Long Beach Medical Center

Abstract Disclosure: S. Yasmin: None. R. Ali: None. M. Zulqarnain: None. R. Noor: None. S. Cheema: None. S. Sahu: None. A. Dixit: None. S. Abdul Rehman Shah: None. S. Iftikhar: None. Introduction: The last several decades have seen an unprecedented increase in the incidence of obesity, affecting 40% of women and 35% of men in the United States (US). Considering 60-70% of obese patients have associated hyperlipidemia, both disorders entail a substantial healthcare burden. We aimed to determine trends and disparities of mortality rates of hyperlipidemia and obesity in the US from 1999-2020. Methods: We analyzed mortality trends for obesity and hyperlipidemia among adults aged 25+ using CDC WONDER data. Mortality rates were stratified by sex, region, race/ethnicity, states, place of death, and urbanization. We calculated crude mortality rates (CMR), age-adjusted mortality rates (AAMR), annual percent change (APC), and average annual percent change (AAPC), with statistical significance at p<0.05. Results: Obesity and hyperlipidemia accounted for 54089 fatalities throughout the study period. There was a significant sharp rise in the AAMR from 0.27 in 1999 to 0.59 in 2003 (APC: 22.04), followed by a significant steady rise to 1.39 in 2014 (APC: 8.53). From 2014 to 2018, the AAMR plateaued with a modest increase to 1.60 (APC: 1.83). Ultimately a significantly escalating upsurge was observed from 1.60 in 2018 to 2.48 in 2020 (APC:25.71) (AAPC: 11.19, 95% CI: 10.56 to 12.43, p<0.000001). This trend was similar across genders. Males (1.43) had higher AAMR than females (0.84), with a more pronounced increase in mortality rates after 2018, and an APC of 25.25. Overall, the age group 65-74 years revealed the highest CMR (3.08), followed by 75-84 years (2.85). Surprisingly, from 2018-2020, the age group 75-84 showed the highest mortality rates, with an APC of 26.07. When stratified by census regions, the Midwest region had the highest AAMR (1.28), followed by West (1.3), South (1.01), and Northeast (0.89). After 2018, the rise was observed across all regions but was particularly pronounced in the Northeast (APC:30.92). When stratified by race, Non-Hispanic (NH) American Indian had the highest AAMR (1.49), followed by NH Black (1.36), NH White (1.16), Hispanics (0.80) and lastly NH Asian (0.32). NH Black showed the steepest increase after 2018 (APC:32.37). Rural areas had higher AAMR (1.33) than urban (1.08), with a more pronounced rise in mortality observed in urban (AAPC: 11.14). The state of North Dakota had the highest AAMR of 2.82. Majority of deaths occurred at Decedent’s home (46.87%) Conclusion: Mortality has risen significantly over the past two decades, with a sharp surge after 2018. The disproportionately higher mortality rates among males, NH Blacks, the Northeast region, and urban areas underscore the need for targeted public health interventions. Further research is necessary to explore contributing factors and reduce mortality in these high-risk groups. Presentation: Sunday, July 13, 2025

ObjectiveEndotracheal intubation is a life-saving intervention for adults with acute respiratory failure (ARF) but may result in unplanned extubation (UE). The success of UE prevention efforts has varied. We describe the development, implementation and impact of an airway safety quality improvement programme (ASQIP) embedded in an existing ABCDEF (A–F) bundle on UE occurrence.DesignBefore-and-after evaluation of an ASQIP.Setting42-bed mixed intensive care unit (ICU) at a university-affiliated teaching hospital.PatientsConsecutive adult patients, endotracheally intubated for ARF.InterventionThe ASQIP, developed from a literature review, the results of a national clinician survey, local clinician focus group input and root cause analyses of prior UE events, included interprofessional rounding scripts and was embedded into an existing A–F bundle. Multiple implementation strategies were employed, including didactic education to all ICU nurses (registered nurse, RN) and respiratory care therapists (RTs), the daily posting of signs of the ASQIP on the doors of rooms with a patient deemed to be at high risk for UE, and daily reminders from managers to bedside RTs and RNs.MeasurementsASQIP implementation was effective and was associated with a significantly lower incidence of UE per 100 MV days (before 0.43 vs after 0.29; p=0.04).ConclusionsA multidisciplinary quality improvement initiative that incorporates airway safety within the A–F bundle may help reduce UE rates in critically ill adults. Future research is needed to validate standardised communication and assess the long-term sustainability of such interventions.

