5-year Perspective Research Articles

A 5-year perspective on coronavirus diseases 2019 (COVID-19).

A 5-year perspective on coronavirus diseases 2019 (COVID-19).

The Efficacy of Second-Generation Cervical Spine Arthroplasty: A 5-Year Perspective

Objective: The aim of this study was to determine the surgical outcomes of second-generation cervical arthroplasty in patients with symptomatic cervical disc degeneration at approximately 5 years of follow-up.Methods: A retrospective study was conducted of consecutive patients who underwent elective cervical spine arthroplasty at our institution with the use of a second-generation cervical prosthesis. The inclusion criteria were: (1) patients aged 25 to 50 years, (2) patients undergoing primary cervical surgery, (3) a minimum follow-up of 5 years. Demographic, clinical, surgical, and radiological data were collected and analyzed for patients who met the inclusion and exclusion criteria.Results: Thirty-seven patients were identified. The mean final follow-up was 75.1 months (range, 62.5–92.2 months). Statistically significant improvement was observed at the end of follow-up in the cervical disability index, neck pain, and radicular pain (p<0.001). In total, 89.1% of patients reported being satisfied or very satisfied. During follow-up, 4 patients required reintervention, including 2 for adjacent segment syndrome, 1 for possible implant failure, and 1 for a prevertebral collection. The mean mobility of the operated segment at 5 years was 8.1 (standard deviation, 5.91). Additionally, radiologically, 1 patient exhibited heterotopic ossification, and 5 patients had asymptomatic adjacent segment syndrome.Conclusion: Promising outcomes are associated with second-generation cervical arthroplasty in the management of symptomatic cervical disc degeneration. The improvement in clinical scores, preservation of segmental mobility, and low incidence of complications such as heterotopic ossification and reintervention underscore the potential benefits of second-generation cervical arthroplasty.

Stable microbial community in compacted bentonite after 5 years of exposure to natural granitic groundwater.

The Materials Corrosion Test (MaCoTe) at the Underground Research Laboratory in Grimsel, Switzerland, assesses the microbiology and corrosion behavior of engineered barrier components of a deep geological repository (DGR) for long-term disposal of high-level nuclear waste. Diversity and temporal changes of bentonite-associated microbial community profiles were assessed under DGR-like conditions for compacted Wyoming MX-80 bentonite (1.25 g/cm3 and 1.50 g/cm3 targeted dry densities) exposed to natural groundwater. Using culture-dependent and molecular techniques, samples taken from the outside layer of 5-year borehole modules revealed up to 66% and 23% of 16S rRNA gene sequences affiliated with Desulfosporosinus and Desulfovibrio, respectively. Putatively involved in sulfate reduction, these taxa were almost undetectable within the bentonite core. Instead, microbial profiles of the inner bentonite core were similar to uncompacted bentonite used to pack modules years earlier, and were consistent with a previously published 1-year time point, revealing no detectable microbial growth. Abundances of culturable aerobic and anaerobic heterotrophic bacteria in the uncompacted bentonite were relatively low, with less than 1,000 and 100 colony-forming units (CFUs) per gram dry weight, respectively. Nearly 5 years after emplacement, culturable heterotrophic bacterial CFUs and sulfate-reducing bacteria did not change significantly inside the bentonite core. Phospholipid fatty acid data indicated similar lipid abundance, and corresponding cell abundance estimates, for inner 5-year MaCoTe bentonite samples compared to those previously obtained for 1-year incubations. Collectively, our results provide complementary evidence for microbial stability inside highly compacted bentonite exposed to conditions that mimic engineered barrier components of a deep geological repository. IMPORTANCE The long-term safety of a deep geological repository for used nuclear fuel is dependent on the performance of the engineered and natural barriers. Microbial activity can produce chemical species that can influence the corrosion of the disposal containers for used nuclear fuel. Although previous studies have evaluated the microbiology of compacted bentonite clay within subsurface environments, these have been limited to relatively short incubations (i.e., 1 year). The current study provides a unique 5-year perspective that reinforces previous findings of growth inhibition for bentonite clay exposed to in situ subsurface conditions.

