Academic Medical Institution Research Articles

Feeding and Swallowing Characteristics of Children With Esophageal Atresia and Tracheoesophageal Fistula.

This study aimed to characterize feeding/swallowing difficulties in children with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) and evaluate associations among feeding difficulties, pharyngeal dysphagia (PD), and other aerodigestive evaluation findings. This was a retrospective cohort study of feeding/swallowing characteristics of 44 patients with EA/TEF treated in the aerodigestive program of a single academic medical institution from 2010 to 2015. Demographics, comorbidities, presence and characteristics of feeding/swallowing difficulties, and results of relevant diagnostic tests [videofluoroscopic swallow studies (VFSS), clinical feeding evaluations (CFEs), chest computerized tomography (CT) scans, pulmonary bronchoscopies, and upper GI (UGI)/esophagrams] were reviewed. Fifty percent of the cohort had PD and 88.6% had feeding difficulties. Across 118 encounters (87 VFSS and 31 CFEs), feeding difficulties suggestive of esophageal dysphagia were most frequently seen in children over 48 months and feeding difficulties suggestive of developmental feeding problems were most frequently seen in children from 24 to 48 months. Abnormal findings were present in 59.8% of VFSS, with aspiration (34.5%) and pharyngeal residue (26.4%) the most frequently observed signs of dysphagia. Abnormal UGI/esophagram findings were not associated with significantly increased risk of feeding difficulties during visits within 3 months (risk ratio, RR = 1.33). Presence of dysphagia was associated with increased risk for some abnormal CT findings (RR= 3.0 for airspace and 3.0 for bronchiectasis). Feeding/swallowing difficulties are common in EA/TEF, and types of feeding difficulties vary by patient age. The presence of abnormal findings on UGI/esophagram did not increase the risk of feeding complaints; however, the presence of dysphagia increased the risk of abnormal chest CT.

Fellow Efficiency During Anterior Cruciate Ligament Reconstruction Improves Over Time, Yet Is Less Than Experienced Physician Assistant But With No Significant Difference in Patient-Reported Outcomes

To evaluate the intraoperative efficiency and patient outcomes of anterior cruciate ligament reconstruction (ACLR) assisted by a sports medicine fellow over the course of the academic year compared with an experienced physician assistant (PA). A single-surgeon cohort of primary ACLRs with either bone-tendon-bone autograft or bone-tendon-bone allograft (without any other significant time-consuming procedures such as meniscectomy/repair) were evaluated using a patient registry system over 2 years assisted by an experienced PA compared with an orthopaedic surgery sports medicine fellow. There were 264 primary ACLRs included in this study. Outcomes included evaluation of surgical time, tourniquet time, and patient-reported outcome measures. The surgical efficiency of the fellow (as measured by surgical time and tourniquet time) improved over each academic quarter. Patient-reported outcomes between the 2 first-assist groups showed no significant difference over 2 years with both ACL graft groups combined. ACLRs assisted by the PA showed shorter tourniquet times by 22.1% and shorter total surgical times by 11.9% compared with the sports medicine fellows when both grafts were combined (P < .001). The surgical and tourniquet times (minutes) for the fellow (standard deviation of surgical time 19.5-25.0 and tourniquet time 19.5-25.0) did not average out to be more efficient in any of the 4 quarters of the year compared with the PA-assisted group (standard deviation of surgical time 14.4-14.8 and tourniquet time 14.8-22.4). Autografts showed more efficient tourniquet (18.7%) and skin-to-skin surgical times (11.1%) in the PA group compared with the fellow group (P < .001). Allografts showed more efficient tourniquet (37.7%) and skin-to-skin surgical times (12.8%) in the PA group compared with the fellow group (P < .001). The surgical efficiency of the fellow during primary ACLRs improves over the academic year. Patient-reported outcomes are similar in cases assisted by the fellow compared with an experienced physician assistant. Cases assisted by the PA were performed more efficiently compared with the sports medicine fellow. The intraoperative efficiency of a sports medicine fellow objectively improves over the academic year for primary ACLRs but may not be as efficient as an experienced advanced practice provider; however, there appears to be no significant differences in patient-reported outcome measures between the 2 groups. This helps quantify the time commitment for attendings and academic medical institutions as the "cost of education" of trainees such as fellows.

