Plan Choice Research Articles

Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation.

Peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CeVD) are characterized by atherosclerosis and inflammation as their underlying mechanisms. This paper aims to conduct a literature review on pharmacotherapy for PAD, specifically focusing on how different drug classes target pro-inflammatory pathways. The goal is to enhance the choice of therapeutic plans by considering their impact on the chronic subclinical inflammation that is associated with PAD development and progression. We conducted a comprehensive review of currently published original articles, narratives, systematic reviews, and meta-analyses. The aim was to explore the relationship between PAD and inflammation and evaluate the influence of current pharmacological and nonpharmacological interventions on the underlying chronic subclinical inflammation. Our findings indicate that the existing treatments have added anti-inflammatory properties that can potentially delay or prevent PAD progression and improve outcomes, independent of their effects on traditional risk factors. Although inflammation-targeted therapy in PAD shows promising potential, its benefits have not been definitively proven yet. However, it is crucial not to overlook the pleiotropic properties of the currently available treatments, as they may provide valuable insights for therapeutic strategies. Further studies focusing on the anti-inflammatory and immunomodulatory effects of these treatments could enhance our understanding of the mechanisms contributing to the residual risk in PAD and pave the way for the development of novel therapies.

Selection on Welfare Gains: Experimental Evidence from Electricity Plan Choice

We study a problem in which policymakers need to screen self-selected individuals by unobserved heterogeneity in social welfare gains from a policy intervention. In our framework, the marginal treatment effects and marginal treatment responses arise as key statistics to characterize social welfare. We apply this framework to a randomized field experiment on electricity plan choice. Consumers were offered welfare-improving dynamic pricing with randomly assigned take-up incentives. We find that price-elastic consumers—who generate larger welfare gains—are more likely to self-select. Our counterfactual simulations quantify the optimal take-up incentives that exploit observed and unobserved heterogeneity in selection and welfare gains. (JEL C93, D12, L11, L94, L98)

Health insurance menu design for large employers

AbstractWe provide a framework for large employers designing a menu of health plan offerings that differ on both financial and nonfinancial dimensions. Using administrative data from Harvard University, we estimate a model of plan choice and utilization, and evaluate the benefits of cost sharing and plan variety. For this population of consumers, and a single plan with a generous out‐of‐pocket maximum and zero deductible, modest cost sharing of approximately 30% maximizes average employee surplus. Gains from offering choice are meaningful only if financial differentiation is paired with differentiation along other dimensions where consumer preferences are correlated with efficient coverage levels.

Strategic planning in public organizations: reviewing 35 years of research

Strategic planning’s popularity in public organizations cannot be denied, with legislative initiatives even making it mandatory for certain public organizations. Due to strategic planning’s continued popularity in practice, recent years have seen a surge in research on the topic. A synthesis of said research is necessary to identify empirical, conceptual, theoretical, and methodological challenges that remain to be tackled. Drawing from a systematic review of 75 studies through a Strategy-as-Practice lens, this paper contributes to public management theory, research, and practice in three significant ways. First, it provides a structured synthesis and integration of a growing and disparate body of literature, offering a roadmap for future research on strategic planning in public organizations. Second, it proposes a middle-range theoretical framework that captures the complex and dynamic nature of strategic planning in public organizations, providing insight into how strategic planning is conducted and why it may or may not work in certain contexts. Finally, it offers practical relevance for public managers and other public professionals by providing an overview of the various strategic planning choices available and how to optimize them according to their unique contexts and desired outcomes.

Clear aligner therapy practice among orthodontists in the United Kingdom and the Republic of Ireland: A cross-sectional survey of the British Orthodontic Society membership.

To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS). A cross-sectional online survey. An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems. Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy. CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.

