Digital Maturity as a Strategy for Advancing Patient Experience in US Hospitals

Patient experience is globally recognized as an important indicator of health system performance, linked to health system quality and improving patient outcomes. Post COVID-19, health systems have embraced digital health and advanced digital transformation efforts; however, the relationship between digital health and patient experience outcomes is not well-documented. Using HCAHPS hospital survey data to measure patient experience, and HIMSS EMRAM Maturity Model data to measure digital maturity, a cross-sectional design using multivariate analyses examined the impact of digital maturity on patient experience in US hospitals. Our analysis shows that advanced digital maturity in US hospitals is associated with stronger patient experience outcomes, particularly relative to communication with nurses, doctors, and communication about medicines and therapies. The findings suggest that there are significant differences in patient experience associated with teaching versus nonteaching hospitals, urban versus rural hospitals. As hospitals advance and progress digital transformation initiatives, evidence to inform how transformation efforts can engage and advance patient experience will contribute to health system performance well into the future.

Real-world survival outcomes of immunotherapy for advanced non-small cell lung cancer: A single-center retrospective review

BACKGROUND

Non-small cell lung cancer (NSCLC) is often diagnosed at an advanced stage. Clinical trials have demonstrated that first-line immunotherapy alone or in combination with chemotherapy improves overall survival. However, reports of survival outcomes in real-world settings are limited. We assessed survival in advanced NSCLC patients treated with immunotherapy alone or in combination with chemotherapy in first- or second-line at the Windsor Regional Cancer Program (WRCP) and compared it to existing literature.

METHODS

We included patients diagnosed with stage IV NSCLC from January 2015 to December 2020 and treated with first-line chemoimmunotherapy (ChemoImmuno1), chemotherapy followed by immunotherapy (Chemo1), or immunotherapy followed by chemotherapy (Immno1) in our survival analysis. Patients with oncogene-addicted mutations were excluded.

RESULTS

There were 160 patients of which 41.5% were female. Mean age was 68 years. Median overall survival from time of diagnosis was 474 days (95% CI: 249, 949) with an estimated 5-year survival of 11.1% (95% CI: 4.5, 21.3). Median OS in ChemoImmuno1 was 9.6 months, in Chemo1 was 19.2 months from time of diagnosis and 10.5 months from time of initiation of immunotherapy, and in Immuno1 was 18.4 months, respectively. Estimated survival at three years from time of diagnosis for ChemoImmuno1 was 17.6% and for Immuno1 was 17.9%. For Chemo1, from diagnosis it was 20.1% and from second-line therapy it was 15.4%. Survival outcomes were comparable to clinical trials and other studies.

CONCLUSION

Real-world survival outcomes of immunotherapy for advanced NSCLC are comparable to the existing literature in this single center study.

Cost-effectiveness analysis of Manuka honey-Omega-3 combination treatments in treating oxidative stress of pediatric β-thalassemia major

OBJECTIVE

Oxidative stress represents a ruthless complication of β-thalassemia that worsens the severity of that medical condition. There is no conclusive evidence on the best antioxidant used for that issue. Our earlier clinical study concluded that omega-3 and Manuka honey add-on to the conventional therapy had a potential therapeutic impact on reducing oxidative stress. However, there is no research evaluating their cost-effectiveness. This paper compares the cost-effectiveness of Omega-3 and Manuka honey supplementation to conventional therapy in treating oxidative stress among children with β-thalassemia major.

SUBJECTS AND METHODS

Cost-effectiveness evaluation of daily supplementation of Omega-3-Manuka honey and Manuka honey alone to the conventional therapy was performed. The economic evaluation was performed on data from a prospective 10-month randomized clinical trial. Fifty patients were recruited into the Omega-3-Manuka honey plus conventional therapy group, 50 patients were included in the Manuka honey alone plus conventional therapy group, and 50 patients receiving the conventional therapy alone served as a control group. Effectiveness measures from the randomized clinical trial were used to determine incremental effectiveness. Cost estimates were calculated from the healthcare payer's perspective. The analysis considered the improvement in oxidative stress biomarkers presented here as a percent change from baseline to determine the incremental effectiveness and cost for the treatment by both interventions.

RESULTS

Adding Omega-3 or Manuka honey to conventional therapy was a more cost-effective add-on than conventional treatment alone. Omega-3-Manuka honey was more cost-effective than Manuka honey alone in treating oxidative stress in that condition. Oxidative stress biomarkers were significantly reduced with both experimental medications compared to the conventional therapy alone.

CONCLUSIONS

The present study showed that using Manuka honey and Omega-3 as add-on treatments for oxidative stress in pediatric β-thalassemia disease could have significant cost-saving and clinical improvement.

