Kootenai Medical Center

BACKGROUND: Over the past 30 years, the treatment landscape for multiple sclerosis (MS) has become increasingly complex. All MS disease-modifying therapies (DMTs) and several symptomatic medications are designated specialty medications, and their financial coverage is subject to complicated insurance processes and a wide array of patient support programs. Many patients receiving MS DMTs need ongoing monitoring or enrollment in a Risk Evaluation and Mitigation Strategy program. Integrated pharmacy services can facilitate financial, technical, and educational aspects of providing specialty medications. Although pharmacy services are often part of the care team for patients with complex chronic medical conditions, MS clinics may not have the benefit of full pharmacy services. We present 4 models of MS health care delivery and discuss how integrating pharmacy services into an MS multidisciplinary team can potentially increase the efficiency and quality of health care delivery. Clinical pharmacists, working with other providers, can optimize and accelerate access to medications requiring prior authorization, improve patient outcomes by promoting medication adherence and persistence, enhance safety by monitoring laboratory findings and potential drug-drug interactions, and minimize clinical workflow burden by improving process efficiency, which may be cost-effective for the MS health care delivery system.

OBJECTIVES/GOALS: An environmental scansoughtto understand research processes, areas for improvement, and opportunities for collaborative quality improvement (QI)across the Northwest Participant and Clinical Interactions Network (NW PCI). METHODS/STUDY POPULATION: NW PCI site champions were invited for semi-structured single and group Zoom-based interviews. Interviewers asked participants about local research processes, strengths and weaknesses, existing infrastructure to support QI, and interest in collaborative QI across the Network. Audio transcripts were coded using Dedoose and analyzed with deductive and inductive coding. RESULTS/ANTICIPATED RESULTS: Between February and April 2023, 10 interviews collected data from 7 research decision makers and 7 staff members across 7 sites. Most participants (n=13, 92%) agreed the diagram shown during the interview was representative of the local process. Organizations consistently identified strengths and weaknesses within the domains of study start-up, recruitment, budgets, and compliance. QI infrastructure was inconsistent (n=5, 36%) and all (n=14, 100%) saw potential for success in multisite QI initiatives to enhance efficiency. DISCUSSION/SIGNIFICANCE: NW PCI sites use similar processes, share common strengths and weaknesses, and universally reported interest in collaborating on QI. Study startup was reported as both a strength and weakness within the same organization, requiring unpacking of key elements before pursuing QI initiatives.

The ELEVATE study evaluated whether an educational workshop would improve the perceptions of shared decision-making of nurses in an organization as demonstrated by an increase in Index of Professional Nursing Governance (IPNG) score. Available literature insufficiently links educational interventions to improvements in shared professional governance. Six hundred ninety-one participants' IPNG scores were analyzed before and after an educational workshop was administered to formal administrative leaders and registered nurse (RN) RN council leaders every 6 months during a 2-year research study. Index of Professional Nursing Governance scores were higher for RNs participating in nursing councils than scores for those who did not. The organization's IPNG scores remained stable from 2019 to 2021. Secondary analysis may suggest that council members were more resilient during crisis. Further investigation is needed researching the relationship between professional governance education and RNs' perception of shared decision making.

Aspirin overdose is still a common cause of presentation to the emergency department and is commonly seen in the setting of one-time, accidental or intentional ingestion of large amounts of salicylate-containing compounds, though can occur with long-term ingestion of super-therapeutic doses of medications. Salicylate toxicity has a predictable progression from early respiratory alkalosis to late metabolic acidosis. We present the case of a 14-year-old girl who intentionally ingested a handful of Aspirin and despite appropriate therapy, developed transient proximal tubule dysfunction. This case highlights the need for a change in the short-term medical management of children presenting with salicylate toxicity.

Sturgeon and paddlefishes (Acipenseriformes) are cultured worldwide for commercial and conservation purposes. Over the past decade, we have learned many sturgeon culture programs experience spontaneous autopolyploidy, or the generation of triploidy without management intervention. Spontaneous autopolyploidy has been shown to negatively impact the physiology, reproductive development and fertility of sturgeon. Given these concerns, it is necessary to understand how it arises, how it affects production, and how it can be managed. The goal of this review is to describe the incidence of spontaneous autopolyploidy in sturgeon relative to other fishes, explain how spontaneous autopolyploids are formed, and report what is known about how triploidy and intermediate ploidy effect sturgeon reproductive development and physiology. We then describe four common methods for detecting spontaneous autopolyploids and their intermediate ploidy progeny and end with recommendations for reducing the incidence of spontaneous autopolyploidy based on the results of recent research. Although spontaneous autopolyploidy may never be completely eliminated from sturgeon culture, following these recommendations may significantly decrease its incidence.