The possibilities of modern radiological modalities in aortic coarctation diagnosis and preoperative planning in infants and young age group children

Objective. Evaluation of diagnostic value of modern imaging modalities: trans-thoracic echocardiography (TTE), CT-angiography (CTA) and cardio-MRI in diagnosis and preoperative planning of aortic coarctation correction (CoA) in in infants and young age group children.Materials and methods. 101 pediatric patients (aged 0 to 5 years) with CoA underwent TTE, 98 of them underwent CT, 30 – cardio MRI. On TTE, CTA and cardio-MRI aorta morphometry was performed. The most common anomalies associated with CoA (ventricular septal defect (VSD), patent ductus arteriosus (PDA), aberrant right subclavian artery (ARSA), hypoplastic arch and brachiocephalic vessels anomalies) were assessed.Results. The overall diagnostic accuracy of TTE, CT and cardiac-MRI in diagnosis of CoA were 89.1%, 95.9%, 86.7% respectively. There was no significant difference in the accuracy in detecting CoA between TTE, CT and MRI (p > 0.05). The accuracy of TTE in determining the brachiocephalic vessels anomalies, ARSA and arch hypoplasia was 84%, 93% and 85.3%, respectively. The accuracy of CT in determining the brachiocephalic vessels anomalies, ARSA and arch hypoplasia was 100%, 100% and 98% and cardio-MRI: 97.1%, 98.4% and 96.8%, respectively.Conclusion. TTE is a widely available and safe method, it has a high diagnostic value in determining CoA. Due to limitations in visualization of all parts of the aortic arch and the detection of concomitant anomalies, TTE cannot be the final method in planning the CoA correction. CT and MRI of the heart, as a TTE, are effective methods in the diagnosis of CoA, however, in the assessment of extracardiac anomalies, they equally show a significantly more accurate result.Taking into account the difficulties in conducting MRI of the heart in children under one year and younger age group, the need for a longer stay in anesthesia, the lack of additional diagnostically significant information in comparison with CT of the heart, cardio-MRI is not the method of choice in the primary diagnosis and preoperative planning of correction of CoA in children under one year and younger age group requiring the use of an anesthetic aid for the duration of the scan. Cardio-MRI may be the method of choice in preoperative planning of CoA in small children with absolute contraindications to the radiocontrast agent.

The additive diagnostic role of diffusion-weighted magnetic resonance and chemical shift imaging (CSI) in differentiation between malignant and benign cervical lymph nodes

BackgroundImaging with conventional MRI plays a pivotal role in differentiation between benign and malignant nodes, which is crucial for choice of therapeutic plan. The purpose of this study was to evaluate the role of diffusion-weighted imaging DWI MRI and chemical shift imaging (CSI) (in and out of phase) in differentiation between malignant and benign cervical lymph nodes.Patients and methodsWe prospectively reviewed MR images of 31 patients presented to ENT department by cervical adenopathy. Imaging parameters documented included: morphology, ADC values and in-phase to out-of-phase (Ip/Op) ratios and signal drop in out-of-phase images.ResultsADC values of the benign and malignant nodes were 1.06 ± 0.25 and 0.85 ± 0.24, respectively. A statistically significant difference was found between the two groups (p = 0.041). An ADC value of 0.9 × 10−3 mm2/s was concluded to be the best cutoff value for differentiating benign from malignant LNs. The mean values of in/out-of-phase ratios of benign and malignant lymph nodes were 0.75 ± 0.16 and 0.96 ± 0.06, respectively. A statistically significant difference was found between the two groups (p = 0.001). The mean in/out-of-phase ratio of the benign nodes was significantly lower than that of the malignant nodes.ConclusionsCSI can differentiate between malignant and benign lymph nodes with a cutoff value of in/out-phase ratio of 0.9. Also, adding the diffusion-ADC map can prefer the same value with a cutoff value of 0.9 × 10−3 cm2/s. Adding CSI sequence to conventional MRI in examining the nodal status in patients with head and neck primary can enhance diagnostic accuracy of the examination.

Medicare Advantage enrollment by immigration and English proficiency status.

Complex Medicare Advantage (MA) health plan choices may overwhelm immigrants, especially for those facing decision-making constraints due to limited English proficiency (LEP). We examined the trends and patterns of MA enrollment by immigration and English proficiency status. We employed a cross-sectional design using data from the 2008-2019 Medical Expenditure Panel Survey. Our outcome was enrollment in an MA plan. Our primary independent variables were immigration and English proficiency status. We categorized the sample into 3 groups: LEP immigrants, non-LEP immigrants, and US-born residents. After adjusting for individual-level characteristics, we estimated the adjusted rates of MA enrollment for each group. Our adjusted analysis showed that MA enrollment was higher among immigrants than US-born residents, but the highest enrollment was found among LEP immigrants (LEP immigrants: 45.5%; 95% CI, 42.7%-48.2%; non-LEP immigrants: 42.1%; 95% CI, 39.4%-44.8%; US-born residents: 35.1%; 95% CI, 34.5%-35.6%). MA enrollment was higher among LEP immigrants with better health status (good self-reported health: 45.4%; 95% CI, 41.9%-48.8%; poor self-reported health: 41.4%; 95% CI, 37.7%-45.1%). However, we found small to no differences in the adjusted rates of MA enrollment between those with good vs poor self-reported health in both the non-LEP immigrants and US-born residents groups. We found no consistent enrollment patterns by socioeconomic status such as race/ethnicity, education, and income. Our findings suggest higher MA enrollment among immigrants, especially for LEP immigrants. Future research should study the care experience of immigrants in MA.