Evaluating YouTube videos on sialendoscopy as an educational resource for patients.

Patients are increasingly relying on YouTube for health information. We objectively evaluated the quality and comprehensiveness of sialendoscopy YouTube videos available to patients. We further investigated the relationship between video content and video popularity. We identified 150 videos using the search term "sialendoscopy." Videos were excluded if they were lectures for medical professionals, operating room (OR) recordings, unrelated, non-English, or non-audio. Video quality and comprehensiveness were evaluated using modified DISCERN criterion (range: 5-25) and novel sialendoscopy criterion (NSC, range: 0-7), respectively. Secondary outcomes included standard video metrics and Video Power Index to measure popularity. Videos were classified binarily by uploader type as from an academic medical center or from other sources. Twenty-two (14.7%) of 150 videos were included for review, with 7 (31.8%) uploaded from academic medical institutions. One hundred-nine (72.7%) videos were excluded as lectures for medical professionals or OR recordings. Overall mean modified DISCERN (13.45 ± 3.42) and NSC (3.05 ± 0.96) scores were low; however, videos uploaded by academic medical institutions were significantly more comprehensive (NSC mean difference=0.98, 95% CI: 0.16-1.80, p=.02). There were no significant correlations between video popularity and objective measures of quality or comprehensiveness. This study highlights the paucity and low quality of sialendoscopy videos for patients. More popular videos are not higher quality, and most videos are targeted more toward physicians rather than patients. As YouTube becomes increasingly used by patients, there is opportunity for otolaryngologists to produce more informative videos for patients while implementing targeted strategies to increase viewership. NA.

Implementation of an Online Reporting System to Identify Unprofessional Behaviors and Mistreatment Directed at Trainees at an Academic Medical Center

Unprofessional behaviors and mistreatment directed at trainees continue to challenge the learning environment. Academic medical institutions should encourage reports of inappropriate behavior and address such reports directly to create a safe learning environment. To determine the feasibility of creating and implementing an online reporting system for receiving and reviewing complaints of unprofessional behavior directed toward or experienced by students, postdoctoral trainees, and residents. This cohort study assessed implementation of an online reporting system (feedback form) with a method for triaging reports, providing both positive and negative feedback, as well as adjudication and transparent public disclosure of aggregate data. The system was launched at a large urban academic medical center with numerous trainees that is fully integrated with a health system of 8 hospitals. Participants included faculty who interact with trainees, medical students, graduate students and postdoctoral fellows, and residents and clinical fellows. Follow-up began in October 2019 (at the time of tool launch) and lasted through December 2021. Data were analyzed from January to March 2022. The primary outcomes were the numbers and types of reports according to the reporter and the person reported about. Participants included 2900 faculty who interact with trainees, 600 medical students, more than 1000 graduate students and postdoctoral fellows, and 2600 residents and clinical fellows. Trainees submitted 196 reports, 173 (88.3%) of which described unprofessional interactions. Among the reports describing unprofessional behavior, 60 (34.7%) were from medical students, 96 (55.5%) were from residents and fellows, 17 (9.8%) were from graduate students or postdoctoral trainees, and 78 (45.1%) were from men. The majority of negative reports described behaviors by faculty (106 [61.3%]), followed by residents and fellows (24 [13.9%]). Twenty faculty (<1.0%) accounted for 52 (50.0%) of the 104 reports describing unprofessional behaviors. Since implementation, most trainees are aware of this process. An increasing number have reported instances of mistreatment, and those who shared concerns through the online system report satisfaction with the outcome of the response to the report. In this cohort study, the new reporting mechanism facilitated identification of the small number of individuals associated with unprofessional behaviors toward trainees and increased awareness of the school's commitment to creating a safe learning environment.