EFFECT OF INSULIN HORMONE ON THYROID HORMONE FUNCTION IN PATIENTS WITH DIABETIC TYPE 2 DISEASE

The thyroid hormones play a crucial role in regulating various physiological processes in the human body. They have a wide range of effects that impact metabolism, growth, development, and overall homeostasis. The current study aimed to investigate the levels of HbA1c and various biomarkers in different patient groups. Two groups of patients were included in the study, each consisting of 30 patients, encompassing both genders. One group comprised patients with type 2 diabetes mellitus (T2DM) who were receiving insulin treatment, while the other group comprised patients with T2DM who were not receiving insulin treatment. These patient groups were compared to a control group of participants from both genders. The research employed the colourimetric method to measure HbA1c levels in all groups. Additionally, they utilized the Enzyme-Linked Immunosorbent Assay (ELISA) method to measure the levels of insulin, and T4 in all groups. The study also involved comparing these biomarkers between groups and examining the effect of insulin levels on thyroid hormones. The mean±SD values were 4.4867±1.02 µg/dl and 3.2367± 0.78 µg/dl for the T2DM groups with and without insulin treatment, respectively, while it was 7.9033±0.29 µg/dl in the control group. These findings provide valuable insights into the relationship between insulin levels and thyroid hormones, shedding light on the complex interplay between these two physiological systems. Overall, the impact of insulin on thyroid hormone regulation underscores the intricate interplay between endocrine systems and highlights the need for a comprehensive understanding of these interactions to optimize patient care and improve health outcomes.

THE ROLE OF GLUTAMIC ACID DECARBOXYLASES IN DIABETES MELLITUS

In the context of diabetes mellitus (DM), anti-glutamic acid decarboxylase (antiGAD) antibodies are associated with a specific form of the disease called type 1 diabetes. The study aims to evaluate the serum cortisol and serotonin levels in patients with type 2 DM disease. A total of 90 Iraqi participants (30 with type 1 diabetes mellitus, 30 with type 2 diabetes mellitus and 30 healthy subjects as a control group) were enrolled in the study. Blood samples were collected, serum separated, and frozen for future analysis. The level of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was measured for each person who participated in this study (whether DM diseases or control individuals) and AntiGAD (anti-glutamic acid decarboxylase). The study examined the descriptive statistics of HOMA-IR and AntiGAD levels in individuals with different types of diabetes. The results showed that individuals with type 1 diabetes mellitus (T1DM) had a significantly lower HOMA-IR compared to the control group, while individuals with type 2 diabetes mellitus (T2DM) had a significantly higher HOMA-IR. The study also found that both T1DM and T2DM groups had significantly elevated levels of AntiGAD compared to the control group. These findings suggest that insulin resistance is reduced in T1DM individuals but increased in T2DM individuals, and the presence of diabetes is associated with increased levels of AntiGAD. In summary, the results of this study demonstrate significant differences in both HOMA-IR and AntiGAD levels between individuals with diabetes (T1DM and T2DM) and the control group. These findings contribute to our understanding of the pathophysiology of diabetes and highlight the importance of these biomarkers in the diagnosis and management of the disease. Further research is needed to explore the underlying mechanisms behind these observations and to determine their clinical implications.

THE ROLE OF COENZYME COQ10 AND VITAMIN E IN PATIENTS WITH BETA-THALASSEMIA MAJOR IN BAGHDAD CITY POPULATION

Our study aimed to evaluate the level of coenzyme (CoQ10) in the plasma of human which suffered from beta-thalassemic major disease and vitamin E concentration in comparison to control cases. We included 90 (60 β-TM patients and 30 persons for control groups). The range of age (15-40 years) during the period from December 2022 to March 2023, and the study included patients previously diagnosed with beta-thalassemia major from Medical City and Karama Hospital. The level of serum CoQ10 in the patients was 2.02 ng/ml and in the control, groups were 3.55 ng/ml. The difference was statically high between the two groups (P<0.001). Likewise, our study includes the concentration of vitamin E in the study groups (patients 2.29 ng/ml and for control cases 7.25 ng/ml). The results highlight that there was a highly significant difference between the two groups (P<0.001). In conclusion, for both β-TM patients and control groups, the results show that the two parameters CoQ10 and vitamin E were highly significant difference((P<0.001) which means there were lower antioxidant capacities as demonstrated by the results of our new study.

MYELOPEROXIDASE AND COENZYME Q10 MODULATED IN THE CHRONIC KIDNEY DISEASE PATIENTS

Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly. Diagnosis of chronic failure is based on a glomerular filtration rate (GFR) of less than 15 or the need for renal replacement therapy. It is also equivalent to stage 5 chronic kidney disease.The study aimed to evaluate the role of MPO and Co Q10 in different stages of CKD, and correlates this parameter with urea, Cr, Na, K, and eGFR.A Case-control study is carried out in Baghdad in the Imamian Kadhimian Medical City and Al-Karamah Teaching Hospital between August 2022 and March 2023. The number of CKD males under study were 60 male whose ages were between 25 to 50 years old. In addition, the control group consisted of 30 healthy volunteer males aged between 25 to 50 years and they did not have any diseases. Blood samples were collected from each male for measurement of Myeloperoxidase (MPO), and Coenzyme Q10 by Enzyme-linked immunosorbent assay (ELISA). The study showed that the reduced mean level of myeloperoxidase (p<0.001) in the patient's group compared with the control group, (19.9±6.82 ng/ml) and (42.4±4.98 ng/ml) respectively. Our study revealed that with increasing CKD stage, the myeloperoxidase levels decrease. Also, the reduced mean level of Coenzyme Q10 was 2.97±0.511 ng/ml in the patient group was highly significant than the control group's 7.07±2.41 ng/ml (p<0.001). Our study revealed that with increasing CKD stage, the coenzyme Q10 levels decrease. The study found a positive correlation of serum myeloperoxidase with coenzyme Q10 in CKD patients.