Abstract 10920: Cost-Effectiveness of Pulmonary Vein Isolation with Epicardial Left Atrial Appendage Ligation for the Treatment of Non-Paroxysmal Atrial Fibrillation

Introduction: Electrical isolation of the left atrial appendage (LAA) using percutaneous epicardial ligation may improve catheter ablation outcomes for non-paroxysmal atrial fibrillation (AF) patients. Little is known regarding the cost effectiveness of this procedure. Hypothesis: We hypothesized that cost-effectiveness between pulmonary vein isolation (PVI) + LAA epicardial ligation using a percutaneous LARIAT ® Suture Delivery Device would be cost effective (CE) compared to PVI alone over 5 years. Methods: A Markov model simulated outcomes for a population with annual stroke risk of 4.6% (CHA 2 DS 2 -VASc score 3). Model inputs for procedure efficacy, stroke and bleed events, health utility, and event costs were estimated from literature. Procedure costs from Medicare rates were used. The model had a 5-year time-horizon and US payer perspective. Univariate and probabilistic sensitivity analyses (PSA) were performed. Outcomes were health care costs and quality-adjusted life-years (QALYs). In the base case, PVI + LAA ligation efficacy from published studies was 67% after 1-year, with an estimated 25% oral anticoagulant (OAC) utilization in PVI + LAA ligation patients in normal sinus rhythm 13-60 months after the index procedure. Cost effectiveness thresholds were evaluated with alternative PVI + LAA ligation efficacy and OAC utilization rates, including 1-year PVI + LAA ligation efficacies of 67%, 70%, 75%, and 80% and OAC utilization of 20-60%. Results: In the base case, PVI + LAA ligation had a mean 5-year cost of $72,865 with 3.25 QALYs and PVI alone had mean cost of $69,936 with 3.19 QALYs. The incremental cost-effectiveness ratio was $46,716; PVI + LAA ligation was CE at $50,000 per QALY gained. In PSA, 64% and 82% of simulations were CE at $50,000 and $100,000 per QALY gained, respectively. In various scenarios, procedure efficacy of 75% combined with OAC utilization of 50% or below yielded CE at $50,000 per QALY gained. Reduction of OAC utilization to 30% yielded CE at $50,000 per QALY gained, regardless of efficacy. Conclusions: In the base case, PVI + LAA ligation was CE at $50,000 per QALY gained when compared to PVI alone. The CE threshold for efficacy was 75% and OAC utilization was 30%. Cost savings were driven by reductions in OAC use and increased efficacy.

Future directions for chatbot research: an interdisciplinary research agenda

Chatbots are increasingly becoming important gateways to digital services and information—taken up within domains such as customer service, health, education, and work support. However, there is only limited knowledge concerning the impact of chatbots at the individual, group, and societal level. Furthermore, a number of challenges remain to be resolved before the potential of chatbots can be fully realized. In response, chatbots have emerged as a substantial research area in recent years. To help advance knowledge in this emerging research area, we propose a research agenda in the form of future directions and challenges to be addressed by chatbot research. This proposal consolidates years of discussions at the CONVERSATIONS workshop series on chatbot research. Following a deliberative research analysis process among the workshop participants, we explore future directions within six topics of interest: (a) users and implications, (b) user experience and design, (c) frameworks and platforms, (d) chatbots for collaboration, (e) democratizing chatbots, and (f) ethics and privacy. For each of these topics, we provide a brief overview of the state of the art, discuss key research challenges, and suggest promising directions for future research. The six topics are detailed with a 5-year perspective in mind and are to be considered items of an interdisciplinary research agenda produced collaboratively by avid researchers in the field.

