Changes In Guidelines Research Articles

Updates in the management of cancer therapy-related hypertension.

To provide a comprehensive review of hypertension among patients with cancer. Several cancer therapies cause hypertension which has resulted in a growing and vulnerable population of patients with difficult to control hypertension which has significant downstream effects. Hypertension affects up to 50% of cancer patients and higher comorbidity when compared to the general population. Many anticancer therapies can cause hypertension through their treatment effect. Antihypertensive treatment is crucial given cardiovascular mortality is a leading cause of death among cancer patients. It is already known that hypertension is poorly controlled in the general population, and there are additional challenges in management among patients with cancer. Patients with cancer suffer from multimorbidity, are on multiple medications creating concern for drug interactions, and often have blood pressure lability, which can worsen clinical inertia among patients and their providers. It is crucial to effectively treat hypertension in cancer patients to mitigate downstream adverse cardiovascular events. In recent years, there have been significant changes in management guidelines of hypertension and simultaneously as influx of new cancer therapeutics. We provide an update on hypertension treatment among patients with cancer on different chemotherapeutic agents.

Diabetic Foot Screening Guidelines and the Role of Artificial Intelligence: Time to Turn the Tide!

Despite medical and technological advancements, foot amputations continue to rise. Thus, the effort of diabetic foot management should be toward prevention and early diagnosis. Healthcare professionals need to be trained, equipped, and supported with adequate resources to be able to identify and deliver appropriate foot care. Every effort should be made to minimize the impact of complications and to ensure prompt access to care for everyone. Artificial intelligence and smart technology could provide a significant opportunity to improve efficiency in diabetes care, which may reduce diabetic foot complications. The possible potential of the new technologies which are emerging together with their current developing applications for diabetic foot care are suggested. A call for immediate change in diabetes foot screening guidelines is imperative to save limbs and lives.

(401) Treatment Utilization and Temporal Trends in Peyronie’s Disease: A Retrospective Analysis of an Insurance Claims Database

Abstract Introduction The current treatment algorithm for Peyronie’s Disease (PD) was updated in 2015 to exclude oral therapies. Non-surgical pharmacological management is now limited to intralesional therapy with Collagenase Clostridium Histolyticum (CCh), Interferon, or Verapamil. Surgical options include tunical plication, plaque incision/excision with or without grafting, and penile prosthesis surgery with or without adjunctive procedures. An understanding of trends in management of PD since the updated guidelines is limited. Objective Our objective is to assess treatment utilization and temporal trends in PD with the change in guidelines. Methods We conducted a retrospective review of men with PD using data in the IBM MarketScan insurance claims database. Patients were identified using ICD 9/10 codes and treatments were identified using J and CPT codes. Only patients aged ≥18 years with at least 1 year before and after a PD diagnosis were included in the analysis. Descriptive statistics were used to describe non-surgical and surgical treatment groups. Linear regressions were also performed to assess the trends of each year based on initial PD treatment. Results Between 2011-2019, we identified a total of 45,114 patients with a diagnosis of PD. Overall, while the majority (91.9%) chose conservative management with no intervention, 1,041 (2.3%) pursued intralesional therapy and 2,594 (5.8%) pursued surgical intervention as an initial treatment option. Among the patients who initially opted for intralesional therapy, 67 (6.4%) sought subsequent surgical treatment whereas 974 (93.6%) did not pursue additional treatment. In comparison, 116 (4.5%) patients who initially underwent surgical intervention sought subsequent treatment with the remaining 2,478 (95.5%) not pursuing additional treatment. Annual overall treatment rates increased from 7.2% to 8.1%. There was a statistically significant increase in the utilization of intralesional therapies from 0.3% in 2011 to 4.1% in 2019 (p=0). Surgical interventions significantly declined from 6.8% to 3.9% over the same time period (p=0.004). Conclusions The present study demonstrates that PD treatment trends have changed over time. With overall low secondary treatment rates for patients initially pursuing either non-surgical or surgical treatment options, a greater proportion of patients are initially pursuing less invasive, non-surgical treatment options with intralesional therapy over time. These findings emphasize the dynamic nature of treatment decisions and contribute to a deeper understanding of the treatment landscape that can be incorporated into patient counseling. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Paterna bio, Firmtech, Turtle health, Maximus, Carrot, Contraline, endo pharmaceuticals, inherent biosciences, techfields inc, macro trials, alto neurosciences, curebase, vivify medical.