Portability of natural language processing methods to detect suicidality from clinical text in US and UK electronic health records.

In the global effort to prevent death by suicide, many academic medical institutions are implementing natural language processing (NLP) approaches to detect suicidality from unstructured clinical text in electronic health records (EHRs), with the hope of targeting timely, preventative interventions to individuals most at risk of suicide. Despite the international need, the development of these NLP approaches in EHRs has been largely local and not shared across healthcare systems. In this study, we developed a process to share NLP approaches that were individually developed at King's College London (KCL), UK and Weill Cornell Medicine (WCM), US - two academic medical centers based in different countries with vastly different healthcare systems. We tested and compared the algorithms' performance on manually annotated clinical notes (KCL: n = 4,911 and WCM = 837). After a successful technical porting of the NLP approaches, our quantitative evaluation determined that independently developed NLP approaches can detect suicidality at another healthcare organization with a different EHR system, clinical documentation processes, and culture, yet do not achieve the same level of success as at the institution where the NLP algorithm was developed (KCL approach: F1-score 0.85 vs. 0.68, WCM approach: F1-score 0.87 vs. 0.72). Independent NLP algorithm development and patient cohort selection at the two institutions comprised direct comparability. Shared use of these NLP approaches is a critical step forward towards improving data-driven algorithms for early suicide risk identification and timely prevention.

Community-Academic Partnerships: A Report on the COVID Support Our Schools (SOS) Initiative.

The SARS-CoV-2 pandemic disrupted the delivery of education in our school systems and exacerbated pre-existing health and educational disparities. School administrators and staff from underserved communities struggled with continuously changing medical guidance, ensuring equitable education by virtual platforms, and re-opening schools safely. The Hackensack Meridian School of Medicine (HMSOM) partnered with statewide resource-limited school districts to create the COVID Support Our Schools (SOS) initiative. This consisted of a physician advisory board, medical student task forces, and community leaders. Numerous sessions were hosted by the COVID SOS team to answer questions, address community needs, and carry out initiatives to meet identified needs. Surveys, including Likert scale questions and open-ended feedback, were administered to all participating school districts. In total, 100% of respondents strongly agreed or agreed that the COVID SOS program was dedicated to community needs and provided timely support with necessary resources. Open-ended feedback described that the K-12 school districts valued our partnership as well as found the opportunity to engage with other districts informative and rewarding. The partnership between our academic medical institution and community school districts is mutually beneficial, providing an opportunity for medical student service learning as well as imparting medical expertise in times of need.

Low-Cost High-Fidelity Minimally Invasive Myomectomy Model for Laparoscopic and Robotic-Assisted Simulation

<h3>Study Objective</h3> The objective of this video is to demonstrate the creation and use of a low-cost, high-fidelity model for simulating a minimally invasive myomectomy. <h3>Design</h3> N/A. <h3>Setting</h3> A simulation center within an academic medical institution. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Residents trialed a high-fidelity model created from a porcine tongue and small potatoes to represent a fibroid uterus. A grounding pad was affixed to the model in order to allow for the use of energy sources. A laparoscopic tower as well as a simulation robot was used to carry out the procedure. <h3>Measurements and Main Results</h3> The model was used to demonstrate the four components of a minimally invasive myomectomy: 1) planning and placement of the hysterotomy, 2) incision, 3) extraction of the fibroid, and 4) suturing the fibroid bed. Residents who used the model "agree"-d to "strongly agree"-d on a 5-point Likert scale that the model simulated in vivo tissue, and all felt that using the model helped them feel more comfortable participating in a minimally invasive myomectomy in the future. <h3>Conclusion</h3> Use of this novel high-fidelity myomectomy model allowed medical trainees to feel more comfortable participating in a minimally invasive myomectomy. Future directions for this model include validating the model in a larger population of trainees and surgeons with various experience levels and using this model to simulate entry into the endometrial cavity.