Editorial: The effect of Cyriax method on the treatment of Lateral Elbow Tendinopathy

Lateral elbow tendinopathy (LET) is the most common chronic disease of the elbow joint [1], affecting almost 1-3% of the general [2, 3]. Its incidence increases with age and is highest in the 35-60 age group [2, 4]. Extensor carpi radialis brevis’ tendon is the most common structure affected by LET [5]. There is a continuous cycle of minor injuries and constant attempts to repair the damage, causing in progressive degeneration [6,7]. Consequently, a domino effect of changes occurs in the peripheral nervous system neurons, ultimately resulting to the sensitization of the central nervous system [3, 8]. Treatment for LET includes a wide variety of techniques, due to the complexity of the condition. Scientific evidence on the efficacy of the various techniques is of poor quality [9], which hampers the choice of the right therapeutic plan [10, 11]. The Cyriax method was empirically developed by James Cyriax as a therapeutic approach to connective tissue damage [12]. It is an inseparable combination of deep transverse friction (DTF) and Mill’s manipulation [13, 14]. This approach aims to the passive mobilization of soft tissues, preparing them to endure load. The regenerative process is boosted and the mobility of the damaged tissue is restored through pain reduction [12, 14]. Despite the fact that clinical experience supports the use of Cyriax method on LET, the results of systematic reviews show that it is not superior to other approaches indicated for this condition [15-17]. At the same time, there is no consensus on how to apply the method, which leads to a lack of standardization of the relative protocols [12]. In addition, great diversity is observed in the methodological design, the instruments and methods of evaluating the variables (pain, functionality) [12]. The disagreement on DTF procedures and the awareness that physiotherapists’ performance may be affected by the lack of understanding of Cyriax’s conclusions motivated the development of this thesis: The primary aim is to analyze the application parameters of the Cyriax method, as well as its effect on the symptoms of LET, by documenting how physiotherapists in Greece use the method. Moreover, and in line with the latest findings [18], a psychometric evaluation of LET will be included in this thesis. Kinesiophobia is an outcome measure that should be considered, as it is affected by LET [18-20].

The role of the lateral pterygoid muscle in temporomandibular disorders

Introduction. The clinical concept that would argue that the activity of the lateral pterygoid muscle, being disturbed, would play an important role as an etiological factor in temporomandibular joint dysfunctions is still widely accepted, being also a decisive factor in the correct choice of the treatment plan. However, because of the fact that very few research and clear evidence were conducted and presented to support completely that concept, it continues to remain a very controversial one. Material and methods. For this literature review were considered and studied scientific articles published between 2000 and 2023, in the following electronic databases: PubMed, MEDLINE, Google Scholar, BIR Publications, ScienceDirect. Research methods – analysis, synthesis, systematization, and description. Results. Patients presenting temporomandibular joint dysfunction complain about pain in the temporomandibular joint or/and in masticatory muscles, limitation and sounds during mandibular activity. Temporomandibular dysfunction is a non-specific collective term, used to describe a heterogeneous group of pathological conditions located in the territory of the stomatognathic system. These are considered musculoskeletal conditions that cause pain while performing the function (mastication, speech, swallowing), with increased sensitivity in the masticatory muscles and/or the temporomandibular joint, with possible limitations of the range of motion, the appearance of joint noises and otological symptoms. One of the theories claims that in temporomandibular dysfunction, the lateral pterygoid muscle becomes hyperactive, hypoactive or that there is a lack of coordination between the superior and inferior branches of the muscle, or that there is a disturbance during the performance of the role of the muscle to control and stabilize the temporomandibular joint. However, the in-depth study of the specialized literature indicates that no scientific evidence is yet available that the function of the lateral pterygoid muscles in temporomandibular dysfunction is somehow disturbed. Moreover, the muscle’s role during the execution of its normal function has also been questioned and remains a matter of controversy. Conclusions. The lateral pterygoid muscle obviously plays an important role in the development of temporomandibular dysfunction through the prism of its anatomical and functional particularities, referring to the superior fascicle responsible for the correct anatomical maintenance of the articular disc during function.

