyses, the strongest associations were observed when restricting to young adults (aged 18-35) with RRs of 2.49, 2.62, and 2.45 for 30, 60, and 90 d readmission, respectively. Conclusions: Overall, high SVI was not associated with all-cause readmission; however, subanalyses suggest an association among young adults. Future research should explore SVI as a tool for identifying patients with trauma at risk for readmission. (c) 2023 Elsevier Inc. All rights reserved.

Introduction Non-cystic fibrosis bronchiectasis is a disease which is increasing in incidence and prevalence worldwide. The incidence of the disease is frequently estimated using databases that rely on International Classification of Diseases, ninth and tenth revisions, clinical modification (ICD-9-CM/ICD-10-CM) discharge diagnoses. Code accuracy has proved to be a major issue for other diagnoses using ICD codes. This study aims to investigate the accuracy of the ICD codes for the diagnosis of non-cystic fibrosis bronchiectasis. Methods This is a retrospective diagnostic accuracy study which compares the radiologist's diagnosis of bronchiectasis with the ICD code reflection of that diagnosis at discharge. Results Sensitivities were 34% (same for both ICD-9-CM and ICD-10-CM windows) and specificities ranged from 69% for the ICD-9-CM window to 81% for ICD-10-CM window. Conclusion We observed that ICD codes are an insufficient method to identify patients with a radiologist diagnosis of bronchiectasis.

Objective: Analyze the association between race and surgery performed for uterine fibroids during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Retrospective exploratory cross-sectional study of patients with fibroids who underwent surgery during the COVID-19 pandemic. We compared the type of surgery performed (minimally invasive hysterectomy [MIH], uterine-sparing procedure [USP], or total abdominal hysterectomy [TAH]) by White versus non-White patients. Absolute percentage differences were estimated with multinomial logistic regression adjusting for age, body mass index (BMI), parity, comorbidities, and maximum fibroid diameter. Results: Of 350 subjects, the racial composition was 1.7% Asian, 23.4% Black, and 74.9% White. Non-White patients had greater fibroid burden by mean maximum fibroid diameter, mean uterine weight, and mean fibroid weight. Although MIH occurred more frequently among White patients (7.5% points higher [95% confidence interval (CI) = -3.1 to 18.2]), USP and TAH were more commonly conducted for non-White patients (3.4% points higher [95% CI = -10.4 to 3.6] and 4.2% points higher [95% CI = -13.2 to 4.8], respectively). The overall complication rate was 18.6%, which was 6% points lower (95% CI = -15.8 to 3.7) among White patients. Conclusion: During the COVID-19 pandemic at a single-site institution, non-White patients were more likely to undergo a uterine-sparing procedure for surgical treatment of uterine fibroids, abdominal procedures, including both hysterectomy and myomectomy, and experience surgery-related complications.

Introduction: We investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC). Materials and Methods: An exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0-15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI >= 90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression. Results: Of 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61-2.29). However, although estimates were unstable, there was a possibility of increased risk of rehospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68-8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively). Conclusion: We observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations. Level of Evidence: Level IV; Prognosis Study.

INTRODUCTION:A variety of labor pain management options is essential to patients and their care providers. Inhaled, patient controlled nitrous oxide (N2O) is a valuable addition to these options. The purpose of this study was to examine laboring patient, newborn, and provider characteristics associated with N2O use for pain relief in labor and to examine the association between N2O, conversion to neuraxial analgesia, and cesarean birth. METHODS:This was a retrospective observational cohort study of the first year of N2O use in one large academic medical center. Patients at least 37 weeks' gestation who were admitted for labor with intended vaginal birth from August 1, 2018, to June 30, 2019, were included (N = 2605). Laboring patient and newborn factors and their relationship to N2O use were calculated as unadjusted and adjusted relative risks (RRs). Poisson regression was used to model the association between N2O use and subsequent use of neuraxial analgesia and type of birth for both nulliparous and multiparous patients. RESULTS:Overall, 20.2% of patients used N2O during labor. Multiparous patients were 24% less likely to use N2O than nulliparous patients (RR, 0.76; 95% CI, 0.69-0.84). Use of N2O did not differ significantly between patients cared for by midwives compared with patients cared for by physicians (RR, 0.95; 95% CI, 0.90-1.00). In multivariable modeling, N2O use in multiparous patients was associated with a 17% decrease in use of neuraxial analgesia (RR, 0.83; 95% CI, 0.73-0.94). There was no association between N2O use and use of neuraxial analgesia in nulliparous patients (RR, 0.99; 95% CI, 0.93-1.06). N2O use was not associated with cesarean birth in either group. DISCUSSION:N2O is an important pain management option for laboring patients and those who care for them. Study results may assist midwives, physicians, and nurses in counseling patients about analgesia options.