Determinants and barriers to junior faculty well-being at a large quaternary academic medical center: A qualitative survey

BackgroundIncreasing levels of burnout among trainees and faculty members at all levels is a major problem in academic medicine. Junior faculty members may be at unique risk for burnout and have unique needs and barriers that contribute to attrition, job satisfaction, and overall workplace well-being. MethodsTwenty-seven faculty members at the assistant professor level at a large, quaternary referral academic medical institution were interviewed. A qualitative analyst with no reporting relationship to faculty was used as the proctor. Seven scripted questions targeting faculty well-being and institutional barriers to well-being were administered, and the responses were coded for common themes between respondents. ResultsRespondents most commonly identified clinical work (26%), research (19%), and teaching (19%) as the best aspects of their job. Among respondents, 3% stated they were not able to devote as much time as they would like to work they enjoyed and found most meaningful. Of these respondents, 44% cited “insufficient help” as the root cause. Also, 33% stated time spent writing and managing institutional review board requirements was a major contributor, and 22% cited both clinical volume/performance benchmarks and administrative responsibilities as significant barriers. The most common responses to departmental factors that can be improved included moving meetings to during the workday versus after hours, establishing a similar value system/metric for all faculty, and providing more opportunities to interact with faculty across divisions. The most common barriers to change identified were difficulty hiring research support, patient volume and clinical demands, and a pervasive culture of continuing to work after the workday has ended. At an institutional level, provision of childcare and promotion of basic science research were identified as areas for improvement. More actionable items were identified at the departmental rather than institutional level (53 vs 34). ConclusionsJunior faculty well-being is most affected at the department level. Qualitative data collection from junior faculty regarding barriers to well-being and academic/clinical productivity can be invaluable for departments and institutions seeking to make cultural or systemic improvements.

Correction to: Prevalence and predictors of inappropriate apixaban dosing in patients with non‑valvular atrial fibrillation at a large tertiary academic medical institution

Correction to: Prevalence and predictors of inappropriate apixaban dosing in patients with non‑valvular atrial fibrillation at a large tertiary academic medical institution

Community-Based COVID-19 Vaccine Clinics in Medically Underserved Neighborhoods to Improve Access and Equity, Philadelphia, 2021-2022.

Vaccination remains key to reducing the risk of COVID-19-related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clinics in medically underserved neighborhoods in Philadelphia, Pennsylvania. Over a 13-month period (April 2021-April 2022), the initiative delivered 9038 vaccine doses to community members, a majority of whom (57%) identified as Black. (Am J Public Health. 2022;112(12):1721-1725. https://doi.org/10.2105/AJPH.2022.307030).

Development and implementation of centralised, cloud-based, employee health contact tracing database and predictive modelling framework in the COVID-19 pandemic

At the onset of the COVID-19 pandemic in early March, 2020, it became apparent that non-electronic exposure investigations would not meet the demands required by the mounting number of employees with COVID-19 in the Mount Sinai Health System in New York City (NY, USA), a multicentre, academic medical institution and hospital system. New York City was an epicentre early in the pandemic, resulting in a peak of more than 6000 cases daily and more than 1000 deaths per day.1 Agile exposure investigation and contact tracing were crucial to containing the spread of COVID-19 among hospital staff.

Pre- and Post-Surgery Attitudes on Gender Identity and Expression

Introduction: Transgender and gender non-binary (TGNB) patients may choose to receive gender-affirming surgery (GAS) in order to better align their bodies with their gender identities. In this study, we examined the change in patients’ comfort, both with their physical appearance and interpersonal interactions, before and after transfeminine GAS through a validated survey tool. Methods: The study was performed at an academic medical institution’s center for transgender medicine and surgery, assessing the outcomes of patients who had undergone GAS. This included vaginoplasty, facial feminization, or chest feminization surgery. The survey included binary questions related to gender identity and Likert scale interpersonal questions. The pre-surgery mean response to each of the 14 survey questions was compared with the mean response 12 months post-surgery using a two-sample t-test assuming equal variances. Results: Patients receiving transfeminine GAS were administered the survey pre-surgery (398 respondents), 2 weeks post-surgery (263 respondents), 6 months post-surgery (94 respondents), and 12 months post-surgery (68 respondents). The mean responses post-surgery for a majority of the survey questions were significantly closer to 0, meaning that patients disagreed significantly more strongly with the survey questions after receiving gender-affirming surgery, while also showing improvement in patients’ sense of how others perceived them. Conclusion: Patients choose to undergo GAS in order to better align their physical appearance with their gender identity. Our findings indicate that patient’s comfort with others’ perceptions of their gender continues to improve over time after GAS. These findings should contribute to better public understanding of GAS and its medical necessity.