ESTIMATION OF VON WILLEBRAND FACTOR IN PATIENTS CARDIAC DISEASES

Ischemic heart disease, also called coronary artery disease (CAD), is the term given to heart problems caused by narrowed heart (coronary) arteries that supply blood to the heart muscle.The study aims to determine the levels of Von Willebrand factor in patients with coronary artery disease.A total of 60 CAD patients and 30 healthy individuals were enrolled in the present study. Blood was withdrawn and serum was separated for measurement of lipid profile, human von Willebrand Factor, and lactate dehydrogenase (LDH).The study demonstrated that the highest mean of VWF was observed among IHD patients (81.75±29.75 ng/ml) and the lowest mean was within the control group (26.53±5.12 ng/ml). The differences were highly significant (P=0.0001). The study showed that the highest means of cholesterol, triglyceride, and LDL and the lowest mean of HDL were detected in IHD patients as compared with the healthy control group. The study showed that the mean of VWF was (88.76 ng/ml) in patients with hypertension which were significantly highest than in non-hypertensive IHD patients (75.76 ng/ml) at P=0.043. The study showed that the highest means of cholesterol, Triglyceride and HDL were detected in hypertensive IHD patients (264.3, 349.1, and 29.24 mg/dl respectively) as compared with non-hypertensive IHD patients group (217.5, 226.1 and 22.02 mg/dl), respectively. The study showed a significant negative correlation between VWF and LDL among IHD patients and showed a positive correlation of VWF with each of cholesterol, triglyceride, and HDL among IHD patients.In conclusion, the findings of the study suggest that patients with ischemic heart disease (IHD) have elevated levels of the von Willebrand factor. More research is needed to fully understand the relationship between VWF and cardiovascular disease and to determine the clinical utility of its measuring in the diagnosis and management of these conditions.

Impact of the COVID-19 Pandemic on Elderly Medical Admissions and Outcomes in a Tertiary Hospital in Northeastern Nigeria: A Comparative Retrospective Study

BACKGROUND

The coronavirus infectious disease 2019 (COVID-19) has been shown to be more lethal in the elderly (>65 years), especially those with co-morbidities. This study examined the impact of the pandemic lockdown period on trends in elderly medical admissions and deaths.

METHODOLOGY

This is a retrospective study of elderly medical admissions and deaths in the medical wards of a Nigerian hospital. Data for the months of March, April, May, June, and July of 2020 was compared to the same months before (2019) and after (2021). Analysis was done using STATA version 15.0.

RESULTS

During the study period, two hundred and seventy-six elderly patients were admitted, with a mean age (±SD) of 73.4 ± 7.4 years. The most common diagnoses at admission were chronic kidney disease (CKD) (26.85%, n=74) and hypertensive heart disease (HHD) (21.7%, n=60). The highest admission was in 2021, with a total of 99 (35.9%). Overall, 60 mortalities were recorded, with a proportional mortality rate of 21.7%, which was highest in 2020 (25.0%) and lowest in 2021 (17.1%). There was no difference between the mortality rates of 2019 versus 2020 (P=0.82) and 2020 versus 2021(P=0.18). Sepsis (35.0%) and CKD (25.0%) were the major contributors in 2019.

CONCLUSION

CKD and HHD were the most common diagnoses at admission, whereas sepsis, CKD, and CVD were the commonest causes of death. The Covid-19 pandemic did not significantly alter the elderly admission pattern in our setting.

Safety and effectiveness of near-zero fluoroscopy paroxysmal AF radiofrequency ablation with a temperature-controlled, contact force-sensing catheter: a Q-FFICIENCY study sub-analysis

Background/Introduction

Q-FFICIENCY evaluated 12-month (M) safety and efficacy of temperature-controlled paroxysmal atrial fibrillation ablation with a novel contact force-sensing, radiofrequency catheter with 3 microelectrodes and 6 thermocouples. Patients underwent pulmonary vein isolation with very high-power short-duration (vHPSD; 90 W/ up to 4 s) mode in combination with conventional-power temperature-controlled (CPTC; 25–50 W) mode.

Purpose

To assess procedural efficiency, safety, and 12M outcomes of participants ablated under near-zero fluoroscopy guidance compared to procedures performed with standard fluoroscopy.

