C-31 A Meta-analysis Examining Fluency Measures in Depressed Elderly

Objective

Late-life depression (LLD) has been associated with cognitive impairments in domains such as memory, processing speed, and executive functions (e.g., initiation). However, it is unclear whether or not LLD is associated with language fluency difficulties that are often seen in some forms of dementia. Broadly, letter fluency is often observed to be associated with frontal deficits while category fluency is thought to be linked to temporal lobe dysfunction. Both tests are commonly used to assess language in older adults. The current meta-analysis examined potential differences between letter and category fluency in LLD and the robustness of previous findings in this population.

Data Selection

Investigators searched eight databases including PubMed and PsycINFO using terms such as “neuropsychol*,” “late-life,” and “depression.” Studies were excluded if participants were diagnosed with severe mental illness, neurological or other medical conditions that impact neurocognition.

Data Synthesis

Independent coders extracted data from 27 studies (k = 10 letter fluency, k = 17 semantic fluency). The effect size for semantic fluency was g = 0.64 (p < 0.001) with significant heterogeneity I² = 73.53% (Q = 60.45, df = 16, p < 0.001). The effect size for letter fluency was g = 0.49 (p < 0.001) also with significant heterogeneity I² = 52.08% (Q = 18.78, df = 9, p < 0.027).

Conclusions

Depressed individuals exhibited poorer performance on both category and letter fluency when compared to controls. This may indicate that depressed elderly individuals have difficulty with initiating verbal responses regardless of whether these responses rely on semantic networks or executive control.

A-25 Paced Auditory Serial Addition Test in Individuals with Cocaine Versus Methamphetamine Dependence

Objective

Research suggests that cocaine and methamphetamine differ in their impact on executive functions (EF). The Paced Auditory Serial Addition Test (PASAT) is used to assess working memory; a component of EF. The purpose of this meta-analysis was to examine the difference between the effect of these two drugs on PASAT scores.

Data Selection

Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared cocaine or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than cocaine or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Six articles were coded and analyzed for the current study.

Data Synthesis

Cocaine studies showed a medium statistically significant effect size (g = 0.370, p = 0.020), while methamphetamine did not (g = 0.198, p = 0.172). There was no heterogeneity in effect sizes for both drugs. Subgroup analysis found no significant difference between the two drugs on the PASAT (Q-between = 0.646, p = 0.421).

Conclusions

In contrast to methamphetamine, cocaine is associated with poorer performance on PASAT. This is in line with previous studies that found that cocaine had more significant impact on EF than methamphetamine. Given the preliminary nature of this meta-analysis and the small number of studies on the topic, future primary studies should directly contrast how these two drugs impact EF.

A-17 Category Test performance in individuals with alcohol versus methamphetamine dependence

Objective

The Category Test (CT) has consistently been found to be sensitive at detecting the effects of alcohol on the brain. However, this test has not been as widely used in examining the effects of methamphetamine. The current meta-analysis compared effect sizes of studies that have examined performance on the CT in alcohol versus methamphetamine dependent participants.

Data selection

Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared alcohol or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than alcohol or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Sixteen articles were coded and analyzed for the current study.

Data synthesis

Alcohol studies showed a large effect size (g = 0.745, p < 0.001) while methamphetamine studies evidenced a moderate effect size (g = 0.406, p = 0.001); both without statistically significant heterogeneity (I2 = 0). Subgroup analysis revealed a statistically significant difference between the effect sizes from alcohol versus methamphetamine studies (Q-between = 5.647, p = 0.017).

Conclusions

The CT is sensitive to the effects of both alcohol and methamphetamine and should be considered when examining dependent patients who might exhibit problem solving, concept formation, and set loss difficulties in everyday living.

Evaluation of a health trainer–led service for people with knee, hip and back pain

Aims:

Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer—led ‘joint pain advice’ (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain.

Methods:

Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people’s opinions of the service’s effectiveness, acceptability and usefulness.

Results:

Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions.

Conclusions:

Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.

Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

BACKGROUND

Nivolumab with ipilimumab (the Regimen) is the first immuno-oncology combination treatment to demonstrate long-term clinical benefit for advanced melanoma patients. We evaluated the cost effectiveness of the Regimen in this population, with and without the availability of overall survival (OS) data.

METHODS

A partitioned survival model and a Markov state-transition model were developed to estimate the lifetime costs and benefits of the Regimen versus ipilimumab. These models were built with and without the availability of OS data, as only progression-free survival data were available from the head-to-head, phase III trial against ipilimumab at the time of the National Institute for Health and Care Excellence (NICE) submission. Patient utilities and resource use data were sourced from trial data or the literature.

RESULTS

Incremental cost-effectiveness ratios (ICERs) and absolute costs were similar between the models with and without OS data, but the model with OS data generated more than 1 additional quality-adjusted life-year (QALY) across both treatment arms. In both models, based on list prices, the Regimen was the most cost-effective treatment.