INTRODUCTION: Polyhydramnios is associated with increased risk of stillbirth at term, but is historically associated with higher risk of cesarean section. The objective was to determine if induction of labor at 38-39 weeks gestation reduces the risk of cesarean compared to expectant management for women with polyhydramnios at term. METHODS: This was a single center, retrospective cohort study of singleton, vertex patients with a diagnosis of polyhydramnios at 38 weeks gestation between July 2014 and March 2018. IRB approval obtained. Women with planned induction at 38 0/7 to 39 6/7 weeks were compared to those expectantly managed. Patients with placental or uterine pathology, significant fetal anomaly, and women undergoing an induction of labor for a medical indication (e.g. diabetes, chronic hypertension) were excluded. Induction time period spanned from 38 0/7 to 39 6/7 weeks. The primary outcome was cesarean section. RESULTS: 168 singleton non-anomalous idiopathic polyhydramnios pregnancies met the inclusion criteria. 97 were induced and 71 were expectantly managed. Cesarean delivery was reduced for women induced compared to those expectantly managed (18.8% vs 35.7%, p=0.015). There were no differences in maternal or neonatal secondary outcomes. There was one case of cord prolapse and one cesarean hysterectomy in the induction group. One case of stillbirth was diagnosed in the expectant group which placental pathology revealed multiple chorangiomas and cardiomegaly on fetopsy. CONCLUSION: Induction of labor is associated with reduced risk of cesarean section in non-anomalous polyhydramnios compared to expectant management. Given the increased risk of stillbirth, induction is preferred over expectant management.

Background Clostridioides difficile infection (CDI) is a major cause of hospital-acquired diarrhea and is associated with substantial morbidity and mortality. Recurrences following treatment are common. Fecal microbiota transplantation (FMT) is a therapeutic intervention in which stool from a healthy donor is administered to a patient with recurrent CDI. Studies to date of predictors of FMT failure have primarily included inpatients. In this study, we aimed to describe FMT failure rates within one year of FMT and evaluate factors associated with FMT failure. Methodology We conducted an exploratory retrospective study of consecutive patients who underwent outpatient FMT at a single tertiary care center in Western Massachusetts from December 2014 through September 2018. We collected patient data including demographics, CDI-related factors, and FMT-related factors. FMT failure was defined as non-response or recurrence of diarrhea, associated with positive stool C. difficile toxin or polymerase chain reaction. Unadjusted relative risk (RR) and 95% confidence intervals for factors associated with FMT failure were estimated using log-binomial regression. Results A total of 92 patients were included with a mean age of 64 years. CDI severity was mild or moderate in 73% and severe or fulminant in 27%. The most common FMT indication was recurrent CDI in 76% of patients. FMT failure occurred in 25 of 92 (27%) patients, with half occurring within 11 days. Factors associated with FMT failure were active malignancy (RR = 2.56), prior hospitalizations (RR = 2.42), and receipt of non-CDI antibiotics within six months of FMT (RR = 2.80). We did not observe strong associations for risk of FMT failure with age ≥65, sex, use of proton pump inhibitors or H2 receptor agonists, history of colectomy, immunosuppression, history of malignancy, diabetes, appendectomy, CDI severity, or probiotic use. Conclusions Active malignancy, prior CDI hospitalizations, and non-CDI antibiotics within six months before FMT were associated with FMT failure in the outpatient setting. Knowledge of the above factors may help inform shared decision-making with patients at risk for FMT failure.