Methods

In this US multi-centre (22 sites), non-randomised investigational study, patients underwent pulmonary vein isolation with vHPSD as primary ablation mode; CPTC was used for PV touch-up or non-PV ablation. Primary safety endpoint was incidence of primary adverse events ≤7 days post-procedure. Primary effectiveness was freedom from documented atrial tachyarrhythmia recurrence and additional pre-defined failure modes (acute failure, repeat ablation, new/higher dose anti-arrhythmic drug). Participants were followed-up through 12M post-ablation (3M blanking & 9M evaluation) to assess safety, effectiveness, and healthcare utilisation.

Results

Of 191 participants enrolled (63.5±10.7 years, CHA2DS2-VASc 2.4±1.5, 60.7% men), 166 were ablated with the investigational catheter, and 165 had fluoroscopy data available for inclusion in this analysis. Forty-four participants received ≤1 minute of fluoroscopy. Compared to the &gt;1-minute of fluoroscopy cohort, the ≤1-minute group showed improved efficiencies in all procedural parameters (Table). Primary adverse event rates were similar among groups (≤1-minute, 4.5%; &gt;1-minute, 3.3%). Kaplan-Meier estimated 12M clinical success rates (i.e., freedom from documented symptomatic recurrence) were similar regardless of fluoroscopy exposure (≤1-minute, 85.4%; &gt;1-minute, 86.0%). Freedom from cardiovascular hospitalisation 12M post-ablation was comparable among groups (90.8% vs 88.0%).

Conclusion

Near-zero fluoroscopy paroxysmal atrial fibrillation ablation with the novel temperature-controlled catheter in vHPSD mode, alone or combined with CPTC, led to enhanced procedural efficiencies with good effectiveness and clinical success without comprising safety.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Biosense Webster, Inc.

Are we overtreating stage I triple-negative breast cancer in Ontario? A population-based retrospective epidemiological analysis using the ICES database

Triple-negative breast cancer (TNBC) is associated with inferior outcomes. The use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy was demonstrated to be correlated with tumor size. Different guidelines exist regarding chemotherapy in early-stage TNBC. This study uses ICES database to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC in Ontario stratified by tumor size. Records of TNBC patients diagnosed in 2012 to 2014 were collected from ICES database. Stage I patients were analyzed by tumor size: T1a (≤ 0.5 cm), T1b (> 0.5 cm and ≤ 1.0 cm), and T1c (> 1.0 cm and ≤ 2.0 cm). Kaplan-Meier curves, log-rank test statistic, and Cox's proportional hazard regression were used to compare differences in overall survival (OS) between chemotherapy and no-chemotherapy groups. Of 610 patients, 183 had tumor sizes ≤ 1 cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumors > 1 cm to 2 cm, representing stage T1cN0M0. Patients with tumors ≤ 1 cm who received chemotherapy did not have a significant difference in OS compared to the no-chemotherapy group (p = 0.41, hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.021-2.5). However, patients with tumor sizes > 1 cm to 2 cm who received chemotherapy demonstrated significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16-0.86). Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy. For TNBC tumors ≤ 1 cm, avoidance of chemotherapy can be considered. Prospective research should further investigate the efficacy of chemotherapy in TNBC stages T1a-bN0M0.Trial Registration University of Windsor REB#16-119.

Hydration status assessment and impinging factors among university students in the UAE

OBJECTIVE

Insufficient water intake has been a global health concern as it is linked to numerous adverse health consequences. Risk factors for dehydration include low fluid intake, sun and heat exposure which is a key element especially in the Gulf region. The aim of this study was to identify the prevalence and the impinging factors of hypohydration among college students in UAE.

SUBJECTS AND METHODS

Bioelectrical Analysis Impedance (BIA), attained using BodyStat 1,500 MDD, was used to assess participants' body water levels. Adequate hydration level was defined as body water level of 50-60% for females and 55-65% for males. Alongside this, a scale and a stadiometer were used to measure the participants' weight and height in order to calculate their BMI.  A self-administered questionnaire was also used to assess and correlate the test findings with the risk factors, signs and symptoms, and the level of knowledge awareness of the participants.

RESULTS

Of the 201 university students that participated in the study, 41.3% were hypohydrated, 55.7% were well hydrated and 3% were hyper-hydrated. Among hypohydrated participants, 56.6% were females and 43.4% were males, highlighting that females were at higher risk of becoming dehydrated than males. A major factor that negatively affected hydration status was BMI; as BMI increased, water percentage and therefore hydration status decreased. We checked for numerous signs and symptoms that could indicate hypohydration levels, and the following were the top five most prevalent among our participants: dry lips (51.90%), thirst (46.90%), tiredness (46.80%), dry skin (39.70%) and headache (36.90%). According to The Urine Color Chart (Human Kinetics, Champaign, IL, USA), 3.5% were classified as dehydrated, 46% were in danger of getting hypohydration levels while 19.5% were classified as having good hydration levels. There was no significant correlation between water intake and urine colour chart (p = 0.334). Among the study participants, 64.2% acquired their knowledge from internet, 30.80% from TV and radio and 26.90% from books and courses. The behavior aspect of the participants when feeling thirsty, was that 79% of them would resort to water, while 11% resorted to soft drinks and 10% to juices.