Reducing the Incidence of PONV in Facial Feminization Surgery through a Standardized Anesthetic Regimen

Introduction: Postoperative nausea and vomiting (PONV) continues to be a major issue for patients undergoing facial feminization surgery (FFS In this study, we aim to examine risk factors and the incidence of PONV before and after the implementation of a new anesthetic and antiemetic regimen throughout all surgical stages; preoperative, intraoperative, and postoperative. Methods: A retrospective cohort study was performed on 158 patients who received FFS at an academic medical institution’s center for transgender medicine and surgery between 2018 and 2022. Of these, 117 patients underwent FFS with no specific antiemetic regimen, and were given antiemetics for nausea or vomiting as seen fit by their surgeon, and 41 patients underwent FFS with the new intervention. Odds Ratios were computed via logistic regression using RStudio to adjust for age, BMI, and smoking status (defined as a patient reported “ever smoker” vs “never smoker”). Results: 80 out of 117 (68%) patients on the old regimen experienced PONV, compared with 8 out of 41 (19%) of patients on the new regimen. After adjusting for age, BMI, and smoking status, the new regimen is associated with a 6 fold reduction in PONV, with a calculated odds ratio of 0.15 (95% CI: 0.06, 0.36; p = 3.9x10^-5) compared with the old regimen. Conclusion: Among patients undergoing FFS, a novel antiemetic regimen reduced the incidence of PONV by 6-fold when compared with standard of care. By introducing an appropriate antiemetic prophylaxis, tailored specifically to curb PONV, providers can ensure a more comfortable postoperative experience for patients.

Prevalence of and Risk Factors for Emergency Department Visits After Outpatient Gynecologic Surgery

To identify the prevalence of and risk factors for emergency department (ED) visits within 30 days of outpatient gynecologic surgery. Retrospective cohort study. Tertiary academic medical institution. Adult patients who underwent outpatient surgery (≤1 midnight in the hospital) between January 2018 and September 2019 (n=2,373). Scheduled, outpatient gynecologic surgery for a benign indication. 109 (5%) patients visited the ED within 30 days of surgery. Patients who visited the ED were significantly younger (median age 37 vs. 42, p=.02) and had a higher prevalence of abdominal surgical history (67% vs. 56%, p=.02) and cardiopulmonary comorbidities (53% vs. 40%, p=.007). They were more likely to have had a hysterectomy (26% vs. 20%) and less likely to have had prolapse surgery (4% vs. 12%, p=0.05). Pain related to the surgical site (42% of ED visits), nausea and/or vomiting (14%), and fever (12%) were the most common surgery-related reasons for ED visits. Medical issues not directly related to surgery accounted for 31% of ED visits. 36% of ED visits resulted in admission. When adjusted for age, insurance status, ASA class, chronic pain and cardiopulmonary comorbidities, abdominal surgical history, primary procedure performed, and surgical route, the following factors were associated with significantly increased risk of visiting the ED: decreasing age (aOR 1.2, 95% CI 1.1-1.3, p<.001), abdominal surgical history (aOR 1.7, 95% CI 1.1-2.6, p=.017), cardiopulmonary comorbidities (aOR 1.9, 95% CI 1.2-3.0, p=.003), undergoing hysterectomy (aOR 2.0, 95% CI 1.1-3.8, p=0.032), and a vulvovaginal as opposed to abdominal surgical route (aOR 2.4; 95% CI 1.2-5.1, p=0.015). ED visits following outpatient gynecologic surgery were uncommon, although approximately one third of visits resulted in admission. Strategies that target our identified risk factors of younger patient age and cardiopulmonary comorbidities may help reduce the ED burden generated by gynecologic surgery patients.