Introduction An invitation to speak at grand rounds (GR) is considered an honor and an activity important for academic promotion. The aim of this study was to determine the representation of women among invited speakers at departmental GR and assess the impact of the COVID-19 pandemic on it. Methods We conducted a retrospective descriptive study on gender differences in all GR speakers between January 2019 and June 2021 at an academic health system in Western Massachusetts. We calculated the overall percentage of women presenters and compared it with the percentage of women faculty at our institution and nationally. To evaluate the impact of COVID-19 on this association, we calculated the absolute percentage difference between women and men speakers using the date of March 13, 2020, as the cut-off and conducted a sensitivity analysis using June 15, 2020, as the cut-off. Results During the study period, 46% (276/607) of GR speakers at our institution were women. This percentage reflected the percentage of the women faculty overall at our institution and was similar to women's representation among faculty nationally. Departments with high percentages of women faculty (Obstetrics and Gynecology, 76%; Pediatrics, 65%) had high percentages of women GR speakers (Obstetrics and Gynecology, 70%; Pediatrics, 51%; Psychiatry, 62%). COVID-19 did not appear to significantly influence gender representation among speakers. Conclusion At our institution, less than half of the GR speakers were women. However, this percentage appears to reflect the overall percentage of women faculty. Potential barriers and opportunities resulting from the COVID-19 pandemic did not appear to impact this finding.

CONTEXT.—:Touch preparation (TP) alone is discouraged for intraoperative lymph node (LN) assessment in the neoadjuvant setting (NAS) owing to overall low sensitivity in detecting metastatic breast cancer.OBJECTIVE.—:To compare the sensitivity, specificity, and negative predictive value of intraoperative LN assessment via TP and examine potential causes of discrepancies along with the clinical, radiologic, and pathologic parameters in the NAS and non-neoadjuvant setting (NNAS).DESIGN.—:A total of 99 LNs from 47 neoadjuvant patients and 108 LNs from 56 non-neoadjuvant patients were identified. Discordant cases were reviewed retrospectively to reveal the discrepancy reasons. Clinical, radiologic, and pathologic data were obtained from chart review and the pathology CoPath database.RESULTS.—:The sensitivity, specificity, and negative predictive value of TP in NAS and NNAS were 34.2% versus 37.5%, 100% versus 100%, and 70.9% versus 90.2%, respectively. In NAS, discrepancy reasons were interpretation challenge due to lobular histotype, poor TP quality secondary to therapy-induced histomorphologic changes, and undersampling due to small tumor deposits (≤2 mm); the latter was the major reason in NNAS. More cases with macrometastasis were missed in NAS compared to NNAS (14 of 25 versus 1 of 10). The parameters associated with discrepancy were lobular histotype, histologic grade 2, estrogen receptor positivity, HER2 human epidermal growth factor receptor 2 negativity, multifocality, and pathologic tumor size greater than 10 mm in NAS; and lymphovascular space involvement and pathologic tumor size greater than 20 mm in NNAS.CONCLUSIONS.—:In NAS, intraoperative TP alone should be used very cautiously owing to a high false-negative rate of macrometastasis, especially for patients with invasive lobular carcinoma and known axillary LN metastasis before neoadjuvant therapy.

STUDY OBJECTIVE:Clinical decision aids can decrease health care disparities. However, many clinical decision aids contain subjective variables that may introduce clinician bias. The HEART score is a clinical decision aid that estimates emergency department (ED) patients' cardiac risk. We sought to explore patient and clinician gender's influence on HEART scores. METHODS:In this secondary analysis of a prospective observational trial, we examined a convenience sample of adult ED patients at one institution presenting with acute coronary syndrome symptoms. We compared ED clinician-generated HEART scores with researcher-generated HEART scores blinded to patient gender. The primary outcome was agreement between clinician and researcher HEART scores by patient gender overall and stratified by clinician gender. Analyses used difference-in-difference (DiD) for continuous score and prevalence-adjusted, bias-adjusted Kappa (PABAK) for binary (low versus moderate/high risk) score comparison. RESULTS:All 336 clinician-patient pairs from the original study were included. In total, 47% (158/336) of patients were women, and 52% (174/336) were treated by a woman clinician. The DiD between clinician and researcher HEART scores among men versus women patients was 0.24 (95% CI -0.01 to 0.48). Compared with researchers, men clinicians assigned a higher score to men versus women patients (DiD 0.51 [95% CI 0.16 to 0.87]), whereas women clinicians did not (DiD 0.00 [95% CI -0.33 to 0.33]). Agreement was the highest among women clinicians (PABAK 0.72; 95% CI 0.61 to 0.81) and lowest among men clinicians assessing men patients (PABAK 0.47; 95% CI 0.29 to 0.66). CONCLUSION:Patient and clinician gender may influence HEART scores. Researchers should strive to understand these influences in developing and implementing this and other clinical decision aids.

