Accredited Centers Research Articles

Organization and structure of intensive care management of adult congenital heart disease in the United States

BackgroundThe growing number of adults with congenital heart disease has led to the formation of dedicated centers to provide specialized care. There is a paucity of published data on the organization, staffing, and resources available when adult congenital heart disease (ACHD) patients are hospitalized in intensive care settings. This study aims to describe the delivery of intensive care for ACHD patients in the United States and identify key differences between accredited centers or those pending accreditation and non-accredited Adult Congenital Heart Association (ACHA) centers. MethodsA web-based cross-sectional survey targeting centers with specialized ACHD programs was conducted. ResultsData were obtained from 48 of 96 centers (50%). Twenty-seven (56%) were accredited by the ACHA and 8 (17%) were pending accreditation. Surgical ACHD patients were primarily co-managed by cardiologists and intensivists (n = 11, 23%) and treated within an adult cardiac surgical intensive care unit (n = 34, 72%). Compared to non-accredited centers, ACHA accredited centers or those pending accreditation were more likely to offer daily rounds with ACHD providers (30, 86% vs. 6, 46%, p=<0.01), were more likely to support an ACHD fellowship training program (16, 46% vs. 0, 0%, p=<0.01); and were more likely to have durable mechanical support, such as ventricular assist devices (35, 100% vs. 8, 62%, p < 0.01). ConclusionThis survey reports current trends in organization, staffing, and resources available to ACHD patients requiring intensive care. ACHA accredited centers or those pending accreditation were more likely to have dedicated ACHD rounds, fellowship training programs, and access to durable mechanical support.

Next Generation Sequencing and Cytogenetics in Acute Myeloid Leukemia - Therapeutic and Prognostic Impact: A Retrospective Cohort from a Private Centre of Reference in Latin America

Introduction: Acute Myeloid Leukemia (AML) is a prevalent and severe hematological disorder. The emergence of Next-Generation Sequencing (NGS) and karyotiping, has demonstrated associations between chromosomal abnormalities and mutations with worse treatment response and mortality in AML. Current classification of AML is based on its cytogenetic and molecular profile, as defined by World Health Organization (WHO) 2022 and European Leukemia Net (ELN) 2022. Despite its evident importance in AML, application of these diagnostic methods poses new challenges. In Latin America, particularly, there is a clear limitation of data and studies regarding molecular and cytogenetic analysis in AML patients, due to the relatively short time these techniques have been employed and the few accredited centers able to perform them. Therefore, this study primarily aims to provide an in-depth evaluation of the application of NGS and cytogenetic analysis in AML, identifying the impact of somatic mutations on AML mortality and progression free-survival based on the experience of a reference center in Latin America. Secondarily, we aim to determine the molecular and cytogenetic profile of these population and analyze the impact of age, sex and comorbidities in AML prognosis. Methods: This is an unicentric, retrospective and non-interventional cohort performed in Brazilian Hospital Albert Einstein. Inclusion criteria were adult patients (aged ≥18 years) diagnosed with AML between May 2017 and August 2022, who underwent myeloid panel testing through NGS and cytogenetic evaluation at diagnosis. Independent variables analyzed were age, gender, prognostic risk according to ELN 2022, indication of bone marrow transplantation and molecular and cytogenetic risk at diagnosis. High cytogenetic risk was defined by the presence of at least one of the high-risk karyotype abnormalities described in ELN 2022 and high-risk NGS was defined by mutation in the genes ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, U2AF1, ZRSR2, TP53 or FLT3. The primary outcomes evaluated were overall survival (OS) and progression-free-survival (PFS), estimated by the Kaplan-Meier method. Secondary outcomes were disease relapse and non-relapse-related mortality (NRM). Results: From a total of 168 selected patients, 64 filled out elegibility criteria and were included in the study. Mean age at diagnosis was 62,7 years old with a equal proportion of both sexes. 7 patients (10,9%) were classified as favourable risk according to ELN 2022, 13 (20,3%) as intermediate risk and 44 (68,8%) as high risk. 42 (65,6%) had a standard-risk karyotype, whereas high-risk karyotype was found in 22 (34,4%) patients. 47 (73,4%) individuals presented high-risk NGS mutations, with a higher prevalence of gene rearrangements in RUNX1 (20,1%), FLT3 (18,7%), TP53 (15,6%) and SRSF2 (15,6%). Only 17 (26,6%) patients reported exclusively standard-risk or no mutations. After a median follow-up was 26 months, estimated OS was 73% in 1 year and 54% in 2 years. 1 and 2 years PFS was 63% and 45%, respectively. 11% relapsed after 1 year and 27% after 2 years. The incidence of NRM was 25% and 28% after 1 and 2 years, respectively. High-risk karyotype was associated with a signficant reduction in overall survival (hazard ratio [HR] 2,27, 95% CI 1,09-4,70; p=0·028) and progression-free-survival (HR 2,15, 95% CI 1,23-4,11; p=0·02). On the other hand, there was no statistically significant association between high molecular risk by NGS and OS (HR 1.45, 95% CI 0.59-3.58; p=0.41) or PFS (HR 1.43, 95% CI 0.65-3.13; p=0.37). Progressive age has discreetly impacted in OS (HR 1,05, 95% CI 1,02-1,08; p=00005), PFS (HR 1,03, 95% CI 1-1,05; p=0,025) and NRM (HR 1,06, 95% CI 1,02-1,11; p=0,002). No differences in outcomes were found between sex, ELN 2022 risk groups, and treatment with bone marrow transplantation. Conclusions: Next-Generation Sequencing, combined with cytogenetic analysis, has improved precision in prognosis prediction of AML patients of each patient, allowing safe implementation of appropriate individualized therapy. This study showed and association between high-risk cytogenetics and worse prognosis in AML, but no association was observed between molecular risk and AML morbimortality. Further studies with a bigger population and longer follow-up should be conducted in Latin America in order to better clarify and delve deeper into the results reported in this cohort.