Educational assessment of intrathoracic and extrathoracic surgical stabilization of rib fractures

BackgroundSurgical stabilization of rib fractures (SSRF) is being done with increased frequency and new advances. Intrathoracic SSRF is a new less invasive approach compared to the traditional extrathoracic plating procedure. Educational assessment can be done through descriptive analysis of learning curves with operation time used as a proxy measurement for learning. The objective of this level 3 observational cohort study is to assess the learning curve of introducing the intrathoracic method of plating at a large academic medical institution. MethodsIntrathoracic surgical stabilization of rib fractures was introduced at a tertiary trauma center in March of 2019. All patients that received SSRF beginning 11/2017 were included. Patients with abbreviated injury scale score of the head, abdomen, extremity, or face greater than three and days from injury to SSRF greater than 4 were excluded. Operation time was determined from time of incision to completion of skin closure. Time per fracture and time per plate were calculated using total operation time. Learning curves and CUSUM graphs for individual surgeons that had completed in more than 3 SSRF cases were generated using and trended for statistical significance. ResultsAfter exclusions, there were 38 patients with extrathoracic SSRF between November 2017–September 2021 and 24 patients with intrathoracic plating between March 2019–Sept. 2021. There were 5 fellows and 6 residents that performed extrathoracic SSRF. Four fellows and 2 residents performed intrathoracic SSRF. Graphs of time per fracture and time per plate over time produced learning curves without an inflection point for extrathoracic or intrathoracic SSRF in any of the following categories: all surgeries (Figs. 1 and 2), academic year (July to June), individual attending surgeons, fellows, or residents. ConclusionThere was no discernible inflection point on the generated learning curves. Time per plate and time per fracture did not decrease as surgeons gained more experience. Introducing intrathoracic SSRF in a large academic hospital may not need to account for a learning curve adjustment period.

Medical Professionalism in the Provision of Clinical Care in Healthcare Organizations.

Medical professionalism is critical toward provision of safe, effective, patient-centered, timely, efficient, and equitable clinical care delivery. The basic tenets of medical professionalism are deeply embedded in the historical context via oaths and expectations. However, standardization of professional conduct and its integration by providers have been a challenge due to the evolving complexity of healthcare organizations (HCOs) and academic medical institutions (AMIs). Increasing heterogeneity of the workforce leads to greater complexity in collaborative teamwork. In this evolving landscape, violations of professional conduct demand closer scrutiny along professional and personal lines. Likewise, actions among minority groups pose challenges between integration and inclusion of certain professional interactions and conduct. Recently, in American HCOs and AMIs, there has been a renewed emphasis on accountability and managing unprofessional behaviors in the delivery of clinical care. This descriptive literature-based treatise explicates the professionalism construct in its historical milieu, underscores key facets of professionalism, highlights principal drivers of unprofessional behaviors, and posits solutions for enhancing and nurturing professionalism in the delivery of clinical care in HCOs and AMIs by a diverse workforce of healthcare providers.

GENDER DISPARITY IN LEADERSHIP ROLES: HOW DOES OBSTETRICS & GYNECOLOGY COMPARE TO OTHER SPECIALITIES?

This study aims to explore gender trends in obstetrics and gynecology (OBGYN) leadership positions compared to other specialties at medical academic institutions in the western region and identify potential contributing factors to existing gender discrepancies.

The accuracy of component positioning during revision total hip arthroplasty using 3D optical computer-assisted navigation.

Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA. A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position. Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0mm vs 9.13 ± 7.9mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84mm vs 7.14 ± 4.8mm, p = 0.68). Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.