We conducted a retrospective exploratory study evaluating factors associated with selection to receive and infusion with coronavirus disease 2019 monoclonal antibodies. While priority was given to high-risk patients, patients with increased Social Vulnerability Index scores were less likely to present for infusion, raising concern that social factors created barriers to treatment.

Objective This meta-analysis aimed to determine the effectiveness of non-physician provider-led palliative care (PC) interventions in the management of adults with advanced illnesses on patient-reported outcomes and advance care planning (ACP). Methods We included randomised trials and cluster trials published in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and ClinicalTrials.gov searched until July 2021 that examined individuals ≥18 years with a diagnosis of advanced, life-limiting illness and received a PC intervention led by a non-physician (nurse, advance practitioner or social worker). Our primary outcome was quality of life (QOL), which was extracted as unadjusted or adjusted estimates and measures of variability. Secondary outcomes included anxiety, depression and ACP. Results Among the 21 studies (2370 subjects), 13 included patients with cancer, 3 with heart failure, 4 with chronic respiratory disease and 1 with chronic kidney disease. The interventions were diverse and varied with respect to team composition and services offered. For QOL, the standardised mean differences suggested null effects of PC interventions compared with usual care at 1–2 months (0.04; 95% CI=−0.14 to 0.23, n=10 randomised controlled trials (RCTs)) and 6–7 months (0.10; 95% CI=−0.15 to 0.34, n=6 RCTs). The results for anxiety and depression were not significant also. For the ACP, there was a strong benefit for the PC intervention (absolute increase of 0.32% (95% CI=0.06 to 0.57). Conclusions In this meta-analysis, PC interventions delivered by non-physician were not associated with improvement in QOL, anxiety or depression but demonstrated an impact on the ACP discussion and documentation.

Non-cystic fibrosis bronchiectasis is a clinically important disease with an estimated 340,000-522,000 persons living with the disease and 70,000 being diagnosed annually. The radiographic diagnosis remains a pivotal part of recognizing the disease due to its protean clinical manifestations. As physicians are sensitized to this disease, a greater proportion of patients are being diagnosed with mild to moderate bronchiectasis. Despite the established use of CT chest as the main tool for making a radiologic diagnosis of bronchiectasis, the literature supporting the process of making that diagnosis is somewhat sparse. Concurrently, there has been an increased trend to have Web-based radiologic tutorials due to its convenience, the ability of the learner to set the pace of learning and the reduced cost compared to in-person learning. The COVID-19 pandemic has accelerated this trend. We wanted to look carefully at the effect of a Web-based training session on interrater reliability. Agreement was calculated as percentages and kappa and prevalence adjusted kappa calculated. We found that a single Web-based training session had little effect on the variability and accuracy of diagnosis of bronchiectasis. Larger studies are needed in this area with multiple training sessions.

Abstract With increasing awareness of the importance of non-cystic fibrosis bronchiectasis, many patients seen will have modest changes on CT chest despite significant symptoms related to their disease. Variability in recognition of the CT changes has implications for the timely recognition of the disease and follow-up. Though very little data is published on longitudinal follow-up of patients with modest bronchiectasis and identifying factors which lead to progression of disease, there clearly are sub-groups of patients who require close follow from early in their disease trajectory. This study looks at whether a Web-based training improves recognition of bronchiectasis in a cohort with mild to moderate bronchiectasis.