Throughout the COVID-19 global pandemic, hospital social workers simultaneously experienced trauma along with the rest of the world impacted by the pandemic, as well as treating others for trauma in their professional capacities. This qualitative study of hospital social workers (n = 27) documents their experiences. Using a reflexive thematic analysis method, four themes were created from our interview data: organizational scarcity, organizational failures, care responsibilities, and the challenges of virtual care. We discuss how these themes relate to a model of collective care seeking to relocate responsibility for employee well-being from the individual to the organization, promoting institutional accountability and an embedding of care as a shared priority.

Background: Quality-of-life (OQL) is recognized as a proven benefit of atrial fibrillation (AF) ablation. The DEEP trial (NCT02393885) showed safety (6.7%) and efficacy (71.8%) of an epicardial-endocardial hybrid ablation (HA) approach with left atrial appendage exclusion (LAAE) for non-paroxysmal AF; results were consistent with two randomized trials comparing HA+LAAE to catheter ablation (CA). Limited data exist on QOL after HA+LAAE. Goal: To evaluate QOL changes from baseline to 12-months post-HA+LAAE in the DEEP trial. Methods: DEEP is a 17-site prospective, international, single arm trial. Key eligibility: adults with non-paroxysmal AF, left atrial diameter ≤5.5cm, failed class I/III anti-arrhythmic drugs, and ≤2 prior failed CA. Stage 1 was thoracoscopic radiofrequency epicardial ablation to isolate the pulmonary veins and left atrial posterior wall, and LAAE. Stage 2 was endocardial mapping and touchup ablation. QOL was measured via the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 12-months post-HA+LAAE. AFEQT yields scores from 0 to 100 (0 as complete disability and 100 as no disability) and includes an overall and four subscale scores. A 5-point AFEQT change is clinically important. Mean differences with 95% CIs were calculated; p-values are from paired t-tests. Results: Of 85 patients, 82 completed both baseline and 12-month AFEQT. The mean change in overall score was 30.1 ± 19.8 (95% CI: 25.8-34.5; median 29.5, min, max: -15.4, 78.2; p<0.0001) (Figure). The greatest improvement was in the Treatment Satisfaction subscale with a mean score of 53.2 ± 29.9 (95% CI: 46.6-59.7; median 58.3, min, max: 0.0, 100.0; p<0.0001), followed by Treatment Concern, Daily Activities, and Symptoms subscale scores. All mean improvements from baseline exceeded a clinically meaningful 5-point change. Conclusion: In the DEEP trial, HA+LAAE resulted in patient-reported QOL improvements at 12-months post-procedure.

We developed and implemented a customized internal clinical informatics (CI) curriculum for the UC Irvine CI Fellowship program. The goal was to transition from an externally sourced curriculum to a more focused, internally developed program, aligning with feedback from early fellows and the evolving practical needs of clinical informatics. By designing this curriculum in-house, we sought to provide a more efficient, cost-effective, and relevant educational experience for fellows. The curriculum was designed over a one-year period, beginning in July 2021 and launched in July 2022. The development process involved collaboration among core clinical informatics faculty, organizing the content into 13 thematic blocks, each spanning four weeks. Each block included a mix of pre-recorded lectures for asynchronous learning and interactive sessions for applied, synchronous learning. The curriculum was designed to cycle twice over the course of the two-year fellowship, with second-year fellows taking on greater teaching responsibilities to solidify their knowledge. Feedback was gathered from graduating fellows and used to iteratively refine the content and structure. Feedback from fellows during the first year of implementation was overwhelmingly positive, with evaluations indicating high satisfaction regarding the relevance, focus, and practical application of the content. Quantitative and qualitative feedback suggested that fellows found the internal curriculum more aligned with their learning goals compared to the prior external curriculum. Modifications were made based on fellow input to adjust the number and structure of interactive sessions, ensuring high-yield learning. This case study highlights the successful development and implementation of a customized clinical informatics curriculum at UC Irvine. The curriculum offers a more tailored, responsive, and comprehensive educational model, addressing both financial constraints and the need for a practical, focused learning experience. This initiative provides valuable insights and a potential framework for other institutions seeking to transition to an internal informatics curriculum.

