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process (QA) could impact results of mpMRI directed fusion biopsies.
We report results of our QA process on biopsy rates, comparing them to
biopsy rates where MRI was done at centers not participating in QA.
METHODS: Performance of fusion biopsy is restricted to 5 of
our practice of 103 providers: 2098 patients were included in this study;
1294 and 804 for the QA and non-QA groups, respectively. Our QA
process requires urologists and interpreting radiologists to
sequentially cross-reference biopsy results to all MRI reads. Non-QA
patients attended sites not participating in QA due to insurance
reasons or patient personal preference. We assessed the positive
biopsy rates for PI-RADS 4 and 5 lesions (P4/5) as well as the
negative biopsy rates for Pi-RADS 3 lesions (P3). There was no
nancial relationship between IMP and any of the radiology centers.
RESULTS: Negative biopsy rates for P3 between groups was
not signicantly different in any year. Positive biopsy rates for P4/5 in
the QA group increased signicantly from 45.5% to 66.3% between
2014 and 2018, respectively (p[0.003) while non-QA group P4/5
positive biopsy rates over the same interval increased non-
signicantly from 36.4% to 53.2% (p[0.07). No difference in positive
or negative biopsy rates was noted between performing providers. By
the third year of the QA process read accuracy was signicantly
greater in the QA group (Table 1).
CONCLUSIONS: A standardized QA process signicantly im-
proves positive biopsy rates for P4/5 lesions over time, and should be
instituted by all groups performing MRI fusion biopsy.
Source of Funding: none
Tejash Shah*, Thaiphi Luu, Juhi Deolanker, Sri Ram Pentakota, Newark,
NJ; Hossein Sadeghi-Nejad, East Orange, NJ
INTRODUCTION AND OBJECTIVE: Priapism is a urologic
emergency with several risk factors, including use of antipsychotics
such as trazodone, and having a history of prolonged erections. There
are several reports of trazodone use leading to both prolonged erec-
tions and priapism, but patients are often not counseled on these well-
known side effects. We sought to evaluate whether patients were
appropriately counseled about trazodone complications regarding
prolonged erections and priapism prior to starting the medication, the
incidence of prolonged erections in those taking trazodone and the
rate of patient reported events of prolonged erection to their
prescribing physicians.
METHODS: A pharmacy search was performed at the East
Orange Veterans Affair Hospital (EOVA) to identify all patients <50 on
trazodone as of February 27, 2019. Patients previously on trazodone or
those who discontinued it prior to this date for any reason, including
priapism, were not included. Patients who agreed to participate were
asked about information provided to them prior to medication initiation,
occurrence of prolonged erections/priapism, and reporting rate to pre-
scribing physicians.
RESULTS: 229/524 male patients on trazodone at the EOVA
participated in the study, average age of 38.57 þ/- 6.88 years. Indica-
tion for trazodone was insomnia or depression and dose was 50mg e
100mg, 2 - 3 times a day. Prior to prescribing trazodone, only 43/229
(18.78%) of patients were informed about the risk of prolonged erec-
tions and only 37/229 (16.16%) patients were informed about the risk of
priapism. Before starting treatment only 17/229 (7.42%) of patients were
asked if they previously had any episodes of prolonged erection and/or
priapism. After starting trazodone therapy 18/229 (7.86%) of patients
developed prolonged erection, only 2/18 of them were informed about
the risk of prolonged erections prior to initiation of therapy. Only 5/18 of
those who developed prolonged erections told their physicians. None of
the patients actively taking trazodone had an episode of priapism.
CONCLUSIONS: Patients on trazodone are known to have an
increased risk of prolonged erections and priapism. However, as this
study shows prior to trazodone treatment only a fraction of patients were
properly screened for previous prolonged erections or priapism and
properly informed about the risks of trazadone treatment. It is imperative
that physicians appropriately screen patients prior to trazodone initia-
tion, educate patients about the risks of prolonged erections and pria-
pism and instruct patients to report any treatment side effects.
Source of Funding: None
Emefah Loccoh*, Tasha Posid, Columbus, OH
INTRODUCTION AND OBJECTIVE: Training and education
focused on improving cross-cultural competency for the purposes of
better addressing health needs of populations who have been
historically marginalized and underserved is uncommon and
understudied. Our objective was to assess baseline cross-cultural
knowledge and preparedness among medical trainees.
METHODS: Participants were current Ohio State medical stu-
dents (n[55), residents (n[31), and fellows (n[14), overall (N[100;
[27.5 years, SD[3.66 years), who assessed their perceptions of
their own cultural preparedness, competence (skills), and attitudes to-
wards providing cross-cultural care, and training in this area to date.
RESULTS: Trainees felt that it was very important to consider
other cultures when providing care (M[4.44/5; p<.001) and felt that
their skills interacting with patients from diverse cultural backgrounds
was slightly higher than average (M[3.23/5; p[.011). Trainees re-
ported that they felt somewhat prepared to care for culturally diverse
patients (M[3.29/5; p[.033) and ranked themselves slightly above-
average when communicating with patients from other cultures (M
[3.58/5; p<.001) (Figure 1). Trainees were generally not satised
with how much cross-cultural training was currently provided either
formally or informally (ps<.01), despite the fact that they felt a
signicant amount of cross-cultural training was needed in order to
succeed in their future career (ps<.02) (Figure 2).
CONCLUSIONS: Although trainees perceive their need for
cross-cultural training to be high, in actuality, they feel that their training
and education on this topic is inadequate. These results should be used
to identify areas where cross-cultural training and education can be
improved ensure that future physicians are equipped with the skills to
accurately care for individuals of various cultural backgrounds.
Vol. 203, No. 4S, Supplement, Sunday, May 17, 2020
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