Left Atrial Appendage Occlusion versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation

Introduction: Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received percutaneous LAAO or direct oral anticoagulant (DOAC) treatment, in a large population from a global federated health network (TriNetX). Methods: Patients with AF treated with percutaneous LAAO were matched with those treated with DOAC between December 1, 2010, and October 1, 2018. Outcomes were all-cause mortality, ischaemic stroke, and intracranial haemorrhage (ICH) at 5 years. Results: We included 200 patients with AF, who received either LAAO or DOAC. The risk of all-cause mortality, ischaemic stroke, and ICH at 5 years was not significantly different between the two groups (risk ratio [RR] for all-cause mortality: 1.52, 95% confidence interval (CI): 0.97–2.38, RR for ischaemic stroke: 1.09, 95% CI: 0.51–2.36, and RR for ICH: 1.0, 95% CI: 0.44–2.30). Conclusion: Patients newly diagnosed with AF, eligible for DOAC, showed similar 5-year risk of death, ischaemic stroke, and ICH when comparing those who underwent percutaneous LAAO to those receiving DOAC. Future randomised controlled trials are needed to confirm the findings and advise changes in guidelines.

Pain management in trauma: the need for trauma-informed opioid prescribing guidelines

Background/objectivesSurgical populations and particularly injury survivors often present with complex trauma that elevates their risk for prolonged opioid use and misuse. Changes in opioid prescribing guidelines during the past several...

Trends in Chlamydia trachomatis Treatment Prescribing Practices in King County, Washington, 2010-2018.

In 2021, national Chlamydia trachomatis (CT) treatment guidelines changed from recommending either azithromycin (1 g; single dose) or doxycycline (100 mg twice daily for 7 days) to recommending only doxycycline as first-line treatment. The distribution and trends in CT prescribing practices before the guidelines change is largely unknown. We conducted a trends analysis using Washington STD surveillance data. We included all female cases of urogenital CT 15 years or older who resided in King County and were diagnosed between 2010 and 2018. Surveillance data included information on demographics, sexual history, clinical features, diagnosing facility (eg, emergency department, family planning), and treatment regimen. We conducted descriptive analyses to examine trends in prescribing practices over time and by facility type. We used Poisson regression to examine the association between CT case characteristics and receipt of receipt of azithromycin. There were 36,830 cases of female urogenital CT during the study period. The percent of cases receiving azithromycin increased significantly from 86% in 2010 to 94% in 2018; the percent receiving doxycycline decreased from 13% to 5%. Five of the 8 facility types prescribed azithromycin to >95% of CT cases by 2018. Cases who were younger or cases of color were more likely to receive azithromycin (versus doxycycline) compared with older and White cases, respectively. A substantial shift in CT prescribing practices will be needed to adhere to new CT treatment guidelines. Our findings highlight the need for targeted provider education and training to encourage the transition to doxycycline use.

"We will be the ones bearing the consequences": Aqualitative study of barriers and facilitators to shared decision-making in hospital-based maternity care.

Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision-making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital-based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. Qualitative semi-structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision-makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. Women expect to be included in decisions about their care. Health service administrators and decision-makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision-making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient-clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational- and system-wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations.

Psychologists' experiences with telepsychology during the COVID-19 pandemic in South Africa.

