Protecting workers in the temporary staffing industry

BACKGROUND

Workers hired through temporary staffing companies have a high rate of severe and fatal injuries despite the legally mandated, shared responsibility of the temporary staffing company and the host company to assure safe work.

AIMS

The aim of this study was to elucidate the perspective of temporary staffing personnel on approaches to mitigating injury risk among the workers they hire.

METHODS

Based on a conceptual model representing the interplay between work and health, we conducted a 'brainstorm' of temporary staffing personnel regarding perceived barriers to protecting temporary workers. A content/context analysis used standard qualitative methods, and the findings were triangulated with notes taken during the discussion.

RESULTS

Temporary staffing employers describe loss of control of the working conditions once workers are placed at host/client companies. Further, they describe a contentious relationship between temporary staffing and host companies, where it is difficult to hold host companies to account. Other barriers to providing temporary workers with a safe work environment include the temp companies' lack of knowledge of site-specific hazards, the poor quality of onsite Occupational Safety and Health training, and ignoring Occupational Safety and Health Administration (OSHA) requirements.

CONCLUSIONS

The perspective of temporary staffing companies should be considered to address the lack of cooperation and shifted responsibility described in this study. Policy and practice changes could include requiring contract language, implementing communication about safety, either sharing workers' compensation purchase or removing exclusive remedy protections from hosts, and prescribing safety training, such as an OSHA 10-h programme. Suggested interventions need further study.

Core needle biopsy causing a pseudoaneurysm in the breast

Core needle biopsy (CNB) is the first-choice method of sampling suspicious, focal breast lesions for histological analysis. Here we present the case of a 65-year-old woman who was recalled for evaluation of the left breast following a screening mammogram. An ultrasound-guided biopsy was performed using a disposable core biopsy needle and 3 weeks later a magnetic resonance imaging scan showed a distended vessel with adjacent sac measuring 17 × 15mm². A Doppler ultrasound scan confirmed pseudoaneurysm. A review of the literature was made on breast pseudoaneurysm following CNB, and over the past 20 years there were few other reports. Pseudoaneurysms in the breast are a rare but serious complication of CNBs. They may spontaneously thrombose, but often require intervention, so it is essential that clinicians are aware of the risk.

1136 Cochlear Implant Outcomes in Patients with Otosclerosis: A Systematic Review

Introduction

In otosclerosis, spongiotic bone replaces normal bone in the ossicular chain. Focal deposits may also be found within the cochlea leading to sensorineural hearing loss refractory to conventional treatment. Cochlear implantation can play an important role in the management of otosclerosis in these patients. Our study objective is to establish hearing outcomes following cochlear implantation in patients with otosclerosis.

Method

Systematic review and narrative synthesis. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement.

Results

Searches identified 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. Significant heterogeneity existed in terms of outcomes and methods of reporting, which precluded a meta-analysis. Access to good rehabilitation support is essential to achieving the good hearing outcomes and Patient Reported Outcome Measures that can be expected by 12 months post-implantation in most cases. There was significant association between the radiological severity of otosclerosis and an increase in surgical and post-operative complications. Post-operative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.

Conclusions

Hearing outcomes are typically good, but patients should be counselled on associated surgical complications which may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counselling.

Artificial intelligence-guided image acquisition on patients with implanted electrophysiological devices: results from a pivotal prospective multi-center clinical trial

Background

A novel, recently FDA-authorized software uses deep learning (DL) to provide prescriptive transthoracic echocardiography (TTE) guidance, allowing novices to acquire standard TTE views. The DL model was trained by >5,000,000 observations of the impact of probe motion on image orientation/quality. This study evaluated whether novice-acquired TTE images guided by this software were of diagnostic quality in patients with and without implanted electrophysiological (EP) devices, focusing on RV size and function, which were thought to be sensitive to EP devices. Some aspects of the study have previously been presented.

Methods

240 patients (61±16 years old, 58% male, 33% BMI >30 kg/m2, 91% with cardiac pathology) were recruited. 8 nurses without echo experience each acquired 10 view TTEs in 30 patients guided by the software. 235 of the patients were also scanned by a trained sonographer without assistance from the software. 5 Level 3 echocardiographers independently assessed the diagnostic quality of the TTEs acquired by the nurses and sonographers to evaluate the effect of EP devices on DL software performance.