Application of the Delphi Technique to Determine the Technological Competencies of a Faculty Member

<p style="text-align:justify">The formed primary level and dynamic and sustainable development of technological competence provides quality management of teaching activities, increases the efficiency of the educational process, accelerates the achievement of pedagogical goals. Delphi expert assessment technique is increasingly used in the paradigm of pedagogy. Due to the set of advantages and objectivity of assessments, it has become the dominant method of this study. The objective of the study is to determine the current level of manifestation of technological competencies, as well as generalized prospects for development and improvement of the identified level within the selected group of freelance teachers using the technology of independent expert assessments –the Delphi method. In general, the following methods were used in the current study: methods of data collection and coordination, anonymous brainstorming, Delphi expert assessment technique, statistical and mathematical processing of results through Delphi formulas, comparative method, generalisations. The diversified approach to the interpretation of the technological competence of faculty members allowed determining: a) the level of faculty members’ knowledge of modern educational technologies at 89.1%; b) activity-practical aspect of training at 83.0%; c) dissonance between the theoretical and empirical level of teacher training and the algorithm for fulfilling the potential in practice at 21.5%; d) mastery of individual creative technologies for the organisation of an effective educational process at 55.9%; e) forecasted development of technological competencies of faculty members in the 5-year perspective under the condition of application of special control and skill trainings at 50.7%. Conclusion of the study is that according to the arithmetic mean of experts’ assessments of differentiated levels of technological competence, the overall level was 75.1%. The average result of the initial student survey on the estimating of the teachers’ technological competence was 69.7%. The difference of 5.4% between the data allows stating that both methods were relevant in this particular case.</p>

FORECASTING EVALUATION SAFETY MOTOR ROADS BY ESTIMATING SOCIO-ECONOMIC LOSSES FROM ROAD ACCIDENTS

Road safety is a major factor in the economic growth of any country. When complying with all regulatory requirements for safety you can achieve "zero" deaths on the roads, in turn allows the efficient use of budgetary financial resources for other needs. In the conditions of constant growth of the number of vehicles on the highways of Ukraine, without proper development of the infrastructure the probability of accidents on the roads will increase. According to world statistics, every year road accidents kill tens of thousands and injure hundreds of thousands of people. Each traffic accident entails significant socio-economic losses, which depend exponentially on the severity of injuries or the presence of casualties. Thus, the annual amount of socio-economic losses from road accidents reflects the result of economic assessment of road safety. The object of the study is evaluation safety motor roads by the amount of socio-economic losses cased by road accidents in Ukraine and European countries. The purpose of the work is to calculate the approximate forecast of socio-economic losses in Ukraine and European countries until 2025 and to assess the effectiveness of investment in projects to improve road safety. Research methods - analysis of statistical data, forecasting of socio-economic losses on the basis of extrapolation of trends with the determination of the parameters of the quadratic equation by determinant method, comparison of the actual savings from reducing the losses from road accidents, calculation of economic efficiency of measures to improve road safety. The article presents the calculation of socio-economic losses from road accidents with the subsequent forecast of these costs in the 5-year perspective, as well as the evaluation of the effectiveness of investment in measures to improve road safety. It has been confirmed that the financing of road projects to improve road safety provides a significant economic benefit to the national economies of the European Union and Ukraine. The results of the work can be used in the investment process and in the preparation of a feasibility study of road projects.

Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome

BackgroundPerson-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown.ObjectivesTo estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective.MethodsThe mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation.ResultsPerson-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold).ConclusionsPerson-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.

Cost-effectiveness analysis of two attachment systems for mandibular overdenture.

ObjectivesThis study analysed the cost‐effectiveness of two different attachments for the 2‐implant overdenture (2IOD) in edentulous mandibles.Materials and methodsWhen considering alternative treatments, cost‐effectiveness analysis is an important factor for stakeholders (patient, clinician, social security, insurance company, etc.). A general practice population (n = 116) was treated between 2003 and 2013 with a mandibular 2IOD with 2 different ball/stud attachment systems, one spherical (Group D) and one cylindrical (Group L). Patient well‐being was assessed with OHIP‐14‐Total (OHIP‐14‐T), at intake and annually up to 5 years, to calculate the health effect. Initial and maintenance costs of both treatments were inventoried. The cost‐effectiveness was compared. Annual discount rates of 4% and 1.5% were applied to future costs and health outcomes, following Dutch guidelines. Prices were adjusted to the year 2003. To offset the uncertainty in relevant input parameters, a sensitivity analysis was performed using bootstrap analysis. Significance was set at p < .05.ResultsThe health effect was 6.36 (SD 5.32) for Group D and 8.54 (SD 5.63) for Group L. The sum of the discounted costs up to 5 years was EUR 4,210.98 (SD 634.75) for the D and EUR 3,840.62 (SD 302.63) for the Group L (p = .005). The bootstrapping reports that L abutment clearly dominates the D abutment in terms of cost‐effectiveness.ConclusionsThe 2IOD on the L abutment is dominant compared to the 2IOD on D abutment, in a 5‐year perspective.

Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5- and 18-year perspective

BackgroundPrevious research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.MethodsTo get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.ResultsThe results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.ConclusionSleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.

Low DLCO in Idiopathic Pulmonary Arterial Hypertension—Clinical Correlates and Prognostic Significance

Introduction: Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. Material and methods: In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as &lt;55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. Results: Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. Conclusions: Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.

Low DLCO in idiopathic pulmonary arterial hypertension - clinical correlates and prognostic significance.

Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.

A 5-year perspective on a removable overdenture appliance for a patient with osteonecrosis of the jaw, a mandibular resection, and rampant caries

A 78-year-old man with a history osteonecrosis of the jaw and 2 subsequent surgeries to repair a fractured mandible had a condition that contraindicates most dentoalveolar procedures to restore his failing dentition. A Snap-On-Smile overdenture restored his opportunity for natural speech, occlusal function, and esthetics.

The burden of diabetes mellitus in KwaZulu-Natal’s public sector: A 5-year perspective

Background. Diabetes mellitus (DM), together with its devastating complications, has a huge impact on both the patients it affects and the global economy as a whole. The economies of developing countries are already under threat from communicable diseases. More needs to be done to stem the tide of non-communicable diseases like DM. In order for us to develop new strategies to tackle this dread disease we need to obtain and analyse as many data as possible from the geographical area where we work. Objective. To describe the burden of DM in the public sector of the province of KwaZulu-Natal (KZN), South Africa (SA). Method. Data on the number of diabetes visits, DM patients that were initiated on treatment, defaulters and DM-related amputations were accessed from the Department of Health records for the period 2010 - 2014 inclusive. Results. There was a decline in the number of patients initiated on treatment per 100 000 population from 2010 to 2014 inclusive (265.9 v. 197.5 v. 200.7 v. 133.4 v. 148.7). Defaulter rates for 2013 compared with 2014 were 3.31% v. 1.75%, respectively and amputation rates were 0.09% v. 0.05% for 2013 and 2014, respectively. There was a strong proportional relationship observed between the number of defaulters and number of diabetes-related amputations (r=0.801; p=0.000) (Pearson correlation). A notable percentage of DM patients ranging between 63% and 80% were commenced on pharmacological therapy at their local clinics rather than at hospitals in the province. Conclusion. Strategies directed towards detection and treatment of DM, together with decreasing defaulter rates and thereby decreasing diabetes-related amputations, need to be addressed urgently. The majority of patients were initiated on therapy at the clinic level. This emphasises the need to strengthen our clinics in terms of resources, staffing, and nursing and clinician education, as this is where diabetes control begins. Although this study was based solely in KZN, the second most populous province in SA, it probably reflects the current situation regarding DM in other provinces of SA as well.

Incidence of Prediabetes and Type 2 Diabetes among People Aged over 20 Years in Ahvaz: A 5-Year Perspective Study (2009-2014).

Background. The present study is the fourth cohort study conducted in the Middle East on the evaluation of prediabetes and type 2 diabetes, implemented in Ahvaz, Iran. Methodology. The individuals aged over twenty years who had participated in a study on the prevalence of metabolic syndrome in 2009 (Phase 1) in Ahvaz were invited again in 2014. The questionnaires were completed via interview, and anthropometric parameters were measured by standard method. The logistic regression and chi-square test were used for data analysis. Results. In the median of five-year follow-up, a number of 593 people participated in reexamination from which 396 individuals were nondiabetic in Phase 1. The incidence of diabetes and prediabetes was 21.9 and 40.6 per 1000 person-years, respectively. Among Phase 1 prediabetics, 16.8% were diagnosed with diabetes in a five-year period. The factors affecting the incidence of prediabetes among the people younger than 65 years include age, family history of diabetes, and gender. The age factor plays an important role in the transformation of prediabetes to diabetes. Conclusion. The city of Ahvaz with type 2 diabetes incidence of 13.64 per 1000 person-years is one of the areas with high incidence of diabetes in Iran.