An Elon Musk generalist or a specialist? The impacts of interdisciplinary learning on post-graduation outcomes

ABSTRACT Interdisciplinary education has become increasingly prominent as a core instrument to prepare the next generation workforce. Yet, little is known about the impacts of long-term degree-oriented interdisciplinary education on post-graduation outcomes. This paper aims to investigate the influence of long-term degree-oriented interdisciplinary education on graduates’ post-graduation plan choices and labour market outcomes using unique administrative micro-data and career-tracking data from a comprehensive research university. Our results indicate that higher levels of engagement in interdisciplinary learning increase the probability of pursuing future study and employment in a field that differs from a graduate’s college degree, and are also associated with a higher probability to enter the workforce. Yet, this positive association between interdisciplinary learning and the probability of entering the workforce is specific to graduates from traditional disciplinary programmes. Additionally, our findings suggest that the impact of long-term degree-oriented interdisciplinary education on early labour market outcomes is overall beneficial but varies across degree fields. The findings of our study provided partial evidence in support of the influence of long-term degree-oriented interdisciplinary education on post-graduation plan choices and early labour market outcomes. We suggest that given resource constraints, higher education institutions could consider relaxing module choice restrictions in traditional disciplinary programmes to promote interdisciplinary education. However, it is important to note that higher education institutions should carefully consider the potential trade-off between the breadth of interdisciplinary content and the depth of specialist content, in order to strike a balance.

Choice of high-deductible health plans among enrollees with a substance use disorder

IntroductionHigh-deductible health plans (HDHPs) expose enrollees to increased out-of-pocket costs for their medical care, which can exacerbate the undertreatment of substance use disorders (SUDs). However, the factors that influence whether an enrollee with SUD chooses an HDHP are not well understood. In this study, we examine the factors associated with an individual with an SUD’s decision to enroll in an HDHP. MethodsUsing de-identified administrative commercial claims and enrollment data from OptumLabs (2007–2017), we identified individuals at employers offering at least one HDHP and one non-HDHP plan. We modeled whether an enrollee chose an HDHP using linear regression on plan and enrollee demographic characteristics. Key plan characteristics included whether a plan had a health savings account (HSA) or a health reimbursement arrangement (HRA). Key demographic variables included age, race/ethnicity, census block income range, census block highest educational attainment, and sex. We separately investigate new enrollment decisions (i.e., not previously enrolled in an HDHP) and re-enrollment decisions, as well as decisions among single enrollees and families of differing sizes. The study also adjusted models for additional plan characteristics, employer and year fixed effects, and census division. Robust standard errors were clustered at the employer level. ResultsThe sample comprised 30,832 plans and 318,334 enrollees. Among enrollees with new enrollment decisions, 24.6 % chose an HDHP; 93.8 % of HDHP enrollees chose to re-enroll in an HDHP. The study found the presence of a plan HRA to be associated with a higher probability of new and re-enrollment in an HDHP. We found that older enrollees with SUD were less likely to newly enroll in an HDHP, while enrollees who were non-White, living in lower-income census blocks, and living in lower educational attainment census blocks were more likely to newly enroll in an HDHP. Higher levels of health care utilization in the prior year were associated with a lower probability of newly enrolling in an HDHP but associated with a higher probability of re-enrolling. ConclusionGiven the emerging evidence that HDHPs may discourage SUD treatment, greater HDHP enrollment could exacerbate health disparities.