Results

Nurses using the AI-guided acquisition software acquired TTEs of sufficient quality to make qualitative assessments of right ventricular (RV) size and function in greater than 80% of cases for patients with and without implanted EP devices (Table). There was no significant difference between nurse- and sonographer-acquired scans.

Conclusion

These results indicate that new DL software can guide novices to obtain TTEs that enable qualitative assessment of RV size even in the presence of implanted EP devices. The results of the comparison to sonographer-acquired exams indicate the software performance is robust to presence of pacemaker/ICD leads visible in the images (Figure).

Nurse-acquired TTE with visible ICD lead

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Caption Health, Inc.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

547 Point-of-care cardiac assessment using machine learning to guide image acquisition

Funding Acknowledgements

Bay Labs, Inc; San Francisco, CA

Background/Introduction: When used by experienced examiners, the utility of point-of-care (POC) ultrasound for assessing cardiac anatomy and function has been well established. However, in some clinical circumstances (Primary Care offices, Intensive Care Unit, some Emergency Rooms, or in remote settings) in which a rapid assessment of cardiac anatomy and dynamics can facilitate patient care, an examiner experienced at POC scanning may not be immediately available.

Purpose

To help novice users acquire clinically useful standard cardiac views using novel machine learning (ML) software.

Methods

We used an investigational device that employs ML software to provide real-time adaptive guidance of transducer position and orientation to help novice users acquire tomographic views of the heart. We tested the utility of this approach when 4 nurses with no prior training in sonography performed POC studies on 16 subjects (10 healthy, 6 with cardiac abnormalities; 9 men; body mass index normal in 6, overweight in 6, and obese in 4 subjects). Each nurse underwent didactic training and 4 hours of supervised practice using the ML program. Each nurse scanned each study subject using a scanner equipped with ML software to acquire 10 digital two-dimensional image clips, including: parasternal long axis, short axis at the aortic valve, mitral valve, and mid-left ventricle (LV), apical 2-, 4-, and 5-chamber, subcostal 4-chamber, and longitudinal views of the inferior vena cava (IVC). All video clips (n = 640) were later reviewed independently by 5 level 3-trained cardiologists who were blinded to subject, scanner, and each other"s assessments. The expert readers reviewed each set of 10 clips to determine if the following variables could be assessed qualitatively: LV size and function; right ventricular (RV) size and function; aortic, mitral and tricuspid valves; pericardial effusion; left atrial size; IVC size.

Results

The majority of expert readers concurred, independently, that the sets of images acquired by nurses using ML guidance allowed qualitative assessment of LV size and function in 98%, pericardial effusion in 98%, RV size and function in 92%, and aortic and mitral valve anatomy and dynamics in 94-97% of cases. Qualitative assessment of LA size was feasible in 95%. Images of the IVC were judged as adequate for assessment in 58%.

Conclusion

This preliminary study suggests the potential value of novel ML software by demonstrating that nurses with limited training can acquire tomographic images useful for qualitative assessment of the cardiac chambers and valves in more than 90% of the subjects examined. This approach might be useful when timely POC cardiac assessment is indicated in settings where an experienced examiner is not available. Further refinements in the guiding software are needed to improve the success rate of IVC imaging, since IVC size can be a useful indicator of volume status.

Abstract P5-11-10: Biomarkers associated with resistance or response to CDK4/6 treatment in patients with metastatic hormone-receptive positive breast cancer

Background:

CDK4/6 inhibitor (CDKi) drugs are the current standard of care for treatment of first and second-line hormone-receptor positive/HER2 negative (HR+/HER2-) metastatic breast cancers. Numerous research efforts have commenced to understand biomarkers of response and resistance. To date, no biomarker of response has been identified. Treatment induced RB1 mutations were noted as mechanism of resistance to palbociclib and fulvestrant in about 5% of patients treated on PALOMA3 trials, whereas PI3K and ESR1 mutations emerged as potential resistance to the anti-hormonal backbone1. Additionally, FGFR1 amplification has been suggested as a resistance pathway to fulvestrant and ribociclib2. A better understanding of the molecular landscape of CDK4/6 treatment is needed. Utilizing next-gen sequencing (NGS), chromogenic in situ hybridization (CISH) and immunohistochemistry (IHC) data from HR+/HER2- patients treated at the University of Tennessee West Cancer Center, we attempted to retrospectively identify a molecular signature of resistance or response as measured by PFS.