1515P Nationwide management of soft tissue sarcoma (STS) in France, before (2019) versus during COVID-19 pandemic (2020)

COVID-19 pandemic has disorganized cancer care management, with a significant decrease in diagnosed common cancer cases such as colon or breast. In France, the management of STS is organized by a network of multidisciplinary tumor boards (MTD) covering the French territory. We describe the number of incident STS cases, delay between diagnosis and 1st surgical procedure, and rate of neoadjuvant treatments in 2019 versus 2020. Eligible cases were confirmed cases of STS (diagnosed within or outside the accredited network) in adult patients; arising in limbs, girdles, superficial and internal trunk. Osseous, and visceral (e.g., GIST) were excluded. The data collected in the national database (NETSARC+) describe the activity of the 25 labelled MTD dedicated to sarcoma management. We present the data using percentages, mean and standard deviation (DS). Incident cases slightly decreased: 1,463 in 2019 versus 1,415 in 2020. Mean age, rate of male patients, tumor size, rate of Grade 1 tumors and M1 at diagnosis were similar: 62.2 (DS: 17.3) versus 63.3 (DS: 16.7); 54.8% versus 52.4%; 104 mm (DS: 79.2) versus 105.3 (DS: 77.5); 14.2% versus 14.1%; and 10.0% versus 10.5%, respectively. In 2019, 68.8% of STS were operated compared to 73.8% in 2020. The mean delay between diagnosis and surgery was 70.4 days (DS: 86.7) versus 72.2 (DS: 76.8). Surgery was performed in accredited centers in 53.5% in 2019 compared to 61.2% in 2020. Outside the network, the rate of R0 resection was 19.9% versus 27.8%. Inside accredited centers, the rate of R0 resection was 60.9 versus 69.8%. In parallel, the use of neoadjuvant treatment was 21.0% in 2019 and 26.4% in 2020. During COVID-19, we observed a slight decrease in STS incidence, while patients’ characteristics did not differ between 2019 and 2020. Both the rate of patients operated in accredited centers and R0 resections increased. There was no neoadjuvant treatment increase nor surgery delay. The accredited network therefore appears particularly robust in the event of major Health crisis.