Acute Myeloid Leukaemia Treatment in Adults in Norway Five Year Survival and Costs

Background: Acute myeloid leukaemia (AML) is a cancer that affects approximately 173 patients per year in Norway with a median age of 69 years at diagnosis. Many patients will not tolerate intensive chemotherapy with curative potential and such treatment is usually given to patients below 70 years. AML is characterized by an abnormal growth of the white blood cells in the bone marrow, which causes anaemia, thrombocytopenia and infections. Intensive treatment with curative potential requires hospitalisation over several months with the potential for life-threatening complications, such as opportunistic infections. About one-third of the patients are eligible for stem cell transplantation. Improving treatments strategies involves understanding the clinical pathways and identifying the associated costs. We conducted a retrospective analysis in Norway based on a similar study from the UK [1]. Similar survival and cost studies on AML have not been performed in Norway.Objective: The aim of this study was to investigate the life expectancy and costs associated with treating AML in order to provide a representation of the Norwegian treatment regime by adapting a model developed for AML in the UK.Methods: A probabilistic model combining a decision tree for the induction treatment and Markov models for remissions, relapses and transplantation was developed to conduct the study. The outcome was life expectancy and expected costs per patient in a 5-year perspective. Life expectancy and costs were estimated for two age groups (16-59 years and ≥60 years) and three different initial treatment regimens (Ara-C+Daunorubicin, Ara-C+Idarubicin and Other) and three responses (response, no response and early death). In the Markov models patients were distributed according to whether they achieved remission, had relapse of leukaemia, received transplantation or palliative care. Transition probabilities were estimated by means of Weibull regressions using individual level data from Oslo University Hospital - Rikshospitalet. The data set contained 307 patients diagnosed and treated between 2000 to 2014. Not all regressions were significant. Still, the insignificant regressions were included by the argument of a small cohort. Information on costs of treatment was partly based on individual level information for patient included in the sample (such as chemotherapy, blood usage, antibiotics and length of stay) and average cost estimates, such as transplantation and cost of care per day according to departments at the hospital.Results: The total mean five year discounted cost and life expectancy was $ 199 828 and 31.87 months, ranging from $ 172 303 to $ 241 727 and 25.37 to 35.63 months per patient, respectively, depending on treatment regime and response. For young patients responding to treatment the mean five year discounted cost and life expectancy was $ 180 702 and 33.53 months, ranging from $ 137 824 to $ 220 896 and 22.14 to 38.77 months per patients. For elderly patients responding to treatment the mean cost and life expectancy was $ 120 711 and 18.77, ranging from $ 72 547 to $ 170 459 and 11.43 to 30.05. This implies heterogeneity in the AML population. The results indicate a better life expectancy and higher costs for young, compared to elderly patients. The model was validated by the use of face, internal, external and cross-validation methods. The results showed a fairly good fit with the empirical overall survival based on numbers from the Norwegian Cancer Registry, and the structure of the model corresponded well with the model developed for the UK.Conclusions: AML life expectancy and costs vary according to clinical pathways and patient characteristics. Both survival and costs may be influenced by the inclusion of new molecular diagnostic tools and new treatment. This AML model may be used to evaluate treatments and enable policy makers to initiate informed decisions.1. Wang, H.I., et al., Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model. Value Health, 2014. 17 (2): p. 205-14. DisclosuresNo relevant conflicts of interest to declare.

Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective.