329P Duration of adjuvant therapy in stage III colon cancer: A real world multi-institutional US-based experience

Since the publication of IDEA, the duration of adjuvant chemotherapy (CTX) in stage III colon cancer (CC) has shifted to a risk-stratified approach as 3 months (mo) of CAPOX vs 6 mo was found to be non-inferior in patients (pts) with low risk (LR) (T1-T3/N0-N1). High risk (HiR) (T4 or N2) disease failed to show non-inferiority, however 3-year DFS differences were less than 2% and only .1% when pts received CAPOX. However in the US cohort, pts did not receive CAPOX, possibly due to capecitabine intolerance. Herein, we performed a real-world evaluation of CTX in US pts with stage III CC. A retrospective review of stage III CC pts treated from 2016-2022 from 5 US academic medical institutions was performed. Pts were stratified into 3mo vs 6mo of CTX, HiR vs LR, and CAPOX vs FOLFOX. 3-year DFS and adverse events were recorded. A total of 443 pts were included. In the overall population, no difference in 3-year DFS was observed in 3 vs 6 mo of CTX (69.3 vs 71.0%, hazard ratio [HR] = 1.26, 95% CI (0.74, 2.17), adjusted p [aP] = 0.40), numerically less than was observed in IDEA. HiR pts were observed to have detriment in 3-year DFS with 3mo vs. 6mo CTX (34.0% vs 62.9%, HR = 1.51, 95% CI (0.77, 2.99), aP=0.23). Grade 3 adverse events (AE) of nausea, diarrhea, and hand/foot syndrome from capecitabine were higher than reported in IDEA.Table: 329PDFS by treatment, duration and riskCTXN (Events)36 Months DFS6 mo FOLFOX255 (76)71.8%6 mo CAPOX54 (17)67.5%3 mo FOLFOX37 (9)68.8%3 mo CAPOX97 (16)69.4%HiR vs LR6 mo LR126 (23)82.3%6 mo HiR183 (70)62.9%3 mo LR102 (13)81.2%3 mo HiR32 (12)34.0% Open table in a new tab In this real-world experience we observed no DFS benefit in pts treated with 3 vs 6mo CTX. In HiR pts treated with 3mo CTX, we observed a lower 3-year DFS rate compared to 6mo of CTX. The findings were not statistically significant due to low number of events in this cohort and was significantly lower than reported in IDEA. AEs were more prevalent in US pts compared to non-US pts in IDEA, likely due to capecitabine intolerance. Our study is the first to assess 3mo vs 6mo capecitabine based adjuvant CTX in a risk stratified US population and suggests discrepancies in DFS and AEs compared to IDEA in US pts who received CAPOX.

Respiratory Symptoms and Skin Sick Building Syndrome among Office Workers at University Hospital, Chiang Mai, Thailand: Associations with Indoor Air Quality, AIRMED Project.

Sick building syndrome (SBS) is the term used to describe the medical condition in which people in a building suffer from symptoms of illnesses for no apparent reason. SBS was found to be associated with indoor air quality (IAQ) but there are a variety of determinants (buildings, in particular). Identifying and controlling factors related to SBS is crucial for improving worker health and efficiency. A cross-sectional study was conducted to investigate (1) the prevalence of respiratory symptoms and skin SBS and (2) their associations with IAQ among office workers in administrative offices in an academic medical institute. A self-reporting questionnaire assessing the worker’s characteristics, working conditions, and perception of working environments was used. The building assessment was via a walk-through survey and IAQ measurement. Of 290 office workers, 261 (90%) in 25 offices of 11 buildings took part in the survey. The highest prevalence of SBS was nasal symptoms (25.3%). We found that to reduce the risk of SBS, optimal air temperature levels in air-conditioned offices should be lower than 23 °C, with relative humidity between 60% and 70%. Lowering indoor CO2 levels below 700 ppm may be indicative of adequate ventilation to prevent SBS by reducing worker discomfort and indoor contaminants (e.g., formaldehyde).