Methods:

We analyzed 115 breast cancer patients who received CDKi treatment and 30 matched controls not exposed to CDKi and underwent comprehensive molecular profiling (Caris Life Sciences, Phoenix, AZ). A Cox proportional hazards model was built using genetic test as predictors and progression free survival (PFS) time as response. Only alterations with known pathogenic potential were considered aberrant. The R package glmnet was used to perform regularized lasso regression for feature selection on the entire data set. Important features were then used to construct Kaplan-Meier curves and perform a log-rank test for difference in PFS times.

Results:

Here we report the analysis for 2 known pathogenic biomarkers, ESR1 and TP53 based on PFS for patients who test positive versus negative. The median PFS for all patients was 234 days. Patients who harbored ESR1 mutations had reduced PFS of 180 days compared to 237 days. Patients who had P53 mutations had shorter PFS of 201 days compared to 240 days. When both groups with positive mutations were combined, the median PFS was 191 days compared to 276 days for patients without either ESR1 or P53 mutation with a p-value of 0.011. Further analysis using 4 way Kaplan Meier Curves for controls versus treated, altered versus non-altered genes, or PDL-1 expression is ongoing and will be presented at the conference.

Conclusion:

This data further support, in a real world model, the poor predictive value of ESR1 and P53 mutations on clinical outcome. Because no testing data was used, additional validation will be necessary to confirm the findings from this analysis.

References:

1. Nicholas C. Turner, Ben O'Leary, Ros Cutts, Massimo Cristofanilliet al, Genetic landscape of resistance to CDK4/6 inhibition in circulating tumor DNA (ctDNA) analysis of the PALOMA3 trial of palbociclib and fulvestrant versus placebo and fulvestrant. J Clin Oncol 36, 2018 (suppl; abstr 1001).

2. Luigi Formisano, Yao Lu, Carlos Arteaga et al. Gain of function kinase library identifies FGFR1 amplification as a mechanism of resistance to antiestrogen and CDK4/6 inhibitor in ER+ breast cancer. SABCS 2017 abstract GS6-05.

Citation Format: Mullins JN, Chaudhry A, Ryder J, Valasareddy P, Jain A, Ranganath H, Hare F, Vidal GA. Biomarkers associated with resistance or response to CDK4/6 treatment in patients with metastatic hormone-receptive positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-11-10.

Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

BACKGROUND AND PURPOSE

Despite the importance of the sympathetic nervous system in homeostasis and its putative role in various disease states, little is known regarding our ability to image the sympathetic chain and sympathetic chain ganglia, perhaps owing to their small size. In this retrospective study, we sought to evaluate the normal anatomy of the sympathetic chain ganglia and assess the detectability of the sympathetic chain and sympathetic chain ganglia on high-resolution 3D-CISS images.

MATERIALS AND METHODS

This study included 29 patients who underwent 3D-CISS MR imaging of the thoracic spine for reasons unrelated to abnormalities of the sympathetic nervous system. Patients with a prior spinal operation or visible spinal pathology were excluded. The sympathetic chain ganglia were evaluated using noncontrast 3D-CISS MR imaging. Statistical analyses included t tests and measures of central tendency. The Cohen κ statistic was calculated to evaluate interrater reliability.

RESULTS

The stellate ganglion and thoracic chain ganglia were identified in all subjects except at the T10-T11 and T11-T12 levels. The stellate ganglion was found inferomedial to the subclavian artery and anterior and inferior to the transverse process of C7 in all subjects. Thoracic sympathetic chain ganglia were identified ventral to the costovertebral junction in all subjects from T2 to T10. There was strong interobserver agreement for the detection of the sympathetic chain ganglia with κ > 0.80. The size, shape, and location of these structures corresponded with gross anatomic and surgical observations.

CONCLUSIONS

The thoracic sympathetic chain ganglia can be identified on precontrast 3D-CISS MR imaging. This technique may aid in the initial evaluation of stellate ganglion and/or sympathetic chain ganglia size and signal change for comparison in future studies.