Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members

PURPOSE

The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS).

METHODS

A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed.

RESULTS

A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS -members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible.

CONCLUSION

There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.

Appearance of reassortant European avian-origin H1 influenza A viruses of swine in Vietnam

Three subtypes-H1N1, H1N2 and H3N2-of influenza A viruses of swine (IAVs-S) are currently endemic in swine worldwide, but there is considerable genotypic diversity among each subtype and limited geographical distribution. Through IAVs-S monitoring in Vietnam, two H1N2 influenza A viruses were isolated from healthy pigs in Ba Ria-Vung Tau Province, Southern Vietnam, on 2 December 2016. BLAST and phylogenetic analyses revealed that their HA and NA genes were derived from those of European avian-like H1N2 IAVs-S that contained avian-origin H1 and human-like N2 genes, and were particularly closely related to those of IAVs-S circulating in the Netherlands, Germany or Denmark. In addition, the internal genes of these Vietnamese isolates were derived from human A(H1N1)pdm09 viruses, suggesting that the Vietnamese H1N2 IAVs-S are reassortants between European H1N2 IAVs-S and human A(H1N1)pdm09v. The appearance of European avian-like H1N2 IAVs-S in Vietnam marks their first transmission outside Europe. Our results and statistical analyses of the number of live pigs imported into Vietnam suggest that the European avian-like H1N2 IAVs-S may have been introduced into Vietnam with their hosts through international trade. These findings highlight the importance of quarantining imported pigs to impede the introduction of new IAVs-S.

System for time-resolved laser absorption spectroscopy and its application to high-power impulse magnetron sputtering

This paper deals with the development and construction of an apparatus for time-resolved tunable diode laser absorption spectroscopy (LAS) for the diagnostics of pulsed plasma. A detailed description of the extension of a progressive method of laser absorption spectroscopy in continuous regime to a direct triggering method of the time-resolved laser absorption spectroscopy (TR-LAS) is presented. The main advantage of the developed method is its capability to measure the time evolution of the whole absorption profile with a preset time resolution, which can be less than 1 μs. Therefore, the presented method of repetitive sampling applied on LAS in plasma processes is capable of simultaneous measurement of the density and kinetic temperature of selected particles. Its appropriate applications are to periodical processes in technological plasma, namely pulsed plasma discharges. The developed method of TR-LAS was applied to measurements of the temporal evolution of density and kinetic temperature of argon metastable species during high-power impulse magnetron sputtering of titanium and titanium dioxide thin films.

Abstract P3-15-06: No Correlation between Endocrine Symptoms and Musculoskeletal Symptoms in Women Receiving Adjuvant Aromatase Inhibitor Therapy

Background:

The etiology of Aromatase Inhibitor (AI) associated musculoskeletal symptoms remains unclear. It has been proposed that musculoskeletal side effects are related to the estrogen depletion achieved on AI therapy. Estrogen depletion with AI therapy is known to result in endocrine side effects. The 18-item Functional Assessment of Cancer Therapy Breast Cancer-Endocrine Subscale (FACTB-ES) is a reliable and well validated quality of life questionnaire shown to be sensitive to changes in endocrine symptoms in breast cancer patients. The objective of this study was to determine whether among women with breast cancer treated with adjuvant AI therapy, self reported musculoskeletal side effects correlate with increased hormonal side effects as measured by the FACTB-ES. Methods:

In this 6 month, single center, prospective cohort study, post-menopausal women with hormone-sensitive, non-metastatic breast cancer prescribed AIs by their treating oncologist were evaluated by a rheumatologist at baseline (before starting the AI) and at 6 months. Women who reported new or worsening musculoskeletal symptoms since starting the AI were classified as symptomatic. The FACTB-ES was administered at each visit.

Changes in scores between baseline and 6 months were compared between

the symptomatic and asymptomatic groups

Results:

Thirty-five subjects completed the 6 month follow up period. Nineteen (54%) were symptomatic and n=2 (5.7%) discontinued the AI due to these musculoskeletal symptoms. Mean time to onset of symptoms was 6 weeks (range 2 to 18 weeks). Baseline characteristics including age, ethnicity and body mass index did not differ between the groups. There was no significant difference in hormonal symptoms between groups. Both groups had equivalent worsening of their endocrine symptoms as seen by the reduction in their FACTB-score. The mean change in FACTB-ES score was -2.52 (range: -31.00, 23.00) in the symptomatic women versus -2.06 (range: -19.00, 22.21) in the asymptomatic women (Wilcoxon rank sum p=0.95). Conclusions:

These data suggest that endocrine symptoms as measured by the FACTB-ES do not correlate with the development of musculoskeletal pain in women treated with adjuvant AI therapy for breast cancer. Though larger studies are necessary to confirm these results, the musculoskeletal symptoms associated with AI use may not be estrogen-dependent.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-15-06.