Adoption and implementation of evidence-based measures for catheter care leads to reductions in central line-associated bloodstream infection (CLABSI) rates in the NICU. The purpose of this study is to evaluate whether this rate reduction is sustainable for at least 1 year and to identify key determinants of this sustainability at the NICU of the Floating Hospital for Children at Tufts Medical Center. We reviewed the incidence of CLABSIs in the NICU temporally to the implementation of new practice policies and procedures, from July 2008 to December 2013. Adoption of standardized care practices, including bundles and checklists, was associated with a significant reduction of the CLABSI rate to zero for >370 consecutive days in our NICU in 2012. Overall, our CLABSI rates decreased from 4.1 per 1000 line days in 2009 (13 infections; 3163 line days) to 0.94 in 2013 (2 infections; 2115 line days), which represents a 77% reduction over a 5-year period. In the first quarter of 2013, there was a brief increase in CLABSI rate to 3.3 per 1000 line days; after a series of interventions, the CLABSI rate was maintained at zero for >600 days. Ongoing training, surveillance, and vigilance with catheter insertion and maintenance practices and improved documentation were identified as key drivers for success. High-quality training, strict compliance with evidence-based guidelines, and thorough documentation is associated with significant reductions in CLABSIs. Mindful organizing may lead to a better understanding of what goes into a unit's ability to handle peak demands and sustain extraordinary performance in the long-term.

Vulnerable Patients with Aortic Stenosis: A 5-Year Perspective from PARTNER

Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic alternative for patients with severe aortic stenosis whose surgical risk is

Abstract 305: Cost of Hospitalization for High Risk Percutaneous Coronary Intervention in the US: A 5-Year Contemporary Perspective

Background: Utilization of intra-aortic balloon pump (IABP) and left ventricular assist device (LVAD) during percutaneous coronary intervention (PCI) has increased in recent years. We analyzed the trends and predictors of hospitalization cost associated with high risk PCI in US over a 5 year period (2005-2010). Methods: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2005 and 2010 using the ICD9 procedure code of 36.07 and 36.06 for PCI. The NIS represents 20% of all hospitals in the US and is the largest all payer hospital discharge database. We defined high risk PCI as PCI plus LVAD (ICD-9 code 37.68, 37.62) or IABP placement (ICD-9 code 37.61) during the same hospital admission. We examined the selective contribution of patient demographics, insurance type, and hospital characteristics, Deyo modification of Charlson comorbidity index (CCI) and hospital PCI volume (split into quartiles with first quartile as referent) to hospitalization cost. For each year, cost was adjusted for inflation according to the 2010 cost. The independent predictors of hospitalization cost were calculated by mixed effects linear regression modeling incorporating hospital ID as random effects. Results: 26,300 (weighted n = 130,151) number of patients were identified. Overall hospitalization cost associated with high risk PCI increased from $137,354 in 2005 to $160,736 in 2010 (P&lt;0.001), with $131,239 in 2005 to $158,937 in 2010 for IABP (P&lt;0.001) and $185,774 in 2005 to $243,657 in 2010 for LVAD (P&lt;0.001). The independent predictors of increased hospitalization cost associated with high risk PCI on a multivariable analysis included teaching hospital (+$10,212, p = 0.005), CCI = 2 (+$17,824, p= 0.001), CCI 3 or more (+$36,354, p= 0.001), presence of myocardial infarction (MI) or shock (+$9,094, p&lt;0.001) and occurrence of any of periprocedural complication (+$68,704, p&lt;0.001). The independent predictors of decreased hospitalization cost for high risk PCI included use of IABP vs. LVAD (-$51,783, p&lt;0.001), female sex (-$3,567, p =0.01) and private insurance (-$6,840, p=0.001) or self-pay, no insurance (-$10,541, p&lt;0.001) compared to Medicare/Medicaid as referent. Conclusion: In this observational study we demonstrated that increased hospitalization cost for high risk PCI is associated with teaching hospital, CCI, presence of MI or shock and occurrence of periprocedural complications. We also found use of IABP, female sex, having private, self-pay or no insurance to be associated with a decreased hospitalization cost related to high risk PCI in the US over a 5 year period from 2005-2010.

Miniaturization of left ventricular assist devices: the ongoing trend

The shortage of appropriate donor hearts and the expanding pool of patients waiting for a heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. With expanding clinical experience and continued technical advances, continuous-flow pumps are evolving from bridge to transplantation to destination therapy for advanced heart failure. This review describes the clinical use and outcome of currently available miniaturized left ventricular assist devices (LVADs). It provides an outlook of the ongoing process of the miniaturization of LVADs, new concepts of partial support and, furthermore, it commentates on the current challenges with LVADs and the 5-year perspective.