Time Series Analysis Research Articles

Emerging trends in antimicrobial resistance in bloodstream infections: multicentric longitudinal study in India (2017–2022)

BackgroundAntimicrobial resistance (AMR) has escalated to pandemic levels, posing a significant global health threat. This study examines the patterns and trends of AMR in Bloodstream Infections (BSIs) across India, aiming to inform better surveillance and intervention strategies. MethodsSix-year data from 21 tertiary care centers in the Indian Council of Medical Research's AMR Surveillance Network (IAMRSN) were retrospectively analyzed to estimate cluster-robust trends in resistance. Time-series analysis was used to discern lead/lag relationships between antibiotic pairs and the directional influence of resistance in community and hospital-acquired BSIs(CA/HA BSIs). A data-driven Bayesian network ensemble averaged over 301 bootstrap samples was modelled to uncover systemic associations between AMR and Sustainable Development Goals (SDGs). FindingsOur findings indicate significant (p<0.001) monthly increases in Imipenem and Meropenem resistance for Klebsiella, E. coli, and Acinetobacter BSIs. Importantly, Carbapenem resistance in HA-BSIs preceded that in CA-BSIs for Klebsiella and Acinetobacter (p<0.05). At a national level, Cefotaxime resistance emerged as a potential early indicator for emerging Carbapenem resistance, proposing a novel surveillance marker. In Klebsiella BSIs, states with higher achievement of SDG3 goals showed lower Imipenem resistance. A model-based AMR scorecard is introduced for focused interventions and continuous monitoring. InterpretationThe identified spatiotemporal trends and drug resistance associations offer critical insights for AMR surveillance aligning with WHO GLASS standards.The escalation of carbapenem resistance in BSIs demands vigilant monitoring and may be crucial for achieving SDGs by 2030. Implementing the proposed framework for data-driven evidence can help nations achieve proactive AMR surveillance. FundingNo specific funding was received for this analysis.

The temporal dynamics of daily stress, affect, and several affect regulation processes, in patients with chronic mood and anxiety disorders before and after a mindful yoga intervention

Background and ObjectivesPatients with chronic mood and anxiety disorders experience many life stressors and are more reactive to these stressors. Although mindful yoga might reduce stress reactivity, little is known about the affect regulation mechanisms involved, such as repetitive negative thinking, fear of emotion, acting with awareness and body awareness. Design and MethodsUsing experience sampling methodology, 12 patients with chronic mood and anxiety disorders completed five daily assessments for 15 days before and after a 9-week mindful yoga intervention. Interrupted time-series analyses were used to assess mean-level change from pre-to-post intervention and vector autoregressive models to assess change in the temporal associations. ResultsMost individuals experienced positive changes in affect and the proposed affect regulation processes. Fear of emotion showed changes from pre-to-post intervention for most individuals (67%), followed by acting with awareness (58%), body awareness (58%) and repetitive negative thinking (50%). In the dynamic relationships between stressors, the four affect regulation processes and affect, there were individual differences in which pathways changed and how they changed. ConclusionsAfter a mindful yoga intervention, affect and several affect regulation processes improve in most individuals. Achieving this in the context of daily life stress, seems to be more complicated. Trial registrationISRCTN register (study ID ISRCTN13612864).

Time Series Analysis of Poverty Reduction Indicators: Case of Pakistan, India and Bangladesh

This paper investigated the indicators of poverty reduction. The independent variables are financial development, military expenditure, remittances, trade openness and world oil prices. A time series analysis was conducted from 1980 to 2016. The ADF and Phillip-Perron unit root tests were applied to find the level of co-integration. The study researched the long-run relationship between independent and dependent variables by applying the Auto Regressive Distributed Lag (ARDL) Bound testing approach. The order of integration according to the unit root test is mixed for the variables. In all three countries, the ARDL bound testing approach found the long-run relationship between poverty and its indicators.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

ABSTRACT Background Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19’s long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. Research design and methods A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and ”4C”-antibiotics. Results Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of ”4C” antibiotic reduced significantly after the second lockdown. Conclusions Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

Revolutionizing travel experiences: An in-depth analysis of intelligent booking systems and behavioral patterns