CONCLUSIONS

The prevalence of hypohydration levels was 41.3% among the study participants of young university students. The main risk factors affecting hydration levels were BMI and gender. This signifies the importance of good hydration habits which were not commonly practiced among students even though they had adequate knowledge regarding the topic. Regular check-ups held intermittently can aid in recognizing those at risk of dehydration and help in educating about the importance of such topic especially regionally.

O-071 In progestin primed double stimulation protocol: Is luteal phase stimulation more effective than follicular phase stimulation in poor responders? A randomized controlled study

Study question

Is follicular phase or luteal phase stimulation more effective in progestin primed double stimulation protocol in poor responders?

Summary answer

The luteal phase stimulation was more effective than follicular phase stimulation in the progestin primed dual stimulation protocol in poor responders.

What is known already

Poor ovarian responders involve 9–24% of patients undergoing in vitro fertilization (IVF), with the management of these patients posing an everyday practical challenge.

Owing to the follicular waves theory, two or three waves of folliculogenesis were detected during the interovulatory interval, two consecutive ovarian stimulation protocols could be initiated in the follicular phase and the subsequent luteal phase. This is an effective way to increase the number of oocytes and embryos obtained over a relative short period of time. Furthermore, there is increasing evidence that progestins can be a reliable method of preventing premature LH surge during ovarian stimulation.

Study design, size, duration

This was a randomized controlled study performed at the Infertility and Assisted Reproduction Unit of ElShatby Maternity Hospital, Alexandria University and Madinah Fertility Centre. The study was conducted on 90 infertile women with poor ovarian response as defined by the Bologna criteria. 7 patients were excluded due to protocol violation, loss to follow-up and patient withdrawal. The study commenced in September 2020 and was finalized in September 2021.

Participants/materials, setting, methods

Group 1

45 patients were given the progestin primed double stimulation protocol. Dydrogesterone was started from the first day of the ovulation induction till the end of luteal phase stimulation. Embryo transfer was scheduled in a subsequent cycle.

Group 2

45 patients were given the flexible GnRh antagonist protocol in 2 cycles. The best blastocyst from either cycle was transferred in the second cycle.

Main results and the role of chance

When comparing the follicular and luteal phases, the M2 oocytes number retrieved in the luteal phase was statistically significantly higher than the follicular phase, with the median number of 4 oocytes against a median number of 2 oocytes (P value 0.001). The fertilization rate was significantly higher in the M2 oocytes of the luteal phase stimulation (P value 0.04). The resultant embryos from the luteal stimulation phase were statistically significantly higher than the follicular phase, with the median number of 3 embryos against a median number of 1 embryo (P value &lt;0.001). However, we found that the days of controlled ovarian hyperstimulation were statistically significant higher in stimulation of the luteal phase with the median of 12 days against the 10 days seen in follicular phase stimulation (P value 0.002). Consequently, the total dosage of gonadotropins was statistically significant higher in the luteal phase with a P value of 0.007.

After Subgroup analysis, Poseidon Group 4 patients demonstrated that a significantly higher number of oocytes were retrieved after the progestin primed double stimulation than after two waves of flexible GnRh antagonist stimulation (median of 12 oocytes against a median of 10 oocytes with P value 0.01).

Limitations, reasons for caution

Firstly, preimplantation genetic testing was not performed to detect euploid embryos which could be vital when comparing both the phases and the protocols. Secondly, despite the importance of the live birth rate as an outcome measure, we did not enroll this measure.

Wider implications of the findings

In the light of our findings, we recommend the usage of progestin primed dual stimulation protocol in poor responder patients. Additionally, we call for multicentric randomized controlled research to verify this protocol as a first-line treatment protocol in poor responder patients.

Trial registration number

ClinicalTrials.gov ID: NCT04537078

Are we overtreating stage I triple negative breast cancer in Ontario? A population-based study using the ICES database

e12511

Background: Triple-negative breast cancer (TNBC) has been associated with poorer long-term outcomes compared to other breast cancer subtypes. Due to the lack of targeted therapies, the use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy has demonstrated to be correlated with tumor size. Currently, different national guidelines exist regarding chemotherapy in early stage I TNBC. This study aims to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC stratified by tumor size and treated in Ontario, using the ICES database. Methods: Records of stage I TNBC patients diagnosed in 2012 to 2014 were collected from the ICES database and analysed. Kaplan-Meier curves and log-rank tests were used to compared differences in overall survival (OS) between groups. Stage I TNBC cancer patients were analyzed by tumor size: T1a (< 0.5 cm), T1b (> 0.5 cm and < 1.0 cm) and T1c (>1.0 cm and < 2.0 cm). A Cox proportional hazard model was used to determine significance of variables. Results: Of the 610 stage I TNBC patients, 183 had tumor sizes ≤ 1cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumor sizes > 1cm to 2cm, representing stage T1cN0M0. Patients with tumor sizes ≤ 1cm who received adjuvant chemotherapy did not have a significant difference in OS compared to those who did not receive adjuvant chemotherapy (p = 0.41, hazard ratio (HR) = 0.40, 95% confidence interval (CI) 0.021-2.5). However, patients with tumor sizes > 1cm to 2cm who received adjuvant chemotherapy demonstrated a significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16-0.86). Conclusions: Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy for better OS. For stages T1aN0M0 and T1bN0M0, patients may be overtreated and avoidance of adjuvant chemotherapy can be considered at this time. Prospective studies should investigate the efficacy of adjuvant chemotherapy in TNBC patients with stage T1aN0M0 and T1bN0M0.