Abstract Introduction Magnesium sulfate decreases the risk of eclampsia in patients with severe preeclampsia. There is a theoretical risk that magnesium sulfate increases the risk of intrapartum hemorrhage. We evaluated whether there was a quantitative difference in blood loss in patients receiving magnesium sulfate at the time of cesarean delivery (CD) compared to those who were not. Materials and Methods A retrospective cohort study was performed using a database of patients with preeclampsia with severe features or eclampsia. The primary outcome was calculated estimated blood loss (cEBL) compared between patients who received magnesium sulfate during CD and those who did not. cEBL was derived through a validated equation by multiplying the patient’s blood volume by percent of blood volume loss. Secondary outcomes were hematocrit change, visual EBL (vEBL), hemorrhage, cEBL >1500mL, Apgar <7 at 5 min, and NICU admission. Exclusion criteria were incomplete records or negative cEBL, as well as blood transfusion prior to collection of a postpartum hematocrit. Results We identified 124 patients with preeclampsia with severe features or eclampsia at time of CD. There were 57 (46%) that received magnesium sulfate during CD and 67 (54%) in which magnesium was stopped during the CD. The mean differences for hematocrit value (0.8, 95% confidence interval (CI) −0.3 to 1.8) and cEBL (108, 95% CI −102 to 318) were not significantly different after adjusting for obesity and history of CD. Conclusion Magnesium sulfate administration for seizure prevention in patients with preeclampsia with severe features at the time of CD does not appear to be associated with an increase in the cEBL.

Special AT-rich sequence-binding protein 2 (SATB2) is a sensitive and specific biomarker for sporadic colonic adenocarcinomas. Previous studies have found that SATB2 is lost in some adenocarcinomas and dysplasias associated with inflammatory bowel disease (IBD). In establishing these findings, the prior studies did not examine cases of IBD interpreted as indefinite for dysplasia. We examined SATB2 expression in this diagnostic category to determine if any potential loss is associated with a diagnosis of definitive dysplasia on follow-up. To investigate this possibility, we collected 87 biopsies of IBD indefinite for dysplasia from 62 patients and stained them with SATB2. Among patients' indefinite for dysplasia, we found SATB2 loss in 6/62 (9.7%). Among those with follow-up (n=51), we observed 5/6 (83%) with a future dysplasia in those with SATB2 loss compared with 10/45 (22%) in those with SATB2 retention, absolute difference 61.1% (95% confidence interval=28.9%-93.3%). We conclude that loss of SATB2 on biopsies otherwise interpreted as IBD indefinite for dysplasia may mark a population at high risk for showing definitive dysplasia on future biopsies.

Abstract Background COVID-19 monoclonal antibodies (mAb) have been shown to reduce risk of ED visit and hospitalization when administered early in disease course. However, there has been little data evaluating the challenges and barriers to delivering an outpatient mAb infusion. Methods This was a retrospective cohort review of patients referred 12/7/20-5/20/21 to evaluate factors associated with selection and treatment with mAb. Inclusion criteria included symptom onset within 10 days of referral, high-risk for severe disease, not hospitalized or meeting hospitalization criteria, and followed by in-network primary care provider. We collected data on demographics, high risk comorbidities, illness course, infusion selection, and adverse events. Using unadjusted regression models, we estimated effect sizes (mean difference or percentage point difference) and 95% confidence intervals to estimate baseline factors associated with infusion. Results Of the 230 eligible subjects, 179 (78%) were selected for mAb treatment and 119 (66%) were infused. Those with a Social Vulnerability Index > 0.5 were more likely to be selected (86% vs 71%) but among those selected were less likely to be infused (59% vs 74%). Other predictors for selection (Fig 1) included Spanish language preference, 3+ symptoms at the time of referral, shortness of breath, headache, immunosuppressive medications, and chronic respiratory disease. Predictors of mAb infusion (Fig 2) included 3+ symptoms at time of referral, diarrhea, myalgias, male gender, being employed, and history of chronic kidney or respiratory disease. Time of onset of symptoms-to-referral was < 5 days and test-to-referral was 2-3 days (Fig 3). 60 subjects were selected but not infused. 19 (32%) were not infused due to becoming ineligible after referral. Reasons for ineligibility included clinical decompensation or passing eligibility window. 39 (65%) were not infused due to refusal after selection. Most common reasons for refusal included feeling better (12, 20%), concerns about mAb (6, 10%), and lack of caregiver for a family member (4, 7%). Figure 1.Predictors of Selection for mAb InfusionFigure 2.Predictors of mAb Infusion After SelectionFigure 3.Days of Symptoms to Testing and Referral Conclusion Our study identified factors that impact selection and infusion of mAb in a real-world setting. This can help address potential barriers in operationalizing the administration of COVID-19 mAb in the future. Disclosures All Authors: No reported disclosures.