The sodium-dependent multivitamin transporter encoded by SLC5A6 is responsible for uptake of biotin, pantothenic acid, and α-lipoic acid. Thirteen individuals from eight families are reported with pathogenic biallelic SLC5A6 variants. Phenotype ranges from multisystem metabolic disorder to childhood-onset peripheral motor neuropathy. We report three additional affected individuals with biallelic SLC5A6 variants. In Family A, a male proband (AII:1) presenting in early childhood with gross motor regression, motor axonal neuropathy, recurrent cytopenia and infections, and failure to thrive was diagnosed at 12 years of age via genome sequencing (GS) with a paternal NM_021095.4:c.393+2T>C variant and a maternal c.1285A>G p.(Ser429Gly) variant. An uncle with recurrent cytopenia and peripheral neuropathy was subsequently found to have the same genotype. We also report an unrelated female with peripheral neuropathy homozygous for the c.1285A>G p.(Ser429Gly) recurrent variant identified in seven reported cases, including this study. RT-PCR studies on blood mRNA from AII:1 showed c.393+2T>C caused mis-splicing with all canonically spliced transcripts in AII:1 containing the c.1285A>G variant. SLC5A6 mRNA expression in AII:1 fibroblasts was ~50% of control levels, indicative of nonsense-mediated decay of mis-spliced transcripts. Biotin uptake studies on AII:1 fibroblasts, expressing the p.(Ser429Gly) variant, showed an ~90% reduction in uptake compared to controls. Targeted treatment of AII:1 with biotin, pantothenic acid, and lipoic acid resulted in clinical improvement. Health Economic analyses showed implementation of GS as an early investigation could have saved $ AUD 105,988 and shortened diagnostic odyssey and initiation of treatment by up to 7 years.

BackgroundIt has not been clearly established if skin cancer or melanoma are manifestations of BRCA1 or BRCA2 mutation carrier status. Estimating the risk of skin cancer is an important step towards developing screening recommendations.MethodsWe report the findings of a prospective cohort study of 6,207 women from North America who carry BRCA1 or BRCA2 mutations. Women were followed from the date of baseline questionnaire to the diagnosis of skin cancer, to age 80 years, death from any cause, or the date of last follow-up.ResultsDuring the mean follow-up period of eight years, 3.7% of women with a BRCA1 mutation (133 of 3,623) and 3.8% of women with a BRCA2 mutation (99 of 2,584) reported a diagnosis of skin cancer (including both keratinocyte carcinomas and melanoma). The cumulative risk of all types of skin cancer from age 20 to 80 years was 14.1% for BRCA1 carriers and 10.7% for BRCA2 carriers. The cumulative risk of melanoma was 2.5% for BRCA1 carriers and 2.3% for BRCA2 carriers, compared to 1.5% for women in the general population in the United States. The strongest risk factor for skin cancer was a prior diagnosis of skin cancer.ConclusionThe risk of non-melanoma skin cancer in women who carry a mutation in BRCA1 or BRCA2 is similar to that of non-carrier women. The risk of melanoma appears to be slightly elevated. We suggest that a referral to a dermatologist or primary care provider for BRCA mutation carriers for annual skin examination and counselling regarding limiting UV exposure, the use of sunscreen and recognizing the early signs of melanoma might be warranted, but further studies are necessary.