Measurement Properties of the Online EuroQol-5D-Youth Instrument in Children and Adolescents With Type 1 Diabetes Mellitus: Questionnaire Study

Background

The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM).

Objective

This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online.

Methods

Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ≥4.5 points, respectively, from the first to the fourth visit.

Results

Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were “having pain/discomfort” (34.6%) and “worried/sad/unhappy” (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ≤15 and >16, respectively) were found in three EQ-5D-Y dimensions (“doing usual activities,” “having pain/discomfort,” and “feeling worried/sad/unhappy”), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in “looking after myself” (P=.005) and according to family function in “having pain/discomfort” (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001).

Conclusions

These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM.

P2879Effectiveness of first versus subsequentes ATP attemps: predictors and clinical consequences

Introduction

Antitachycardia pacing (ATP) terminates the majority (but not all) of slow VTs (S-VT) with a cycle length (CL) >320 ms.

Purpose

To analyze the efficacy, safety and predictors of ATP, comparing the first (ATP-1) to the second (ATP-2) and third (ATP-3) attempts.

Methods

We studied 556 S-VT (CL=354±18 ms; range: 321–415 ms; 1.6% syncopes) occurring in 67 patients. ATP programming was standardized, including three consecutive bursts of 15 pulses at 91% of VT CL.

Results

ATP effectiveness declined significantly from ATP-1 (436/556: 78%) compared to ATP-2 (24/103: 23%) and ATP-3 (10/79: 13%), p<0.01 for all comparisons. The percentage of variation of RR intervals (P-RR, %) was significantly higher prior to effective ATP-1 (2.73±1.45 vs 1.23±0.9; p<0.001). After an ineffective ATP-1, the P-RR decreased dramatically, with no differences between episodes terminated or not at ATP-2 (0.6±0.14 vs 0.44±0.16; p=0.6) or ATP-3 (0.54±0.15 vs. 0.52±0.14; p=0.7). The postpacing interval – CL difference (PPI-CLd) after an unsuccessful ATP-1 was shorter in episodes terminating at ATP-2 or ATP-3 (180±24 vs 211±15 ms; p<0.001) being 200 ms the cut-off point with the best sensitivity and specificity for non-effective ATP-2 and ATP-3 (93% and 74%, respectively). By multivariate analysis, the duration of native QRS complex (dQRS) (ms) was found the only independent predictor of a PPI-CLd ≥200 ms (OR=1.04; p=0.003). The best cutoff point of dQRS for PP-CLd ≥200 ms was 120 ms (sensitivity and specificity of 66% and 79%, respectively).

Several predictors of ATP efficacy were found by logistic regression: a) ATP-1: P-RR (OR=7.3; p<0.001), beta-blockers (OR=4.1; p<0.001) and dQRS (OR=0.95; p<0.001); b) ATP-2: PPI-CLd (OR=0.94; p=0.001) and dQRS (OR=0.96; p=0.04); c) ATP-3: PPI-CLd (OR=0.93; p=0.009).

Patients with a dQRS≥120 ms had a lower adjusted effectiveness of ATP and a higher proportion of S-VT causing syncope. Table.

Table 1 Patients with QRS <120 ms Patients with QRS ≥120 ms p value Adjusted effectiveness of ATP-1 89% (82–96) 70% (59–80) 0.008 Adjusted effectiveness of ATP-2 47% (32–63) 23% (11–35) 0.036 Adjusted effectiveness of ATP-3 18% (3–33) 3% (0–6) 0.003 Adjusted incidence of syncope due to S-VT 0.18% (0–0.6) 4.1% (2.1–6.1) 0.025 Values are expressed as mean (95% CI). Generalized Estimating Equations Method.

Conclusions

The efficacy of ATP in terminating S-VT is mainly due to the ATP-1. The regularization of RR intervals after ineffective ATP-1 underlies the lower efficacy of ATP-2 and ATP-3. Since the dQRS correlated significantly with the PPI-CLd, patients with a dQRS≥120 ms had a lower ATP-1, ATP-2 and ATP-3 effectiveness, leading to a higher incidence of syncope.

3325Incidence, outcomes and microbiology in patients with infective endocarditis

Introduction

Despite recent improvements in management, infective endocarditis remains associated with high morbidity and mortality. Over the last few decades, several factors have impacted on both the incidence and outcomes following infective endocarditis.

Purpose

Using a national linkage approach, we describe the changing age- and sex-stratified incidence and outcomes of infective endocarditis in Scotland over the last 25 years.