This study delves into the intricacies of booking behaviors, focusing on the preference for tropical coastal cities during colder seasons, given the burgeoning need for personalized and intelligent travel recommendations in the modern tourism landscape. Traditional booking systems, with their static algorithms, have often neglected the dynamic interplay of environmental factors and user preferences, necessitating an evolution towards more sophisticated, adaptive models. To address this, the research employed advanced machine learning and artificial intelligence techniques, amalgamating data from diverse sources like major tourism websites, hotel platforms, and social media. The methodology involved meticulous data preprocessing to ensure data quality and depth, followed by the implementation of deep learning models and time series analysis, which were instrumental in deciphering complex patterns and offering predictive insights. This comprehensive approach facilitated the integration of various environmental factors such as weather conditions and temporal events, enabling the system to craft hyper-personalized recommendations that resonate with user preferences and environmental nuances. The findings were illuminating, unveiling a significant inverse relationship between temperature and bookings and highlighting the influential role of temporal events in driving bookings. The advanced predictive models showcased commendable accuracy, underscoring the transformative potential of such intelligent systems in enhancing user experiences and engagement in the tourism sector. These insights pave the way for the development of innovative strategies that can significantly elevate user satisfaction and industry growth. The study concludes that the integration of machine learning and AI in booking systems can revolutionize the tourism industry by offering unprecedented levels of personalization and adaptability, catering to the diverse and evolving needs of modern travelers.

Impact of national drug price negotiation policy on the accessibility and utilization of PCSK9 inhibitors in China: an interrupted time series analysis

BackgroundPCSK9 inhibitors are a novel class of lipid-lowering drugs that have demonstrated favorable efficacy and safety. Evolocumab and alirocumab have been added to China’s National Reimbursement Drug List through the National Drug Price Negotiation (NDPN) policy. This study aims to evaluate the impact of the NDPN policy on the utilization and accessibility of these two PCSK9 inhibitors.MethodsThe procurement data of evolocumab and alirocumab were collected from 1,519 hospitals between January 2021 and December 2022. We determined the monthly availability, utilization, cost per daily defined dose (DDDc), and affordability of the two medicines. Single-group interrupted time series (ITS) analysis was performed to assess the impact of the NDPN policy on each drug, and multiple-group ITS analysis was performed to compare the differences between them.ResultsThe NDPN policy led to a significant and sudden increase in the availability and utilization of PCSK9 inhibitors, along with a decrease in their DDDc. In the year following the policy implementation, there was an increase in the availability, utilization, and spending, and the DDDc remained stable. The affordability of PCSK9 inhibitors in China have been significantly improved, with a 92.97% reduction in out-of-pocket costs. The availability of both PCSK9 inhibitors was similar, and the DDDc of alirocumab was only $0.23 higher after the intervention. The market share of evolocumab consistently exceeded that of alirocumab. Regional disparities in utilization were observed, with higher utilization in the eastern region and a correlation with per capita disposable income.ConclusionsThe NDPN policy has successfully improved the accessibility and utilization of PCSK9 inhibitors in China. However, regional disparities in utilization indicate the need for further interventions to ensure equitable medicine access.

Optimized Fabrication of Supercapacitor Using MOF-Derived NiCo2O4 with Porous Carbon as Cathode: Electrochemical Characterization and Stability Analysis using Time Series Analysis Technique

Optimized Fabrication of Supercapacitor Using MOF-Derived NiCo₂O₄ with Porous Carbon as Cathode: Electrochemical Characterization and Stability Analysis using Time Series Analysis Technique

Impact evaluation of guidelines on antibiotic utilisation &amp; appropriateness in Malaysian public primary care: an interrupted time series analysis

Impact evaluation of guidelines on antibiotic utilisation &amp; appropriateness in Malaysian public primary care: an interrupted time series analysis

A time series analysis of disruptions to maternal and child health care in northern Togo during the COVID-19 pandemic in the context of an integrated primary care program

There are significant concerns that COVID-19-related disruptions in routine health care will reverse the gains made over the past 2 decades in reducing maternal and under-5 mortality in low- and middle-income countries. The objective of this study was to examine the extent of disruptions in community-based maternal and child health services and explore community perceptions and experiences with health care use in the year following the start of the COVID-19 pandemic in one district in northern Togo, West Africa. This study included analysis of multiple types of data including: (1) routine health management information system data from 18 public sector health centers, (2) programmatic data collected through an integrated health center- and community-based primary care program at 5 health centers, and (3) semi-structured interviews with health center managers, community health workers (CHWs), and community members at those 5 health centers. We found only short-term declines in service utilization coinciding with the COVID-19 pandemic and no decline in the delivery of community-based care by CHWs. Qualitative data were consistent with the quantitative results, reporting sustained use of health-care services. Multilevel factors related to the continued provision of care during the COVID-19 pandemic included regular and clear communication from CHWs as trusted community sources, risk minimization at the health-center level, continued provision of community-based care by CHWs, and collaboration between community leaders and health-care workers to limit COVID-19 transmission. Findings demonstrate resiliency of an integrated primary care system when equipped with an adequately trained, supervised, and supplied health workforce, implementation of infection prevention and control measures, communication by trusted community sources, and adaptations to health-care delivery that enable the continued provision of care.