CONCLUSIONS

The analyses show that the Regimen is a cost-effective treatment for advanced melanoma patients in England, and methods to overcome the lack of OS can give reasonable estimates of QALYs gained and ICERs.

Correction to: Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

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Prevention of chronic rhinosinusitis

Prevention of chronicity of disease and minimising its impact with individualized treatment is a fundamental tenet of precision medicine. A review of the literature has been undertaken to explore how this may apply to chronic rhinosinusitis (CRS). Prevention may be thought of across 3 main domains. Primary prevention of CRS focuses on the avoidance of exposure to environmental factors associated with increased incidence of disease. This includes avoidance of tobacco smoke and occupational toxins. Although allergic rhinitis, respiratory infections and gastro-oesophageal reflux have been shown to be risk factors, there is no evidence as yet that treatment of these conditions is associated with reduced incidence of CRS. Secondary prevention of CRS is concerned with detecting a disease in its earliest stages, intervening to achieve disease and symptom control and preventing future exacerbations. Evidence based guidelines facilitate early diagnosis and appropriate use of medical and surgical interventions. In the future the use of endotypes to direct optimal is like to allow more clinically and cost-effective use of current and emerging treatments, such as monoclonal antibodies. Tertiary prevention aims to minimise the impact of an ongoing illness or injury that has lasting effects. Anxiety and depression have been shown to be associated with symptom amplification and may require treatment. The role of disease-related factors such as the role of the microbiome and osteo-neogenesis in the development of chronicity, and the development of severe combined upper airway disease needs further research.

Rhinitis and its impact on quality of life in swimmers

INTRODUCTION

Limited data suggest that swimmers might be affected by rhinitis significantly more often than the general population. This can have impact on quality of life but also on performance. The aim of this study was to determine the prevalence and impact of QOL of rhinitis in swimming compared to nonswimming athletes and controls.

MATERIALS AND METHODS

This was an observational case-control, questionnaire-based study involving elite (n = 101) and nonelite swimming athletes (n = 107), nonswimming athletes (n = 38) and sex- and age-matched controls (n = 50). The survey instrument consisted of a general and the miniRQLQ. Main question used to assess the prevalence of rhinitis was from the ISAAC study.

RESULTS

Rhinitis was reported significantly more often by the elite swimmers (45%) than nonelite swimmers (31%), nonswimming athletes (32%) and controls (24%). Allergic rhinitis prevalence was similar in all groups (12%-18%). The prevalence of nonallergic rhinitis (NAR) was significantly higher in elite swimmers (33%) and nonelite swimmers (22%) compared to nonswimming athletes and controls. Overall mean miniRQLQ score and all subdomains except the "eye" domain showed significantly reduced QOL in elite and nonelite swimmers compared to nonswimming athletes and controls. Regular nasal medication was used significantly less by elite swimmers (18%) compared to controls (67%) and nonswimming athletes (42%).

CONCLUSION

This study revealed a high prevalence of NAR in swimmers and related impact on QoL. These findings highlight the importance to increase the awareness towards upper airway disorders in the swimming athletes and to ensure adequate management.

Preliminary observations on clotting under three hydrocolloid dressings

Four patients with five wounds were randomly assigned to treatment with three occlusive dressings: DuoDERM®, Restore® and Comfeel Ulcus®; the dressings were left intact for 24-48 h.

When the dressings were removed, it was found that wounds that had been covered with Restore and Comfeel contained coagulated sanguinous material. Two wounds that had been covered with Comfeel and Restore, respectively, were then covered with DuoDERM, while one wound previously covered with DuoDERM was covered with Restore. Either no clotting occurred under DuoDERM or clots may have resolved.

Although these preliminary data suggest that DuoDERM gel may have fibrinolytic properties, more extensive and controlled studies are needed to assess the characteristics of this dressing.

Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional-led primary care

INTRODUCTION

Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain.

METHODS

At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods.

RESULTS

Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice.

CONCLUSIONS

AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.

Abstract P2-11-06: Analysis of cardiac events among node positive breast cancer (NPBC) patients treated with three-dimensional conformal radiation therapy (3D-CRT)

Background: Regional nodal irradiation (RNI) in addition to the chest wall and/or breast can maximize local regional control and improve overall survival, but has been associated with late cardiac morbidity. We examined NPBC patients treated with RNI using 3D-CT based radiation therapy (RT) to evaluate incidence and type of cardiac events.

Methods: Between 2000 and 2007, 156 NPBC patients were treated with RNI following lumpectomy or mastectomy using 3D-CRT. In all cases, treatment target and normal tissue volumes were delineated on treatment CT scans. The heart contour included the left ventricle and the atria. Prescription dose was typically 50Gy in 25 fractions (range 44-54 Gy) to the chest wall and/or breast PTVeval. 37% received a boost to the chest wall and 73% to the lumpectomy cavity. The mean prescription dose to the axilla and supraclavicular lymph nodes was 47.6 Gy (range 43.2 – 54 Gy) and 46.8 Gy to the IMN (range 35.3 – 50.4 Gy). The dose-volume cardiac data and incidence of cardiac events is reported.