모바일 데이터 요금제 가입 선택의 결정요인 분석

The unlimited data plan has been pointed out as one of the main reasons for the increase in household communication costs while accelerating the spread and evolution of mobile services. This study empirically analyzed what factors affect consumers' unlimited data plan choices in the mobile Internet market and how switching between data plans affect consumer benefits, and data from the period 2019 to 2022 of the Korea Media Panel Survey were employed. The results of Probit model suggest that the lower the age and higher the income, the higher the probability of changing the data plan, and the customers who subscribed to the bundling service are more likely to change from a usage-based plan to a data unlimited plan. The results from Mixed Conditional Logit model suggest that the consumers’ benefit decreases when changing from a usage-based plan to a data unlimited plan, while the benefit increases when changing in the opposite direction. Despite the predictability and convenience of the unlimited plan, it can be interpreted that disutility occurs when a customer chooses a plan with a high rate exceeding the customer's optimal usage in a situation where there are few subdivided data plans, which has implications for operators’ pricing strategies and government policies.

Comparative effectiveness and safety of Chinese medicine belly button application for childhood diarrhea: a Bayesian network meta-analysis of randomized controlled trials.

Chinese medicine belly button application (CMBBA) has been used to treat childhood diarrhea (CD) in several randomized controlled trials (RCTs), but its effectiveness and combination strategy still need to be clarified. Therefore, we aimed to evaluate the effectiveness, safety, and the optimal combination strategy of CMBBA in treating CD. Up until January 2023, we searched for studies that met our inclusion criteria in six databases, including PubMed, the Cochrane Library, Chinese SinoMed, CNKI, VIP, and Wanfang. Heterogeneity was quantified using I2 statistics. A methodological evaluation was performed using the Cochrane Risk Bias Tool 2.0. The Confidence in Network Meta-Analysis online software was employed to evaluate evidence grading. A minimally contextualized framework was used to provide a comprehensive conclusion for the network meta-analysis. This study protocol was registered with PROSPERO. We analyzed data from 33 RCTs that included 4,490 children with diarrhea. In terms of clinical effectiveness, CMBBA plus montmorillonite powder plus anti-infectives may be the most effective treatment option for children with diarrhea and concurrent infection according to a minimally contextualized framework. Either exclusive use of CMBBA or CMBBA in combination with modern medicine was beneficial in reducing the time to diarrhea disappearance (MD = -1.33 days, 95% CI: -1.59 to -1.08, Z = -10.103, p < 0.001) compared to modern medicine exclusively, and the difference was statistically significant. The combined usage of CMBBA could shorten the recovery time of dehydration by an average of 0.74 days (MD = -0.74 days, 95% CI: -1.10 to -0.37, Z = -3.931.103, p < 0.001). While some studies have reported mild allergic reactions and mild abdominal pain after CMBBA use, these symptoms can be cured in a relatively short period of time. The combination of CMBBA, montmorillonite powder, and anti-infectives may provide superior clinical effectiveness for children with diarrhea and concurrent infection. To treat CD, CMBBA can be used effectively and safely. However, the findings must be interpreted with cautiously due to the limited number of clinical trials and the low quality of the studies. In addition, the choice of treatment plan should also be based on the specific conditions of each patient. https://www.crd.york.ac.uk/prospero/, identifier: CRD42022380694.

Is having an expert “friend” enough? An analysis of consumer switching behavior in mobile telephony

We present novel evidence from a large panel of UK consumers who receive personalized reminders from a specialist price-comparison website about the precise amount they could save by switching to their best-suited alternative mobile telephony plan. We document three phenomena. First, even self-registered consumers with positive savings exhibit inertia. Second, we show that being informed about potential savings has a positive and significant effect on switching. Third, controlling for savings, the effect of incurring overage payments is significant and similar in magnitude to the effect of savings: paying an amount that exceeds the recurrent monthly fee weighs more on the switching decision than being informed that one can save that same amount by switching to a less inclusive plan. We interpret this asymmetric reaction on switching behavior as potential evidence of loss aversion. In other words, when facing complex and recurrent tariff plan choices, consumers care about savings but also seem to be willing to pay upfront fees in order to get “peace of mind”.

North Carolina's Medicaid Transformation: the Early Enrollee Experience.