Measuring Corrosion on Vehicles, in Real-Time, Using Digital Imaging and Analysis Techniques

This research outlines a digital imaging method under development to systemize a rapid in-field corrosion evaluation measure, to evaluate and monitor the degree of corrosion on target corrosion-prone parts on light-duty vehicles. This procedure uses digital imaging to study and compare corrosion levels of 228 vehicles that were treated with aftermarket applications of corrosion prevention products versus 141 vehicles that were untreated. It introduces a Corrosion Index (CI) as a common measure. Single-factor and two-factor analysis of variance (ANOVA) of the digitally-based corrosion measurements show statistically significant correlations between CI and treatment (treated versus untreated), as well as CI, vehicle age, and treatment. The ANOVA results show that the aftermarket-treated vehicles have statistically significantly less corrosion than the untreated vehicles, demonstrating that digital image analysis is a viable method of measuring corrosion on corrosion-prone vehicle parts, offering the potential to monitor and track the performance/efficacy of aftermarket corrosion treatment in real-time.

HP47 : Post covid optic neuritis,Egyptian two case reports

The exact incidence of neurological complications from coronavirus disease 2019 (COVID-19) infection remains unknown. Neurological symptoms are more common with severe form of the disease. Through neuro-invasion, the virus can affect both neurons and glial cells and induce wide range of neurological pathologies.

CNS symptoms is commoner representing 91% of all neurological patients with 9% only with PNS.

PNS manifestations showed variable results where visual impairment and nerve pains were more frequent in the severe COVID-19 category of patients.

This is a 2 case report study of post covid optic neuritis , both after severe covid infection and hospitalization ,they developed acute onset visual affection mostly1.5 month in the first case and 2 month in the second one after almost complete cure.

The first case had monocular delayed perception of vision , the second one had complete visual loss of one eye of unexplained causes.

All neurological and ophthalmological investigations were normal apart from visual evoked potentials that showed small amplitude p100 response in the first case and absent response in the last one.

This supports a study Based on murine models of other CoVs, stated that viral-induced optic neuritis secondary to autoantibody production against neuroretina should also be included in the differential diagnosis and infected patients should be monitored for signs of neuroretinal degeneration in the long term.

A prospective phase II clinical trial identifying the optimal regimen for carboplatin plus standard backbone of anthracycline and taxane-based chemotherapy in triple negative breast cancer

Addition of platinums to combination chemotherapy for triple negative breast cancer (TNBC) has shown efficacy and is increasingly accepted in the clinic, yet optimal delivery is unknown. A prospective clinical trial with TNBC patients was conducted to determine the optimal chemotherapy regimen to deliver carboplatin with standard dose dense ACT. Tissue microarray was conducted to isolate markers indicative of response to treatment. 90 TNBC patients were enrolled onto our trial. The most successful version placed the carboplatin on the second and final paclitaxel treatment with liberal hematological parameters. Our final regimen had the lowest grade 3 or 4 toxicities, no delays, no dose reductions of carboplatin, and 32% reduction in paclitaxel doses. Stage I (AJCC7) patients did well with carboplatin-based chemotherapy with zero relapse rate. Reduction in protein levels of androgen receptor and PD-L1 were found to be potential indicators of patient relapse. We have optimized a protocol for the addition of carboplatin to standard of care chemotherapy in TNBC patients. Early data indicates reduced protein levels of androgen receptor and PD-L1 as indicators of response to treatment.Trial registration This trial was registered at Canadian Cancer Trials. http://www.canadiancancertrials.ca/.

Patient vital signs in relation to ICU admission in treatment of acute leukemia: a retrospective chart review

OBJECTIVES

The objective of the current study was to investigate the relationship between changes in vital signs and intensive care unit (ICU) admission. Windsor Regional Hospital treats 15-20 new patients a year with acute leukemia. These patients are at increased risk of neutropenic fevers and admission to the ICU following induction chemotherapy.

METHODS

Retrospective review examined the correlation between acute leukemia patient vitals and ICU admission. The analysis included 37 patients: 7 ICU versus 30 controls. Changes were compared to baseline over 24 hours prior to ICU admission or 5 days after the initiation of induction chemotherapy in the following vital signs: heart rate (HR), mean arterial pressure (MAP), temperature (T), respiratory rate (RR), and fraction of inspired oxygen (FiO₂) required to maintain a stable oxygen saturation.