Methods

We conducted a consecutive retrospective individual patient linkage study across multiple national databases. Using data extracted from the Scottish hospital discharge dataset held by the Information Services Division of NHS National Services Scotland, we extracted episodes for all patients aged 20 years or older who were admitted with infective endocarditis between January 1, 1990, and December 31, 2014 in Scotland, UK. Patient episodes with infective endocarditis were linked to national prescribing and microbiology databases. The primary outcome was 1-year mortality following the index presentation. Generalised additive models were constructed to estimate the crude and age- and sex-stratified incidence rates (using a poison distribution) as well as trends in mortality (using a binomial distribution) adjusted for age, sex and comorbidity.

Results

Across 12,446 individual patients, there were a total of 12,667 hospitalisations (mean age 68±17 years, 55% females) with infective endocarditis using a 5-year look back period. The estimated crude rate of hospitalisation increased from 7.38 per 100,000 (95% CI 6.58 to 8.28) in 1990 to 15.09 per 100,000 (95% CI 13.90 to 16.39) in 2014 (p<0.001). Over the period of the study, 31% (3,877/12,667) of people admitted to hospital with infective endocarditis died within one year of admission. Case fatality fell markedly in both men and women from 1990 to 2014 (Figure). Microbiology was status was available for 34% of all hospitalisations with staphylococcus cultures associated with worse outcomes.

Conclusions

Despite the crude incidence of infective endocarditis doubling over the last 25 years and case fatality remaining high, the risk of death has markedly fallen over the last two decades. Staphylococcus cultures remain an independent marker of poor prognosis in this cohort.

Acknowledgement/Funding

British Heart Foundation

Scale Thickness Predicts Skin Puncture-Force Resistance in Three Pleuronectiform Fishes

In fishes, the skin and scales provide a physical barrier to the external environment and must withstand direct physical insult from biotic and abiotic features of the habitat. Flatfishes likely rely heavily on their scales for physical defense because they rest directly on the substrate. Using a flatfish model, we asked: what are the effects of scale type and scale morphology on puncture force resistance? We also asked: are there morphological and functional differences between the eyed and blind sides in flatfishes and do the morphological and functional properties of scales vary with organism size? Using a large size range of three species of Pleuronectid flatfish (Isopsetta isolepis, n = 10; Parophrys vetulus, n = 10; and Platichthys stellatus, n = 12), we measured the force required to puncture the integument using a sample of skin+scales taken from the eyed and blind side of each individual. We also measured the diameter, area, and thickness of the scales of each individual. Scaling relationships (body length vs. variable of interest) were derived for each species and compared with a priori expectations of geometric similarity. We found no relationship between scale type and puncture resistance and no differences in morphological parameters or puncture resistance between the eyed and blind side within a given species. These flatfish species do vary in their ability to withstand puncture forces; however, once scale thickness is taken into account, species differences disappear. Thus, the ability of a flatfish to withstand mechanical insult from puncture-forces varies depending on the thickness of the scale.

Tree root dynamics in montane and sub-alpine mixed forest patches

BACKGROUND AND AIMS

The structure of heterogeneous forests has consequences for their biophysical environment. Variations in the local climate significantly affect tree physiological processes. We hypothesize that forest structure also alters tree root elongation and longevity through temporal and spatial variations in soil temperature and water potential.

METHODS

We installed rhizotrons in paired vegetation communities of closed forest (tree islands) and open patches (canopy gaps), along a soil temperature gradient (elevations of 1400, 1700 and 2000 m) in a heterogeneous mixed forest. We measured the number of growing tree roots, elongation and mortality every month over 4 years.

KEY RESULTS

The results showed that the mean daily root elongation rate (RER) was not correlated with soil water potential but was significantly and positively correlated with soil temperature between 0 and 8 °C only. The RER peaked in spring, and a smaller peak was usually observed in the autumn. Root longevity was dependent on altitude and the season in which roots were initiated, and root diameter was a significant factor explaining much of the variability observed. The finest roots usually grew faster and had a higher risk of mortality in gaps than in closed forest. At 2000 m, the finest roots had a higher risk of mortality compared with the lower altitudes.

CONCLUSIONS

The RER was largely driven by soil temperature and was lower in cold soils. At the treeline, ephemeral fine roots were more numerous, probably in order to compensate for the shorter growing season. Differences in soil climate and root dynamics between gaps and closed forest were marked at 1400 and 1700 m, but not at 2000 m, where canopy cover was more sparse. Therefore, heterogeneous forest structure and situation play a significant role in determining root demography in temperate, montane forests, mostly through impacts on soil temperature.