On July 1, 2021, North Carolina's Medicaid Transformation mandatorily switched 1.6 million Medicaid beneficiaries from fee-for-service to managed care plans. We examined the early enrollee experience in terms of engagement in plan selection, provider continuity, use of primary care visits, and assistance with social needs. Using electronic health records (EHR) covering pre- and post-transition periods (1/1/2019-5/31/2022) from the largest provider network in western North Carolina, we identified all children and adults under age 65 with continuous Medicaid or private coverage. We conducted primary surveys of a random sample of Medicaid-covered enrollees and obtained self-reported rates of engagement in plan selection, continuity of provider access, and receipt of social need assistance. We used comparative interrupted time series models to estimate the relative change in primary care visits associated with the transition. Our EHR-based study cohorts included 4859 Medicaid and 5137 privately insured enrollees, with 398 Medicaid enrollees in the primary surveys. We found that 77.3% of survey participants reported that the managed care plan they were on was not chosen but automatically assigned to them, 13.1% reported insufficient information about the transition, and 19.2% reported lacking assistance with plan choice. We found that 5.9% were assigned to a different primary care provider. Over 29% reported not receiving any additional social need assistance. The transition was associated with a 7.1% reduction (95% CI, -11.5 to -2.7%) in the volume of primary care visits among Medicaid enrollees relative to privately insured enrollees. Medicaid enrollees in North Carolina may have had limited awareness and engagement in the transition process and experienced a reduction in primary care visits. As the state's transition process gains a foothold, future policy needs to improve enrollee engagement and develop evidence on healthcare utilization and patient outcomes.

Comparison of Single and Multiple Treatment Plans Made in CyberKnife® Radiosurgery System on Phantom

While the use of CyberKnife® radiosurgery systems is increasing, the choice of treatment plan is also important. In this study, it was aimed to determine the more advantageous application by comparing the irradiation of all metastases at once and the protocols of irradiation of metastases separately in multiple brain metastases. For this, on an entirely new head phantom; 6 brain metastases and 3 critical organs, including the spinal cord, brain stem, and chiasm, were determined over the spaces where the dosimeters were placed. Computed tomography (CT) images of the head phantom were taken and these 6 tumors and 3 critical organs were drawn (contouring) on the image. In the treatment planning system, the dose we wanted to give was written and irradiation plans were created to be done separately with a single irradiation. Luminescence (OSL) dosimeters with BeO optical excitation were removed from the phantom after each irradiation and the count value obtained from the dosimeter reader device was recorded. Homogeneity index (HI), conformity index (CI), new conformity index (nCI), duration of treatment, and gradient index (GI) values of irradiation at one time and separately were compared. While it was found that irradiation of tumors with a separate treatment plan was more advantageous in terms of conformity index (CI), new conformity index (nCI), homogeneity index (HI), and coverage values, it was seen that a single plan was more suitable in terms of gradient index and duration.

EFFICACY OF FRONT‐LINE IMMUNOCHEMOTHERAPY FOR TRANSPLANT‐INELIGIBLE MANTLE CELL LYMPHOMA: A NETWORK META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: In the past 20 years, there have been significant advances in the prognosis of mantle cell lymphoma (MCL) patients because of the introduction of rituximab. However, there is still no cure, and the relapse is inevitable. The earlier MCL patients progress after the first-line therapy, the worse the prognosis, especially for those who progress within 6 months after first-line therapy. There is no standard first-line immunochemotherapy regimen for transplant-ineligible patients with MCL currently, and the efficacy of various treatment remains unclear. Methods: Network meta-analysis (NMA) can compare the relative treatment effects of multiple interventions by synthesizing evidence from a network of randomized controlled trials (RCTs), which can be very useful for the choice of clinical treatment plans. We conducted a Bayesian NMA of all eligible randomized controlled trials. Pairwise comparisons and ranking of different first-line treatment options were performed. Results: nine studies were included in the NMA, involving a total of 2,897 MCL patients. The BR-Ibrutinib+R regimen showed the best progression-free survival (PFS), with a surface under the cumulative ranking curve (SUCRA) of 0.89 (Figure 1a) and probability of being the best treatment (PbBT) of 69%, followed by the BR+R regimen (SUCRA 0.76, PbBT 11%) and the BVR regimen (SUCRA 0.64, PbBT 13%). The VR-CAP regimen was the most potential intervention to improve overall survival (OS), with a SUCRA of 0.89 (Figure 1b) and PbBT of 63%, followed by the BR regimen (SUCRA 0.74, PbBT 22%) and the R-CHOP regimen (SUCRA 0.65, PbBT 1%). Compared with the R-CHOP regimen, the BR regimen achieved a better PFS (hazard ratio [HR] 0.45 [95% credible interval 0.2–0.96]). The BR-Ibrutinib+R regimen (HR 0.14 [0.02–0.99]), BR+R regimen (HR 0.19 [0.034–0.99]), and BR regimen (HR 0.19 [0.08–1.03]) were superior to CHOP regimen with better PFS. The R-FC regimen (HR 2.27 [1.01–5.21]) or FC regimen (HR 3.17 [1.15–8.71]) was inferior to the VR-CAP regimen with a worse OS. The research was funded by: This work was supported by Achievement Transformation Project (No. CGZH21001), 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZYJC21007), Translational Research Grant of NCRCH (No. 2021WWB03), Chengdu Science and Technology Program (No. 2022-YF05-01443-SN, 2022-YF05-01444-SN), Key Research and Development Program of Sichuan Province (No. 2023YFS0031, 2023YFS0306), National Natural Science Foundation of China (No. 82204490), and National Key Research and Development Program of China (No. 2022YFC2502600, 2022YFC2502603). Keywords: Aggressive B-cell non-Hodgkin lymphoma, Chemotherapy, Immunotherapy No conflicts of interests pertinent to the abstract.

