St. John Fisher College

Progressive fibrosing interstitial lung disease is characterized by continuous functional decline and early mortality despite conventional immunosuppressive therapy. The dual pathophysiology involves both inflam-mation and fibrosis and provides rationale for combination antifibrotic and immunosuppressive therapy. To review and synthesize current clinical evidence on the efficacy, safety, and clinical positioning of combination antifibrotic and immunosuppressive therapy in progressive fibrosing interstitial lung disease. We conducted a comprehensive literature review of randomized controlled trials, observational studies, and real-world cohorts published between 2015 and 2025 that evaluated combined antifibrotic (nintedanib or pirfe-nidone) and immunosuppressive therapy in adults with non-IPF progressive fibrosing ILD. We synthesized evidence from randomized controlled trials, observational studies, and real-world data regarding their methodolo-gies, patient population, therapies and outcomes. Forty-one studies were identified, including 14 RCTs and 12 observational cohorts. The available evidence suggests that combination therapy demonstrates promising results across various PF-ILDs. Clinical trials and real-world data have shown improved lung function and forced vital capacity with combination therapy in PF-ILD. Evi-dence supports combination therapy to be well-tolerated, with manageable safety and tolerability profile consistent with individual agents rather than additive effects. Limitations of the available evidence include heterogeneity of PF-ILD populations, variable background immunosuppression, and limited long-term outcome data. Combination antifibrotic and immunosuppressive therapy shows meaningful efficacy in select PF-ILD patients. Evidence supports individualized combination approaches, particularly for progressive systemic sclerosis-ILD and connective tissue disease-ILD with nonspecific interstitial pneumonia pattern. Critical evidence gaps remain regarding optimal sequencing, patient selection, and long-term outcomes, requiring future investigation.

The Longevity Games Interview Simulator provides an innovative approach to preparing students for real-world research interactions by leveraging the capabilities of large language models (LLMs) like OpenAI's GPT-4o and Claude-3.7. This paper outlines the development and demonstrates the benefits of the simulator, designed to mimic interviews with older adults to enhance students' interviewing skills, empathy, and cultural competence. Key outcomes included preparing students for real-world interactions with interview subjects, improving their ability to identify and properly document protected health information (PHI), gaining experience in asking relevant follow-up questions, and directing conversations to achieve interview goals. The simulator used generative AI models to create realistic interview scenarios based on demographic data from Rochester, NY. Components of the simulator included a student interview-question selection and creation portion, an interview-guide worksheet, a post-simulation quiz on the materials, and a reflective exercise focusing on information gathering and ethical considerations regarding PHI. This tool was designed for the Science of Aging course's CURE (Course-Based Undergraduate Research Experience) to provide students with practical, repeatable interview practice. A small pilot study with senior nursing students indicated that the simulator improved students' confidence, preparedness, and understanding of ethical considerations. This paper also discusses how the simulator has potential for adaptation across educational contexts and encourages educators to develop their own custom interview simulations.

BackgroundPatient portals demonstrate significant potential for improving health care engagement but face critical adoption challenges. Disparities persist across different demographic groups, creating a digital divide in health care access. Targeted training strategies, particularly personalized and one-on-one approaches, show promise in increasing portal utilization. Innovative solutions, like community health workers specializing in digital navigation, offer a potential pathway to reduce enrollment barriers. The key challenge remains developing a scalable, cost-effective training model.ObjectiveOur quality improvement (QI) project aimed to assess the feasibility and effectiveness of a collaborative effort between a free community-based digital navigation program and an urgent care clinic in facilitating patient access to their portal.MethodsWe created the Digital Health Equity Navigation Training (DHENT) program to improve patient portal access and usage. The program used a train-the-trainer model to scale up patient portal training across the community. DHENT trainers partnered with urgent care physicians to enroll patients in the portal. Physicians briefly explained portal benefits and referred interested patients for DHENT assistance. Trainers then contacted patients by phone to help with enrollment and navigation. We employed 3 Plan-Do-Study-Act cycles to understand the feasibility of the collaboration. We used descriptive statistics to describe participant characteristics and referral processes.ResultsThe collaboration was marginally successful, exceeding referral targets by 27.7% (115/90). Most patients were under 60 years old (94/115, 81.7%) and White (78/115, 67.8%). There was a significant delay in contact, averaging 37 days. While 4.8% (5/104) of patients accessed the portal with DHENT trainer assistance, 9.6% (10/104) had already signed up independently after their urgent care visit.ConclusionsOverall, we found our partnership had a moderate impact, and only a low dose of intervention and resources were needed.

Abstract Background Limited data are available to describe a pharmacist-driven Gram-negative bacteremia (GNB) protocol on treatment optimization and outcomes. The primary outcome was a composite of the percentage of patients on a pharmacist-driven antibiotic protocol. Secondary outcomes evaluated 30-day all-cause mortality and infection-related readmission. Methods This was a single-center, quasi-experimental study conducted in a 451-bed community teaching hospital. The pre- and post-intervention cohorts included patients from 8/1/22-9/30/23 and 10/1/23-4/31/24, respectively. Patients aged >18 years with GNB were included. Patients who are immunocompromised, had a non-functional gastrointestinal tract, were enrolled in hospice, expired during hospitalization, pregnant, left against medical advice, had a polymicrobial infection, bacteria resistant to all PO agents, inadequate source control, or those with infectious disease consultations were excluded. For the intervention, a pharmacist-driven GNB protocol was developed to include the definition of uncomplicated GNB, clinical improvement criteria, ranked order of preferred PO antibiotics with appropriate dosing and duration of therapy. These recommendations were communicated to providers by pharmacists. The Chi-square test and student t-test were used for nominal and continuous data, respectively. A p-value of < 0.05 was considered statistically significant. Results There were 61 and 41 patients in the pre- and post-intervention cohorts, respectively. Demographics were similar. The primary outcome was achieved in 59% and 81% of patients, respectively (p=0.02). Urinary source was most common, including 75% in the pre and 85% in the post-intervention group (p=0.22). Trimethoprim-sulfamethoxazole use increased from 6% to 29% (p=0.002). No difference in 30-day all-cause (p=0.51) and infection related readmission (p=0.82) was identified. Conclusion Implementation of a proactive pharmacy-led GNB protocol increased the use of appropriate PO transition regimens in uncomplicated GNB. Disclosures All Authors: No reported disclosures

ABSTRACTThe killing of cousins and siblings‐in‐law has been examined as part of ‘relative killings’ in prior research. However, they have not been disaggregated and examined in their own right. A content analysis of a major Korean newspaper (Chosun Ilbo) and sentencing verdicts from regional trial courts of original jurisdiction in Korea was conducted. This paper examines the offence characteristics in cousin and siblings‐in‐law killings. Cousin and siblings‐in‐law killings made up 4% of 682 family homicides. The victims and offenders were primarily men who used edged weapons to kill one another during the course of arguments. Women appeared as offenders and victims in the early period (1948–1962) while they appeared primarily as victims in the latter period (2013–2023). The data suggest a shift in the age structure of victims and putative motivations across time. The average age of victims and offenders increased by 20 years; the character of violence also shifted from confrontational homicides to killings in the context of domestic disputes between relatives' spouses.