Subspecialty training in Europe: a report by the European Network of Young Gynaecological Oncologists

BackgroundESGO (European Society of Gynaecological Oncology) and partners are continually improving the developmental opportunities for gynaecological oncology fellows. The objectives of this survey were to evaluate the progress in the...

Challenges for Expansion of Thoracic Transplant Clinical Pharmacy in Brazil: Comparison with U.S. Accredited Centers and Call for Action

Clinical pharmacists' involvement in the care of transplant recipients has become a requirement in the accreditation process of transplant centers. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programs nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centers in Brazil and compared them with accredited U. S. programs. An electronic questionnaire was distributed to all heart and lung transplant centers registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. The survey consisted of 16 questions on presence, full-time equivalents (FTEs), practice-setting and training of clinical pharmacists at each center. Survey findings were compared to available published data from accredited U.S. centers. From 39 centers invited, 22 (16 heart and 6 lung) responded, representing 88.6% (n=420) of thoracic transplants performed nationally in 2018. Ten centers (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translates into 144 (35.2%) transplant recipients without any direct pharmaceutical care. In centers with pharmacists (n=12), none had a full-time professional dedicated to their programs. When compared to U.S. centers, there was a significantly lower expression of several aspects of transplant clinical pharmacist activities among Brazilian centers (Figure 1). Importantly, pharmacist FTE in Brazil was less than half of that observed in the U.S. Marked differences exist in Brazilian centers in comparison to the U.S. Our findings point to an unmet need related to clinical pharmacist activity within thoracic transplant programs, especially in developing countries, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

Perspective of Consumers and Providers Regarding Services Quality at Accredited and Non Accredited Primary Health Care Centers

Introduction: Assessment of the quality of care from the consumers and providers perspectives is a fundamental part of quality evaluation. Aim Measuring service quality from perspective of consumers and health care providers in accredited and non accredited primary health care centers at Sahel Seleem health district. Study design: A descriptive comparative. Setting: The study has been conducted in primary health care centers at Sahel Seleem health district. Subjects and Method: The study subjects consisted of two categories (640) consumers and (193) health care providers. The data collected through self- administered questionnaire which include socio demographic data and the service quality model (servperf) developed by (Cronin and Taylor, 1992) .Results: The highest mean scores of consumers perspectives in favor of non accredited centers except in tangibles dimension and health unit characteristic and the highest mean scores of providers perspectives in favor of non accredited centers except in health unit characteristic. Conclusions: There were statistical significant differences between the consumers and the health care providers perspectives in all dimensions except tangibles dimension. Recommendations: Raise consumers and services providers awareness about services quality in the primary health care centers.

Primary care providers' awareness and utilization of survivorship care plans.

94 Background: The Commission on Cancer (CoC) standard 3.3 requires that all patients who complete cancer treatment receive a survivorship care plan (SCP). To aid in care coordination, the standard also requires that the SCP be provided to the patient’s primary care provider (PCP). St. Luke’s Mountain States Institute (MSTI) has been providing patients and PCPs with SCPs for more than 5 years. Other local accredited cancer centers also provide SCPs for their patients. Methods: In partnership with the local chapter of the American Cancer Society, MSTI created an online survey aimed at assessing the utilization of the SCP in primary care clinics and the PCP’s comfort level carrying out the recommended surveillance. The survey link was distributed through email to approximately 300 PCPs across a large geographical area in varying sized practices. Results: Sixty three responses were received in 3 weeks with 46 responses from physicians and 17 responses from advanced practice providers. All of the respondents said they care for cancer survivors in their practice but 54% have never received a SCP. Twenty nine reported having received a SCP and answered 8 questions related to how they use the SCP in practice. The majority refer to the SCP to monitor for recurrence and 52% use it as a tool for coordination of care. Forty eight percent use the SCP to manage co-morbid conditions. Ninety-five percent of all respondents indicated they feel comfortable carrying out a surveillance plan provided by the oncologist for patients 2 years out from treatment. Sixty-four percent indicated they would like additional education about caring for cancer survivors. A common theme in comments included the desire for improved communication between the oncologists and PCPs. Conclusions: This standard was created in part to improve care coordination between oncologists and PCPs. More than have of the PCPs in the MSTI service area have not seen a SCP for their patients. Most indicated they are comfortable providing surveillance if they have a clear follow-up care plan from the oncologist. More than half want additional information about caring for cancer survivors. Future exploration could include assessment of barriers to communication and utilizing the SCP in practice.