“THE FRAMES CHAT”: DOES THE PREOPERATIVE FRAMES COUNSELLING SESSION ADEQUATELY PREPARE PATIENTS FOR LIFE WITH A CIRCULAR FRAME?

IntroductionIntroduction: Pre-operative counselling to prepare patients for frame surgery is important to ensure expectations of recovery and rehabilitation are realistic and anxiety is reduced. The aim of the study was to ascertain whether the current clinical nurse specialist frames counselling session (CNS FCS) prepared patients adequately for life with a frame as well as to explore information patients felt was missing.Materials &amp; MethodsMaterials and Method: Patient reported questions were used to assess frames patient views on the CNS FCS. Thirty frames patients were asked about the CNS FCS information, involvement in decision making, factors influencing frames surgery decision and patient experience.ResultsResults: There were 27 patients who received CNS frames counselling and 82% of those (N=22) said they definitely received enough information to make a decision when faced with a choice of surgical plans. 85% (N=23) reported definitely feeling involved in the decision making process with factors contributing to choosing frame treatment being lower risk of deep infection, quicker / safer recovery and advice from the limb reconstruction team. 48% (N=13) definitely felt the CNS FCS gave them a realistic idea of what it's like to live with a frame and 52% (N=14) answered yes to some extent. Feedback on providing more information around sleeping with a frame was provided which has been added to future CNS FCS.ConclusionsConclusion: The current CNS FCS does prepare patients for frames surgery and life with a circular frame and important points raised by patients in this study have been added to future patient information sessions. Regular patient satisfaction audits should be carried out to ensure information remains useful and current patient needs and concerns are met.

"It's just not easy to understand": A mixed methods study of health insurance literacy and insurance plan decision-making in cancer survivors.

Understanding cancer survivors' health insurance decision-making is needed to improve insurance choice, potentially resulting in reduced financial hardship. This explanatory mixed methods study assessed health insurance decision-making in cancer survivors. Health Insurance Literacy Measure (HILM) captured HIL. Quantitative eye-tracking data collected from two simulated health insurance plan choice sets gauged dwell time (seconds), or interest, in benefits. Dwell time differences by HIL were estimated using adjusted linear models. Qualitative interviews explored survivors' insurance decision-making choices. Cancer survivors (N = 80; 38% breast cancer) had a median age of 43 at diagnosis (IQR 34-52). When comparing traditional and high-deductible health plans, survivors were most interested in drug costs (median dwell time 58 s, IQR 34-109). When comparing health maintenance organization and preferred provider organization plans, survivors were most interested in test/imaging costs (40s, IQR 14-67). Survivors with low versus high HIL had more interest in deductible (β = 19 s, 95% CI 2-38) and hospitalization costs (β = 14 s, 95% CI 1-27) in adjusted models. Survivors with low versus high HIL more often ranked out-of-pocket (OOP) maximums and coinsurance as the most important and confusing benefits, respectively. Interviews (n = 20) revealed survivors felt alone "to do their own research" about insurance choices. OOP maximums were cited as the deciding factor since it is "how much money is going to be taken out of my pocket." Coinsurance was considered "rather than a benefit, it's a hindrance." Interventions to aid in health insurance understanding and choice are needed to optimize plan choice and potentially reduce cancer-related financial hardship.