The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis.

To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance. The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022. Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio. After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China

BackgroundSince 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity.Materials and methodsWe conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients.ResultsAfter the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform.ConclusionThe DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.

Impact of the organ-system integrated curriculum on the research productivity of a Philippine government medical school: An ARIMA-based bibliometric analysis

The organ-system integrated (OSI) curriculum was pioneered in the country by the U.P. College of Medicine (UPCM) in 2004. Data on its impact on research productivity was lacking. This study aims to describe the trends in research productivity of UPCM in a time series and the impact of OSI implementation on publication trends. Relevant electronic databases (PubMed, Scopus, and WPRIM) were searched from the earliest indexed record until December 2023. The auto-regressive integrated moving average (ARIMA) time series analysis was used to compare the actual and predicted trends during the OSI implementation using the pre-OSI trend. A total of 2,705 articles were included. Acta Medica Philippina is the journal with the highest number of publications (n = 420, 20.24%). Although there is a considerable rise in the number of publications utilizing evidence synthesis and qualitative design, observational studies remain as the most common design (n = 293, 2021-2023 period). The leading clinical departments are Neurosciences and Medicine. The departments of Biochemistry and Clinical Epidemiology take the lead among basic sciences departments. Despite the glaring uptrend in publications concurrent with OSI implementation, the actual trend is not significantly different from the predicted trend (LR chi2(1) = 0.37; Prob &gt; chi2 = 0.5432). The OSI curriculum did not significantly change the trend of productivity. Medical curriculum designers should revisit strategies dedicated for research competencies. It is imperative to include activities for qualitative and mixed-methods designs. Future studies should consider relevant critical events in the time series forecasting models and the scientific outputs in the grey literature.

Skin treatment with non-thermal plasma modulates the immune system through miR-223-3p and its target genes

ABSTRACT Non-thermal plasma, a partially ionized gas, holds significant potential for clinical applications, including wound-healing support, oral therapies, and anti-tumour treatments. While its applications showed promising outcomes, the underlying molecular mechanisms remain incompletely understood. We thus apply non-thermal plasma to mouse auricular skin and conducted non-coding RNA sequencing, as well as single-cell blood sequencing. In a time-series analysis (five timepoints spanning 2 hours), we compare the expression of microRNAs in the plasma-treated left ears to the unexposed right ears of the same mice as well as to the ears of unexposed control mice. Our findings indicate specific effects in the treated ears for a set of five miRNAs: mmu-miR-144-5p, mmu-miR-144-3p, mmu-miR-142a-5p, mmu-miR-223-3p, and mmu-miR-451a. Interestingly, mmu-miR-223-3p also exhibits an increase over time in the right non-treated ear of the exposed mice, suggesting systemic effects. Notably, this miRNA, along with mmu-miR-142a-5p and mmu-miR-144-3p, regulates genes and pathways associated with wound healing and tissue regeneration (namely ErbB, FoxO, Hippo, and PI3K-Akt signalling). This co-regulation is particularly remarkable considering the significant seed dissimilarities among the miRNAs. Finally, single-cell sequencing of PBMCs reveals the downregulation of 12 from 15 target genes in B-cells, Cd4+ and Cd8+ T-cells. Collectively, our data provide evidence for a systemic effect of non-thermal plasma.