RESULTS

RR and FiO₂ demonstrated significant change over baseline leading up to ICU admission within the ICU group. T, HR and MAP did not demonstrate significant changes over time in either group. RR, FiO₂ and HR were significantly higher in the ICU group at time zero compared with the control group. RR was recorded least frequently in the 24 hours leading up to ICU admission.

DISCUSSION

Changes in RR and FiO₂ predicted clinical deterioration requiring ICU admission in acute leukemia patients. This is consistent with the predominant reason for ICU admission which was respiratory failure.

CONCLUSION

We present preliminary evidence to support enhanced monitoring of RR and FiO₂ in acute leukemia patients following induction chemotherapy with early intervention if identified.

538 Patient Satisfaction from ENT Phone Consultations During COVID-19

Introduction

Telephone consultations (TCs) have rapidly increased in the outpatient setting due to the coronavirus pandemic. We have implemented a quality improvement project to improve patient satisfaction of TCs in our unit.

Method

This was a prospective complete-cycle project, with online patient satisfaction questionnaires sent following TCs in ENT clinics. This consisted of 28 questions including the Medical Interview Satisfaction Scale (MISS-21).

Based on results and a current literature review, a two-pronged intervention was designed, comprising of staff education and application of a model structured TC framework. A follow-up survey was subsequently undertaken.

Results

100 patient questionnaires were collected (April & June 2020). Significant improvements in MISS-21 scores were seen over the two surveys (p = 0.026). An average MISS-21 score of 114.6 (range 49 – 147) was seen in the first survey, with a mean score of 128.5 (range 79 – 142) seen in the second (maximum score of 147). There was a significantly increased preference for TC over FTF appointments over the two surveys (p = 0.021).

Conclusions

We have shown significant improvements in patient satisfaction and an increased TC preference through use of a structured consultation model. Its potential benefits in infection control and impact on outpatient workload may see TCs persist in the post-coronavirus era.

Patient satisfaction from ENT telephone consultations during the coronavirus disease 2019 pandemic

BACKGROUND

Telephone consultations have rapidly increased in the out-patient setting because of the coronavirus pandemic. A quality improvement project was implemented to improve patient satisfaction of telephone consultations in our unit.

METHODS

This was a prospective complete-cycle project. Patient satisfaction questionnaires were sent to patients following telephone consultations in ENT clinics. Based on a literature review and initial results, clinicians were encouraged to follow a structured consultation format. A second questionnaire survey was conducted following its implementation.

RESULTS

One hundred patient questionnaires were collected during the survey (April and June 2020). There was significant improvement over the two surveys in terms of satisfaction scores (p = 0.026), along with a significantly increased preference for telephone consultations over face-to-face consultations (p = 0.021).

CONCLUSION

This study showed significant improvement in patient satisfaction and an increased telephone consultation preference through the use of a structured consultation model. The potential benefits in terms of infection control and impact on out-patient workload may see telephone consultations persist in the post-coronavirus era.

A bivariate autoregressive Poisson model and its application to asthma-related emergency room visits

There are no gold standard methods that perform well in every situation when it comes to the analysis of multiple time series of counts. In this paper, we consider a positively correlated bivariate time series of counts and propose a parameter-driven Poisson regression model for its analysis. In our proposed model, we employ a latent autoregressive process, AR(p) to accommodate the temporal correlations in the two series. We compute the familiar maximum likelihood estimators of the model parameters and their standard errors via a Bayesian data cloning approach. We apply the model to the analysis of a bivariate time series arising from asthma-related visits to emergency rooms across the Canadian province of Ontario.

THU0540 A PHASE 2B STUDY OF INTRAVENOUSLY (IV) ADMINISTERED TC 99M TILMANOCEPT TO DETERMINE DIFFERENTIAL UPTAKE, REPRODUCIBILITY OVER TIME AND IMAGE STABILITY IN HEALTHY SUBJECTS AND IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA) ON STABLE TREATMENT

Background:

At present, there are no reliable noninvasive means to directly monitor disease activity in RA patients. Activated macrophages are a critical component of the inflammatory etiology of RA due to their role in prolonged RA joint inflammation and destruction through the release of pro-inflammatory cytokines and chemokines. Tc 99m tilmanocept is a radiopharmaceutical imaging agent that binds with high affinity to the macrophage mannose receptor CD206 that resides on activated macrophages. Previous clinical trials demonstrated safety and tolerability of Tc 99m tilmanocept, as well as a determination of optimal clinical dose and timeframe for RA imaging.

Objectives:

The current phase 2b study aims to evaluate reproducibility and stability of imaging and will assess quantitative Tc 99m tilmanocept uptake cut points that reliably enable discrimination between joints of healthy people and RA patients.