Results: Median follow-up of surviving patients was 7 years (range, 0.3-10.6). Median patient age was 50 (range, 27-91), 52% were premenopausal, 76% estrogen receptor positive, and 18% were HER-2 positive. The IMN received &gt; 40 Gy in 66%. Chemotherapy was used in 94% of patients, and it was anthracycline-based in 82.3%. At the time of RT, 12.5% smoked, 9% had diabetes, 33% with HTN, and 4.4% had a history of CAD.

Average mean heart dose for the cohort was 5.2 Gy (range, 0.2 - 25.3 Gy). Mean cardiac V25 was 5.4% (range, 0-20%), mean cardiac V45 was 1.7% (range, 0-13.3%), and mean maximum cardiac point dose was 45.4 Gy.

There was 1 (0.7% of cohort) right sided patient with cardiac events and 8 (5.1% of cohort) left experiencing cardiac events. A total of 18 cardiac diagnoses were experienced among the 9 patients: Coronary artery disease with or without myocardial infarction (4), congestive heart failure (6), cardiomyopathy (3), and arrhythmia (5).

Conclusions: The cardiac event rate among these NPBC patients treated with RNI and anthracycline-based chemotherapy was low, but more common in women with left-sided breast cancer compared to right. Additional analysis using 3DCRT volumes are important to validate these findings and better define the dose-volume parameters for cardiac toxicity.

Citation Format: Bradley JA, Sparks I, Prior P, Bergom C, Walker A, Wilson JF, Li XA, White J. Analysis of cardiac events among node positive breast cancer (NPBC) patients treated with three-dimensional conformal radiation therapy (3D-CRT) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-06.

Meat allergy associated with galactosyl-α-(1,3)-galactose (α-Gal)-Closing diagnostic gaps by anti-α-Gal IgE immune profiling

BACKGROUND

Glycoproteins and glycolipids of some mammalian species contain the disaccharide galactosyl-α-(1,3)-galactose (α-Gal). It is known that α-Gal is immunogenic in humans and causes glycan-specific IgG and also IgE responses with clinical relevance. α-Gal is part of the IgE-reactive monoclonal therapeutic antibody cetuximab (CTX) and is associated with delayed anaphylaxis to red meat. In this study, different α-Gal-containing analytes are examined in singleplex and multiplex assays to resolve individual sensitization patterns with IgE against α-Gal.

METHODS

Three serum groups, α-Gal-associated meat allergy (MA) patients, idiopathic anaphylaxis (IA) patients with suspected MA, and non-meat-allergic healthy control individuals (HC), were analyzed via singleplex allergy diagnostics and a newly established immunoblot diagnostic system. The new dot blot detection system resolved individual IgE sensitization profiles for α-Gal-containing analytes CTX, bovine thyroglobulin (Bos d TG), and human serum albumin (HSA)-conjugated α-Gal.

RESULTS

Singleplex allergy diagnostics using the α-Gal analytes CTX and Bos d TG confirms the history of MA patients in 91% and 88% of the cases, respectively. A novel dot blot-based assay system for the detection of IgE against α-Gal reveals individual IgE sensitization profiles for α-Gal-containing analytes. An α-Gal-associated IgE cross-reactivity profile (IgE against CTX, Bos d TG, and HSA-α-Gal) was identified, which is associated with MA.

CONCLUSIONS

Detection of individual sensitization patterns with different α-Gal-containing analytes provides the basis for an individual allergy diagnosis for α-Gal-sensitized patients. Higher amounts of α-Gal in pork and beef innards compared to muscle meat as indicated by a higher staining intensity are a plausible explanation for the difference in allergic symptom severity.

A Collaborative Study to Establish the 5th International Standard for Unfractionated Heparin

Twenty-four laboratories participated in a collaborative study to calibrate a replacement for the 4th International Standard for Unfractionated Heparin (82/502). Both candidate materials A and B, gave excellent intra- and inter-laboratory variations (majority of mean %gcv <10%) when assayed against the 4th International Standard. No major differences of potency estimates were found between methods, although the USP method generally gave lower potencies than the other methods and candidate B gave a greater variation between methods than A. Overall, this study showed that the differences between the candidates are marginal. Based on its narrower molecular weight profile, higher specific activity and slightly lower inter-method variation, candidate A, 97/578, was proposed and accepted in October, 1998, by the Expert Committee on Biological Standardisation of the World Health Organisation to be the 5th International Standard for Unfractionated Heparin with an assigned potency of 2031 IU/ampoule.