A collaborative research model was developed and tested to enable regional healthcare systems to join multisite clinical trials emanating from the Clinical and Translational Science Award (CTSA) Trial Innovation Network (TIN) by the Institute of Translational Health Sciences at the University of Washington and the Northwest Participant and Clinical Interactions (NW PCI) Network. The NW PCI is a collaborative group of regional research programs located at medical centers, healthcare systems, and universities across Washington, Wyoming, Alaska, Montana, and Idaho. This article describes the purpose, development, barriers, and initial experience with feasibility assessment for TIN-supported studies in the NW PCI. The tools and processes of the NW PCI Network were adapted to enable network sites to assess studies for clinical relevance and feasibility. Seven of seventeen TIN-supported studies were reviewed for consideration; three of which resulted in successful completion of study documentation for site selection by NW PCI sites. The NW PCI/TIN model can be adapted by other CTSAs to increase involvement of regional research programs in national multisite clinical research studies. Barriers to expanding TIN-supported trials to regional networks include short timelines for study document submissions, insufficient site reimbursement rates, and non-feasible study designs.

Abstract Burbot (Lota lota: Gadidae) is a difficult species to manage effectively due to its preference for deep‐water habitats and under‐ice spawning behaviour, resulting in a poor understanding of its reproductive activity. However, the use of acoustic signalling by burbot as part of their mating system has recently been described and this behaviour may provide a means of investigating questions regarding the spatial and temporal distribution of spawning aggregations using passive acoustic monitoring.We used audio and video recording to confirm that burbot vocalise and that these vocalisations can be detected under field conditions as well as to characterise the relationship between burbot acoustic signalling and spawning behaviour. We also evaluated the feasibility of locating and monitoring burbot spawning aggregations in real time using passive acoustics.Burbot vocalisations were difficult to identify with only about 6% of the recordings containing calls being successfully identified as such in the field. Burbot vocalised more often between sundown and sunrise than during daylight hours. Calls recorded at night tended to be lower frequency, longer duration, and have lower bandwidth than those made during the day.Burbot vocalisations could not be recorded in conjunction with video recordings of spawning activity, indicating that burbot may not call during active spawning, but may use acoustic communication to signal the onset of reproductive readiness and to form pre‐spawning aggregations.While burbot calls were readily identifiable, observers had a difficult time identifying burbot calls in real time under field conditions. Passive acoustic monitoring demonstrates considerable potential as a management tool to locate burbot spawning grounds and identify periods of activity, but may not be an appropriate technique for monitoring spawning activity in real time.

Water guns have shown the potential to repel nuisance aquatic organisms. This study examines the effects of exposure to a 1966.4 cm3 seismic water gun array (two guns) on the abundance and behavior of Bighead Carp Hypophthalmichthys nobilis, Silver Carp H. molitrix (collectively referred to as bigheaded carp) and native fishes (e.g., Smallmouth Buffalo Ictiobus bubalus). Water guns were deployed in a channel that connects the Illinois River to backwater quarry pits that contained a large transient population of bigheaded carp. To evaluate the effect of water guns, mobile side-looking split-beam hydroacoustic surveys were conducted before, during and between replicated water gun firing periods. Water guns did not affect abundance of bigheaded carp, but abundance of native fish detected during the firing treatment was 43 and 34% lower than the control and water guns off treatments, respectively. The proximity of bigheaded carp to the water gun array was similar between the water guns on and water guns off treatments. In contrast, the closest detected native fish were detected farther from the water guns during the water guns on treatment (mean ± SE, 32.38 ± 3.32 m) than during the water guns off treatment (15.04 ± 1.59 m). The water gun array had a greater impact on native fish species than on bigheaded carp. Caution should be taken to the extrapolation of these results to other fish species and to fish exposed to water guns in different environments (e.g., reduced shoreline interaction) or exposure to a larger array of water guns, or for use of water guns for purposes other than a barrier.