The temporal variation in the effects of extreme temperature on respiratory mortality: Evidence from 136 cities in China, 2006–2019

BackgroundIn the context of climate change and urbanization, the temporal variation of the adverse health effect of extreme temperature has attracted increasing attention. MethodsThe meteorological data and the daily death records of mortality from respiratory diseases of 136 Chinese cities were from 2006 to 2019. Heat wave and cold spell were selected as the indicator events of extreme high temperature and extreme low temperature, respectively. The generalized linear model and time-varying distributed lag model were used to perform a two-stage time-series analysis to evaluate the temporal variation of the mortality risk associated with extreme temperature in the total population, sub-populations (sex- and age- specific) and different regions (climatic zone and relative humidity level). ResultsDuring the study period, relative risk (RR) of respiratory mortality associated with heat wave decreased from 1.22 (95 %CI: 1.07–1.39) to 1.13 (95 %CI: 1.01–1.26) in the total population, and RR of respiratory mortality associated with cold spell decreased from 1.30 (95 %CI: 1.14–1.49) to 1.17 (95 %CI: 1.08–1.26). The impact of heat wave reduced in the males (P = 0.044) and in the females as with cold spell (P < 0.001). The respiratory mortality risk of people over 65 associated with cold spell decreased (P = 0.040 for people aged 65–74 and P < 0.001 for people over 75). The effect of cold spell reduced in cities from tropical or arid zone (P = 0.035). The effects of both heat wave and cold spell decreased in cities with the relative humidity in the first quartile (P = 0.046 and 0.010, respectively). ConclusionThe impact of heat wave on mortality of respiratory diseases decreased mainly in males and cities with the lowest relative humidity, while the impact of cold spell reduced in females, people over 65 and tropical and arid zone, suggesting adaptation to extreme temperature of Chinese residents to some extent.

Comparative Analysis of Epidemiological Outcome of Incidence, Mortality and Lethality by COVID-19 between the States of Espírito Santo and Minas Gerais, Brazil.

At the beginning of December 2019, a new type of coronavirus emerged, SARS-CoV-2. This virus causes COVID-19, a highly contagious disease that can initially present asymptomatically and can also lead to death. Our ecological study goal was to evaluate the incidence, mortality, and lethality rates for COVID-19 between the states of Espírito Santo and Minas Gerais, with time series analysis using secondary and public databases on COVID-19 from January 2020 to December 2022. Prais-Winsten linear regression was used for trend analyses. In 2020, the rate in Espírito Santo was 2.19 times greater than in Minas Gerais. This trend continued in 2021, with Espírito Santo's rate being 1.29 times greater. In 2022, Espírito Santo's rate remained 2.65 times higher than Minas Gerais. Furthermore, Espírito Santo had the highest mortality, with the exception of 2021. In turn, Minas Gerais had the highest fatality rate throughout the analyzed pandemic period. The state of Espírito Santo had a higher incidence of COVID-19, as well as higher mortality when compared to the state of Minas Gerais. Furthermore, both states showed similar trends for mortality, lethality, and incidence in the years 2020 and 2021.

Protest and repression on social media: Pro-Navalny and pro-government mobilization dynamics and coordination patterns on Russian Twitter

In this study, we examine connective protest mobilization and suppression during the 2021 protests in Russia. We use time series analysis to study the dynamic interplay between the pro-Navalny movement and pro-government countermovement on Twitter, complemented by network analyses of co-retweeting networks to assess the movements’ coordination patterns. Findings show that pro-Navalny accounts were more active and coordinated within more centralized Twitter networks than pro-government accounts. Contrarily, the pro-government camp employed preventive communication tactics and coordinated in more clustered networks. Granger causality tests reveal that pro-Navalny tweeting activity triggered increased pro-regime reaction during the largest protests on 23 January and 21 April, whereas pro-government tweeting activity caused the escalation of pro-Navalny reaction during the 14 February protests. Both sides’ tweeting activity decreased after the February protests, presumably due to external repression. These findings contribute to a deeper understanding of online mobilization and coordination strategies via social media in authoritarian contexts.

Multi-Threshold Recurrence Rate Plot: A Novel Methodology for EEG Analysis in Alzheimer's Disease and Frontotemporal Dementia.

This study introduces Multi-Threshold Recurrence Rate Plots (MTRRP), a novel methodology for analyzing dynamic patterns in complex systems, such as those influenced by neurodegenerative diseases in brain activity. MTRRP characterizes how recurrence rates evolve with increasing recurrence thresholds. A key innovation of our approach, Recurrence Complexity, captures structural complexity by integrating local randomness and global structural features through the product of Recurrence Rate Gradient and Recurrence Hurst, both derived from MTRRP. We applied this technique to resting-state EEG data from patients diagnosed with Alzheimer's Disease (AD), Frontotemporal Dementia (FTD), and age-matched healthy controls. The results revealed significantly higher recurrence complexity in the occipital areas of AD and FTD patients, particularly pronounced in the Alpha and Beta frequency bands. Furthermore, EEG features derived from MTRRP were evaluated using a Support Vector Machine with leave-one-out cross-validation, achieving a classification accuracy of 87.7%. These findings not only underscore the utility of MTRRP in detecting distinct neurophysiological patterns associated with neurodegenerative diseases but also highlight its broader applicability in time series analysis, providing a substantial tool for advancing medical diagnostics and research.