Cost implications of delayed radiotherapy for early stage breast cancer

6549

Background: Delayed radiotherapy (RT) for early invasive breast cancer has been shown to increase recurrence rates, but whether it influences costs of treatment or downstream medical care is unknown. Methods: Using linked SEER-Medicare data from 1992–2005 for 5,905 women ages 66+ diagnosed with stage I breast cancer undergoing post-lumpectomy RT, we estimated mean total monthly costs paid by Medicare by phase of care (treatment, continuing, or terminal care). Continuing care covers costs after treatment including for recurrences, and terminal phase includes costs in the last 6 months of life. We evaluated whether costs were different by timely vs. delayed RT (delay = 12 weeks post-surgery, or 8 weeks post-chemotherapy) and patient characteristics including comorbidity, age, and race. Results: Mean monthly treatment costs were $427 lower for women with delayed RT (p < 0.00001), but monthly continuing-care costs were $129 higher (p < 0.00001). Delayed RT yielded a 26% decrease in monthly treatment costs (p < 0.0001) and 20% increase in continuing-care costs (p < 0.0001) in multivariable analyses, and inpatient comorbidity index>1 yielded cost increases of 12% (p = 0.03) and 70% (p < 0.0001) in those phases, respectively, compared to no comorbidity. Terminal phase costs were affected primarily by inpatient comorbidity index>1 (86% cost increase compared to no comorbidity, p < 0.0001) and black race (52% cost increase compared to white, p = 0.02), but not delayed RT. Treatment phase averaged 2.5 months longer for women with delayed RT (p < 0.00001). Average post-treatment follow-up was 7 years. Conclusions: Delayed RT is associated with lower mean monthly costs for treatment but higher continuing-care phase costs, possibly due to higher recurrence rates. Treatment was longer for women with delayed RT, even if total treatment cost is the same, making the average monthly cost for delayed RT lower. Preliminary analysis suggests that total average costs through follow-up are nearly $11K higher for women experiencing delayed RT. Combined with higher recurrence rates, delayed RT likely is worse in terms of both costs and effectiveness.

No significant financial relationships to disclose.

Impact of timeliness of breast radiotherapy on health outcomes in early breast cancer

6591

Background: The objective of this study is to understand the impact of timely radiotherapy on disease-free survival (DFS) in early breast cancer patients ages 65 and above. Methods: The study population is women diagnosed from 1991–1999 in the linked SEER-Medicare database who underwent breast-conserving surgery and radiotherapy within 6 months of diagnosis. Median followup varies from 4 years for ductal carcinoma in situ (DCIS)(n=1,185) to 5 years for Stage 1 disease (n=7,481), and ranges from 0–11 years. Descriptive and proportional hazards analysis of this longitudinal cohort were conducted. Covariates include age, race, poverty, marital status, comorbidity, rurality, radiation completion and delay, elapsed time since diagnosis, comedo necrosis histology (DCIS only), and chemotherapy receipt (Stage 1 only). Subjects were censored at end of followup (including enrolling in Medicare managed care from Medicare fee-for-service) or death. Treatment delay is defined as radiotherapy beginning 8+ weeks post-surgery without chemotherapy or 4+ weeks after chemotherapy ends; other definitions also were explored. Radiotherapy is considered complete if the patient received greater than 16/22 of expected treatments, based on scientific literature. Results: DFS is negatively associated with radiation delay (OR=1.24, p=0.003 for Stage 1; OR=1.40, p=0.054 for DCIS) and Klabunde's inpatient comorbidity index (OR=1.32, p=0.004 for Stage 1; OR=1.66, p=0.065 for DCIS). Additional analyses suggest that a longer delay of 12+ weeks post-surgery (16+ weeks post-chemotherapy) further reduces DFS (OR=4.66, p<0.0001 for Stage 1; OR=12.4, p<0.0001 for DCIS). Non-white women with Stage 1 disease are more likely to delay radiotherapy (p<0.0001), but are not more likely to have worse outcomes (p>0.3). Conclusions: Delayed initiation of radiation therapy is associated with decreased DFS following radiotherapy for early breast cancer and DCIS. Non-white race is associated with delay, but not reduced DFS. Programs targeting referring physicians and patients should be developed to promote timely receipt of radiotherapy by early breast cancer patients, thereby reducing the risk of adverse health outcomes.

No significant financial relationships to disclose.

Economic impact of hyponatremia in hospitalized patients with cancer

17053

Background: Hyponatremia, defined as a serum sodium concentration ([Na+]) =134 mEq/L, is a common electrolyte abnormality in hospitalized cancer patients that may be caused by the primary tumor or metastasis, diagnostic or therapeutic interventions, or a secondary complication. Hospital-acquired hyponatremia is associated with higher costs of care, but many patients present with hyponatremia at admission. Methods: This retrospective case-controlled study assessed the outcomes and cost of care among patients hospitalized for neoplasm who presented with hyponatremia at admission. Laboratory and cost-accounting data from 841 adult patients admitted to an 811-bed university hospital between January 2004 and May 2005 with a principal diagnosis of neoplasm and either mild-to- moderate or moderate-to-severe hyponatremia (serum [Na+] 130–134 mEq/L or <130 mEq/L, respectively) were compared with data from control subjects with matching ICD-9 codes and normal serum [Na+] (135–145 mEq/L) at admission during the same period. Endpoints included hospital length of stay (LOS), ICU admissions, in-hospital mortality, and total costs per admission. Results: Hyponatremia was evident in 18.9% of patients admitted for neoplasm. Patients with moderate-to-severe hyponatremia (n=192) and mild-to- moderate hyponatremia (n=649) demonstrated a significantly longer hospital LOS, higher ICU admission rate, higher in-hospital mortality, and higher median costs than control subjects (n=3610) (Table). These differences among groups remained significant after adjustments were made for age, race, sex, and comorbidity score. Conclusions: Cancer patients presenting with hyponatremia at admission have a longer hospital LOS and higher risk of death and cost of care than do cancer patients presenting without hyponatremia.

[Table: see text]

No significant financial relationships to disclose.