Pathologic Complete Response Rates after Neoadjuvant Chemotherapy for Invasive Breast Cancer Vary by Facility Type and Volume at Commission on Cancer Accredited Centers

Pathologic Complete Response Rates after Neoadjuvant Chemotherapy for Invasive Breast Cancer Vary by Facility Type and Volume at Commission on Cancer Accredited Centers

A169 - Laparoscopic Revision of Chronic Marginal Ulcer and Bilateral Truncal Vagatomy

Bariatric surgery is the only proven and effective long term treatment for morbid obesity. In accredited centers, bariatric surgery is performed with very low mortality, morbidity and readmission rates. However, a small number of bariatric patients develop postoperative complications like marginal ulcers. The etiology of marginal ulcers following a Laparoscopic Roux en Y gastric Bypass (LRYGB) is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers such as smoking, ischemia, foreign body reaction, gastro-gastric fistulas, large gastric pouches and tension at the anastomosis.

Developing CAHPS for cancer care prototype: Progress and next steps.

134 Background: The CAHPS Survey for Cancer Care Prototype (application for CAHPS trademark in process) represents a significant advancement towards helping cancer care providers understand patients’ experiences of care. Although a number of standard commercial surveys are in use, currently none are available that both (1) capture the aspects of care most important to patients and (2) allow comparisons of those aspects of care across treatment centers and modalities. Methods: We developed a survey instrument that incorporated patient, clinician, and other stakeholder input throughout the development process. The survey measures patients’ perceptions of observable provider behaviors that are indicative of high quality care. Field test data were collected from 1,367 of 2,826 eligible patients (48% response rate) treated with surgery, radiation, or medical oncology from 6 accredited cancer treatment centers across the US. Classical psychometric methods were used to evaluate the measurement properties of composite scales per standard CAHPS methodology. Results: Based on a priori conceptualization, patient and stakeholder input, and empirical analyses, we identified 5 composites measuring shared decision-making, exchanging information about treatment, affective communication, access to care, and patient self-management. A confirmatory factor analysis using structural equation modeling showed an excellent fit (CFI &gt; 0.96; RMSEA &lt; 0.05) between the observed data and the structure for these five composites. Cronbach’s alpha for these composites ranged from 0.71-0.88, discriminant validity was good for all scales, and correlations with overall ratings of cancer care providers were moderate (0.31) to high (0.69). Evaluation of the precision with which the composites distinguish among cancer centers indicated that the measures were reliable; however, a second field test with a greater number and variety of centers will be needed to establish a standard sampling approach and confirm these results. Conclusions: We anticipate wide-spread adoption of this measure by cancer care providers to direct quality improvement efforts due to great interest and involvement in this project on the part of stakeholders.

The European School of Antennas: Structure, Results and Perspectives

The European School of Antennas (ESoA) is a geographically distributed nonprofit post-graduate school on antennas, propagation, and relevant applications. The ESoA courses are distributed in the most accredited European research centers of antennas and wireless systems. In the first three year of life, the ESoA courses involved about 680 students and more than 150 different teachers, mostly university professors. This paper presents the structure of the school, the results obtained since its founding, and its future development and perspectives.