Can Sri Lanka be a net-zero nation by 2050?—Current renewable energy profile, opportunities, challenges, and recommendations

Sri Lanka as a country has tremendous potential for harnessing energy from renewable sources such as solar, wind, and hydro. However, as of 2018, only 39 % of Sri Lanka's energy generation capacity was harnessed through renewable energy sources. The continuous increase in electrical energy demand and the drastic increase in vehicle population over the past few years have resulted in much of its annual income being spent on purchasing fossil fuels from foreign countries. This has placed the country's future at risk due to the predicted shortage of fossil fuel reserves and in release of an unexpected level of harmful emissions to the environment. In the meantime, Sri Lanka also has an ambitious plan of achieving Net Zero by 2050. The study conducted a systematic review followed by a time series analysis to first identify the present state of the renewable energy progress of the country and through the time series analysis recognize any discrepancies in these efforts. The initial findings revealed the lack of coordination amongst relevant institutions and contrasting government policies such as the increase in investment for non-renewable energy resources as well as backing away from providing initial investment needed to boost the usage of renewable sources for businesses and smaller entities. The study further identified sectors such as transportation and non-renewable power generation activities as the two main barriers deterring the country from having a feasible plan for its efforts for net zero by 2050. From a non-governmental perspective, the study also recognized the knowledge gap and lack of awareness in the wider population of the long-term benefits of switching to renewable sources.

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty.

The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

Impact of carboplatin and cisplatin shortages on treatment patterns in patients with metastatic solid tumors.

11149 Background: The United States experienced cisplatin (CP) and carboplatin (CB) shortages in 2023, leading to potential rationing or switching to alternative therapies in multiple cancers. Using a US nationwide, real-world oncology dataset, we assessed changes in the use of CP and CB in 7 cancers during the shortage period. Methods: All patients (pts) from the Flatiron Health electronic health record-derived de-identified database (~280 cancer clinics, ~800 sites of care) with a machine learning-extracted metastatic (met) diagnosis of a cancer of interest between March 2022 and June 2023 and evidence of first-line (1L) therapy, were selected. Pts with multiple primaries were excluded. Platinum of interest was identified based on frequency of pre-period 1L use for a given cancer. The pre-period was June 2022 through first month of reported shortage (February 2023 for CP; April 2023 for CB); data cutoff was June 2023. Clinical characteristics of platinum-treated pts stratified by pre- vs post-period by disease were assessed. 1L platinum utilization rates (UR), calculated as the proportion of 1L-treated pts initiating CB/CP within 30 days of met diagnosis, were plotted by month. Cohort-level impact was evaluated with an interrupted time series analysis—overall and stratified by practice type, practice size, and socioeconomic status (SES). Multiple testing was controlled using the Benjamini-Hochberg procedure. Results: 10,983 pts received 1L therapy in the study period. Monthly platinum UR were stable across diseases in the pre-period. However, there was a significant post-period decrease in CB usage for non-small cell lung (NSCLC) and endometrial cancers (EC), and a decreasing trend in UR for CB in bladder (BC), ovarian (OC), and small cell lung cancers (SCLC). We also observed a decreasing trend in CP usage for cholangiocarcinoma (CC). Post-period monthly UR were stable for CB and CP in head and neck cancer (HNC), and for CP in BC. Odds ratios (OR) representing the month-over-month change in the odds of receiving platinum therapy during both pre- and post-periods are shown (table). OR trends varied by practice type and disease; no notable trends were seen by practice size or SES. UR with additional follow-up times will be presented. Conclusions: We observed decreased platinum use across multiple cancers during the shortage period, most notably for met NSCLC and EC, suggesting shortages led oncologists to seek alternatives to standard 1L platinum-based regimens. Further study of how treatment changes due to platinum shortages impacted pt outcomes is warranted. [Table: see text]