Methods:

The analysis cohort contained 18 healthy controls (HC) clinically free of inflammatory joint disease and 12 subjects with clinically diagnosed RA who are on stable anti-inflammatory and/or anti-rheumatic therapy. Each subject received a 150-mcg dose of tilmanocept radiolabeled with 10 mCi of Tc 99m in a 3mL IV injection. Injection was followed by planar imaging at 60 and 180 minutes for both HC and RA subjects on study Day 0 and repeated in RA subjects on Day 8. Images were quantitatively assessed to detect localization within synovial spaces of bilateral hands and wrists by determining average pixel intensity in each region of interest relative to average pixel intensity in a joint-specific reference region.

Results:

Data obtained from the interim analysis support the hypothesis that Tc 99m tilmanocept imaging can provide robust quantitative imaging in HC and RA subjects. Repeat images within and between days demonstrate root mean squared differences that are approximately 10% or less of the observed localization of Tc 99m tilmanocept. Qualitatively, images of HC indicated no disease-related site-specific localization, whereas localization is present in RA subjects at levels expected given the difference in macrophage number and density in different pathotypes of RA. Notably, images from patients with active RA exhibit the same localization patterns on images taken in a test-retest fashion on the same day as well as in subjects with images acquired on Day 0 and Day 8 (see Figure 1). These results show low imaging readout variability, enabling reliable quantification of joints with RA-involved macrophage-mediated inflammation. Analysis of the HC and RA images was used to determine initial quantitative “cut-points” to differentiate between joints with and without the inflammation typically seen in RA.

Figure 1.

Tilmanocept consistently localizes in areas of macrophage-driven inflammation, demonstrating low variability. RA patients exhibit reproducible localization over a 1-week period. Typical of healthy subjects, no evidence of inflammation-related Tc 99m tilmanocept uptake was observed in the healthy control. Images on the right show same patient imaged on 2 different days.

Conclusion:

Tc 99m tilmanocept imaging of the joints in healthy subjects as well as in patients with active RA under stable treatment is reproducible and stable over time. The results confirmed that the signal in joints of healthy subjects and RA patients can be quantified and used to establish cut points to distinguish inflamed and non-inflamed joints on a joint-by-joint basis. These results provide the foundation for a noninvasive, objective method to monitor activity in macrophage-driven inflammation in joints of patients with RA.

Disclosure of Interests:

Ayah Hussein Employee of: Currently employed by Navidea Biopharmaceuticals, David Ralph Consultant of: Previous consultant for Navidea Biopharmaceuticals, Employee of: Currently employed by Navidea Biopharmaceuticals, Beth Potter Employee of: Currently employed by Navidea Biopharmaceuticals, Bonnie Abbruzzese Employee of: Currently employed by Navidea Biopharmaceuticals, Rachael Hershey Employee of: Currently employed by Navidea Biopharmaceuticals, Katherine Repp Employee of: Previously employed by Navidea Biopharmaceuticals, Haya Shakhtra Employee of: Currently employed by Navidea Biopharmaceuticals, Mehak Goel Employee of: Currently employed by Navidea Biopharmaceuticals, Madison Palmer Employee of: Currently employed by Navidea Biopharmaceuticals, Allison Kissling Employee of: Previously employed by Navidea Biopharmaceuticals, Carley Hartings Employee of: Previously employed by Navidea Biopharmaceuticals, Michael Blue Employee of: Currently employed by Navidea Biopharmaceuticals, Michael Rosol Employee of: Currently employed by Navidea Biopharmaceuticals

Determination of Total, Saturated, Unsaturated, and Monounsaturated Fats in Cereal Products by Acid Hydrolysis and Capillary Gas Chromatography: Collaborative Study

Fifteen laboratories participated in a collaborative study to determine total, saturated, unsaturated, and monounsaturated fats in cereal products by gas chromatographic (GC) analysis of fatty acid methyl esters (FAMEs). Cereal products, representing a wide range of cereal grains and processes, were hydrolyxed in 8N HCI and extracted with ethyl and petroleum ethers. FAMEs were produced by the reaction of the mixed ether extracts with sodium hydroxide in methanol (NaOH/MeOH) and then with boron trifluoride reagent (14% BF3 in MeOH). They were quantitatively determined by capillary GC. Total fat was calculated as the sum of individual fatty acids expressed as triglyceride equivalents in accordance with nutrition labeling guidelines. Saturated, unsaturated, and monounsaturated fats were calculated as sums of individual fatty acids. The total fat contents of samples ranged from 0.56 to 12.64%. A split design was used to determine performance parameters of results obtained by 15 laboratories on 24 samples. Of the 24 samples, 7 were blind duplicates and 5 were independent materials. Statistical analysis for total fat yielded a relative standard deviation for repeatability (RSDr) range of 1.32 to 13.30% and a relative standard deviation for reproducibility (RSDr) range of 4.42 to 22.82%. The goal of this study was to determine total fat, saturated fat, unsaturated, and monounsaturated fat in cereal-based products by complete extraction, methylation, and quantitation of total fatty acids. The acid hydrolysis-capillary GC method for determining total, saturated, unsaturated, and monosaturated fats in cereal products has been adopted by AOAC INTERNATIONAL.