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Purpose: As the most common cause of skin cancer death, incidence and mortality of melanoma vary widely between ethnic and racial groups. Methods: Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence and survival in patients with melanoma concerning race and ethnicity in Wayne County, Michigan between 2000 and 2016. Results: Analysis of data revealed significantly higher melanoma-specific death in non-Hispanic black patients compared to their non-Hispanic white counterparts (p <0.001). However, no increased risk of death due to melanoma was observed following adjustment of data for the stage, age, and sex (H.R. = 1.00, 95% CI 0.64-1.56). Conclusion: Non-Hispanic black patients have the highest percentage of late-stage melanoma. Increased incidence of melanoma mortality in non-Hispanic black patients is likely a consequence of late-stage diagnosis.

Objective: The primary aim of this study was to test the feasibility of non-invasive cerebral perfusion monitoring post-arrest. We secondarily tested the association between measured autoregulation, the presence of cerebral edema, and neurological recovery. Methods: This was a prospective, pilot study inclusive of patients successfully resuscitated from cardiac arrest in the Emergency Department (ED). After return of spontaneous circulation, an investigator placed non-invasive, bifrontal monitoring to measure cerebral perfusion. The device uses an acousto-optic sensor to measure continuous cerebral perfusion and measurements are arbitrary units between 0-100, where 0 represents no flow (Ornim, Tel Aviv). Subjects had invasive, continuous arterial monitoring to assess mean arterial pressure (MAP). Multimodal measurements continued for 60 minutes. We calculated a Pearson coefficient between the perfusion measurements and MAP as an assessment of cerebral autoregulation, where a correlation coefficient > 0.3 indicates poor autoregulation, and a coefficient of 1 indicates completely passive cerebral perfusion to changes in MAP. Head computed tomography defined the presence of cerebral edema in the ED. Results: We enrolled 14 patients post-arrest with sustained return of circulation. The mean age was 55 ± 14 years, 7 were female, and 10 were African American. Six patients had pulseless electrical activity, 5 asystole, and 2 ventricular fibrillation. Bystander CPR rates were low (4 of 14, 31%). Two patients (14%) survived to hospital discharge. Cerebral perfusion was comparable between patients that survived and those that died (difference 3.1, 95% CI -14 to 8). Cerebral perfusion measurement was higher in patients with cerebral edema (difference 6.1, 95% CI 0.2 - 11.9). Autoregulation was worse in the presence of edema (0.30) compared to no edema (0.14), though this difference did not reach statistical significance (95% CI -0.7 to 0.4). Conclusions: In a pilot study, non-invasive post-arrest perfusion measurements plus coupling with MAP for autoregulation was feasible. Perfusion measurements were increased in the presence of cerebral edema but whether such measurements have prognostic value requires further study.

Obesity is a prime example of a non-contagious condition that has reached pandemic proportions. Efforts by the World Health Organization to establish standards of care for this population have not met with universal acceptance. Female obesity during the reproductive years has been consistently reported in association with adverse events, both for the mother and the fetus with short-and long-term health effects on both, including and not limited to cardiac disease, obesity and early death. The effects of obesity are seen early in the reproductive period and are a continuum during prenatal care and delivery. Extreme maternal obesity is consistently reported in association with dysfunctional labor and increased risk for cesarean delivery and certain complications like post-partum hemorrhage and surgical site infection. We report a contemporaneous analysis of a limited cohort of nulliparous, extremely obese women with body mass index (BMI) ≥50 K/m², delivering at term (≥37 weeks gestation), carrying a single live normal fetus in vertex presentation (NTSV). These patients have been cared for by a limited number of board-certified obstetrical providers, in one institution. These patients were selected because they are considered candidates for an effort at safely reducing the cesarean rate. The results observed indicate a higher incidence of induction of labor, followed by failed induction of labor and delivery by cesarean compared with extant literature in the non-obese population. These results may represent a local practice that may not be generalizable to other geographic practice locations or a true decreased ability to reduce cesarean delivery in extremely obese pregnant women that merits additional considerations. We encourage multi-institutional well conducted studies to determine if this population should be differentially considered as NTSV-XTO and reported as a separate group.

Background Hospital-acquired catheter-associated urinary tract infection (CAUTI) was estimated to cause 19,700 cases in 2020 across the United States per the Centers for Disease Control and Prevention (CDC). While this is a 25% decrease in reported incidence rates since 2015, ad-hoc changes in care practices and limitations of surveillance definitions brought on by the giant burden of COVID-19 on the healthcare system possibly resulted in underreporting of CAUTIs. In a 290-bed tertiary, community hospital in the Detroit metropolitan area, there was a 200% increase CAUTIs from 2020 (5 CAUTIs) to 2021(16 CAUTIs). A multidisciplinary, resident-led team was assembled to reduce hospital-acquired CAUTIs. Methods A multi-pronged quality improvement initiative was conducted from January 1, 2021, through March 31, 2022. CAUTIs were identified and reviewed via electronic health records using predefined criteria related to CDC surveillance definitions, urinary catheter insertion indications, laboratory data, and antibiotic use. Plan-Do-Study-Act (PDSA) Cycle model was used to guide the initiative. Thus far one PDSA cycle has been completed. The initial intervention bundle was designed by the multidisciplinary team and led by internal medicine and transitional year residents. The intervention bundle included 1. Provider (including physician and RN) education, 2. Design and implementation of an appropriate urinary catheter practice algorithm, and 3. Expert review of positive urine cultures and CAUTI cases. Results Baseline data collected from January to December 2021 showed 16 CAUTIs. Post-implementation of the intervention bundle from January to March 2022 resulted in a 75% reduction in CAUTI incidence (1 CAUTI flagged). Conclusion A targeted intervention bundle improved CAUTI incidence by reducing inappropriate urinary catheter insertion and prolonged removal. Ongoing local initiatives focused on hospital-acquired infections, such as this one, are paramount to the persistent optimization of infection prevention despite national trends. Disclosures All Authors: No reported disclosures.

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Background: Teledermatology became a necessary modality for dermatologic patient care during the COVID-19 pandemic. Due to disparities in access to technology, “The Digital Divide” refers to worsening health care disparities despite telemedicine’s best efforts to improve access. Methods: Retrospective chart review was performed of all patients who were scheduled to be seen in dermatology during the first wave of pandemic (March 27, 2020 to April 27, 2020). Demographic characteristics of patients who pursued virtual visits was compared with those who did not. Results: Compared to patients who canceled office visits, patients who completed virtual visit appointments were more likely to be younger (mean age 37.8 versus 45.5 years), female (68.7% versus 62.9%, p=0.01), unmarried (68.7% versus 61.0%, p<0.01). Of the diagnoses rendered during virtual visits, 53.3% were associated with dermatoses. Conclusions: Patient populations above the age of 65 were less likely to complete a video visit, regardless of socioeconomic factors. Future policies must take marginalized populations into account to improve ease of access to technological services.