Fasciola and fasciolosis in ruminants in Europe: Identifying research needs

Fasciola hepatica is a trematode parasite with a global distribution, which is responsible for considerable disease and production losses in a range of food producing species. It is also identified by WHO as a re-emerging neglected tropical disease associated with endemic and epidemic outbreaks of disease in human populations. In Europe, F. hepatica is mostly associated with disease in sheep, cattle and goats. This study reviews the most recent advances in our understanding of the transmission, diagnosis, epidemiology and the economic impact of fasciolosis. We also focus on the impact of the spread of resistance to anthelmintics used to control F. hepatica and consider how vaccines might be developed and applied in the context of the immune-modulation driven by the parasite. Several major research gaps are identified which, when addressed, will contribute to providing focussed and where possible, bespoke, advice for farmers on how to integrate stock management and diagnosis with vaccination and/or targeted treatment to more effectively control the parasite in the face of increasing the prevalence of infection and spread of anthelmintic resistance that are likely to be exacerbated by climate change.

Abstract OT1-03-01: Chemotherapy-free trastuzumab and pertuzumab in HER2 [+] breast cancer: FDG-PET response-adapted strategy. The PHERGain study

BACKGROUND:

Several studies have confirmed that a significant subset of patients (pts) with early stage HER2[+]breast cancer (BC) achieve pathological complete response (pCR) with a dual HER2 neoadjuvant blockade without chemotherapy (chemo). Early metabolic evaluation using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might help to recognize those pts with a higher likelihood of obtaining a pCR and an excellent outcome with a chemo-free strategy.

TRIAL DESIGN:

This is a randomized, multicenter, non-comparative phase II trial. Pts age ≥ 18 years with centrally-confirmed, treatment-naïve, HER2 [+] operable BC will be randomized, in a 1:4 ratio, and stratified by HR status, to receive docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) (cohort A), or trastuzumab and pertuzumab (HP) ± endocrine therapy (ET) according to HR status (cohort B). Centrally-reviewed 18F-FDG PET/CT scans will be performed prior to randomization and after 2 cycles of therapy. Pts allocated into cohort A will continue with the same therapy for a total of 6 cycles regardless of 18F-FDG PET/CT results. Pts enrolled into cohort B showing at least a 40% reduction of the SUVmax on 18F-FDG PET/CT respect to baseline (PET responders) will continue with the same therapy for a total of 8 cycles. PET non-responders pts will receive 6 cycles of TCHP. After surgery, cohort B/PET responders pts who do not achieve a pCR will receive 6 cycles of TCHP. Moreover, all pts from cohorts A/B must complete 18 cycles of HP, along with adjuvant ET and radiotherapy (RT) according to HR status and institutional practices, respectively. Pts with subclinic metastases will be assigned to cohort C to receive 6 cycles of TCHP. Surgery and RT will be evaluated on a case-by-case basis on cohort C, and all pts will continue with HP for at least 12 additional cycles ± ET according to HR status.

The first co-primary endpoint is to evaluate the rate of pCR defined as the absence of invasive disease in the breast and axilla (ypT0/isN0) achieved with HP ± ET in PET responders pts (cohort B/PET responders).The second co-primary endpoint is to evaluate 3-year (3-y) invasive disease-free survival (iDFS) rate defined as time from the first date of no disease to invasive recurrence, new invasive disease, or death by any cause in cohort B.

Total accrual will be 400 pts. Considering a 10% and 25% of drop-out rates at the time of first and second co-primary analysis, the study will be positive if ≥41 pts achieved a pCR in cohort B/PET responders; or if we observe ≤14 events of 3-y iDFS in cohort B. Decisions will be based on one-sided, exact binomial test. With a 2.5% type I error rate (H0: pCR ≤20% and 3-y iDFS ≤89%) and 80% power (HA: pCR ≥30% and 3-y iDFS ≥95%).

The secondary objectives are to evaluate other definitions of pCR, rates of breast-conserving surgery, tumor response by magnetic resonance imaging, optimal 18F-FDG PET cut-off for pCR and other 18F-FDG PET quantification parameters for pCR prediction, DFS, distant-DFS, overall survival, progression-free survival, and health-related quality of life. Translational sub-studies will analyze biomarkers that may be predictive of response to dual HER2 blockade with HP.

Citation Format: Llombart-Cussac A, Curigliano G, Gebhart G, Gligorov J, Khaldoun K, Marmé F, Prat A, Schmid P, Cortes J, Perez J. Chemotherapy-free trastuzumab and pertuzumab in HER2 [+] breast cancer: FDG-PET response-adapted strategy. The PHERGain study [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 OT1-03-01.