During the COVID-19 pandemic, South African psychologists started to use telepsychology to continue providing services. However, diverse factors may influence psychologists' decisions regarding the use of telepsychology. To investigate South African psychologists' experiences with using telepsychology during the COVID-19 pandemic. Health Professions Council of South Africa (HPCSA)-registered psychologists practising in South Africa. A quantitative, cross-sectional study was conducted. Psychologists were invited to complete an online survey on the REDCap platform. Convenience sampling was used for respondent selection (n = 179). The study explored demographic variables, telepsychology use, changes in psychotherapy format, guidelines, ethical considerations, training, socio-economic factors, and individual patient and psychotherapist factors. Descriptive statistics, including categorical variables (frequencies and percentages) and numerical variables (medians and percentiles) were utilised for the data analysis. A bivariate analysis with backward selection was subsequently used, and significant variables were integrated into the logistic regression model. Most respondents (84.8%) used telepsychology, with 72.8% considering it a positive experience. Private psychologists used electronic means for delivering services significantly more than public sector psychologists. The public sector psychologists had more challenges relating to changes in the therapeutic format, additional training requirements and technology access. During the COVID-19 pandemic, psychologists turned to telepsychology as a valuable tool for providing services while navigating the unique challenges it presented. This study provides insights into the utility of telepsychology in the South African context during COVID-19. It underscores the experiences, importance of guidelines, and needs regarding training and technology access among psychologists.

Service implications of the revised 2022 National Institute for Health and Care Excellence (NICE) follow-up guidelines for stage IA-IIC melanoma.

The 2022 National Institute for Health and Care Excellence melanoma guideline update made significant changes to follow-up. The aim of this study was to assess the impact these changes will have on a national melanoma cohort over a 5-year follow-up interval. Anonymized, individual-level, population-scale, linkable primary and secondary care National Health Service data for an 18-year interval (2000-2018) in Wales, UK were analysed. These data were used to predict the number of patients over a 10-year interval (2020-2030) that would be diagnosed with melanoma. Follow-up schedules for the 2015 and 2022 National Institute for Health and Care Excellence melanoma guidelines were then used to calculate the number of clinician-led appointments, the number of radiological investigations, and the total healthcare cost between 2025 and 2030, corresponding to a 5-year patient follow-up interval, for those with stage IA-IIC melanoma. Between 2025 and 2030 it is predicted that implementation of the 2022 guidelines would lead to 21 122 (range 19 194-23 083) fewer clinician-led appointments for patients with stage IA-IIC melanoma. However, there would be a significant increase in the number of radiological investigations (7812; range 7444-8189). These changes would lead to a €2.74 million (€1.87 million-€3.61 million) reduction in the total cost of follow-up over the interval 2025-2030. Melanoma follow-up guideline changes will result in a substantial reduction in the number of clinical follow-up appointments, but a significant additional burden to radiological services. The overall cost of follow-up at a national level will be reduced.

Medicare formulary restrictions for glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors used in type 2 diabetes mellitus: 2019-2023.

Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is) have proven benefits in patients with type 2 diabetes mellitus related to decreasing cardiovascular events and heart failure hospitalizations as well as preventing the progression of kidney disease. This led the American Diabetes Association (ADA) to update their guidelines in 2022 to recommend GLP1-RAs and SGLT2is as potential first-line options in patients with cardiorenal conditions. Formulary restrictions, such as step therapy and prior authorizations, can limit access to these beneficial medications. To evaluate trends in Medicare formulary restrictions of GLP1-RAs and SGLT2is following the recommendations by the ADA for first-line use. We conducted a retrospective cohort study of Quarter 1 Medicare formulary restrictions on GLP1-RAs and SGLT2is from 2019 to 2023. We analyzed changes in formulary restrictions by year, before and after the ADA first-line recommendations, single vs combination products, and products with and without other indications on a medication level (ie, each unique National Drug Code number on each unique formulary) and formulary level (ie, any prior authorization or step therapy requirements yield formulary restriction). We analyzed 12,212 unique Medicare formularies. GLP1-RAs were 12.5% less likely (relative risk [RR] = 0.87; 95% CI = 0.84-0.91; P < 0.001) and 33.2% less likely (RR = 0.67; 95% CI = 0.60-0.74; P < 0.001) to have restrictions after the ADA guideline changes on a medication and formulary level, respectively. SGLT2is were 87.8% less likely (RR = 0.12; 95% CI = 0.11-0.13; P < 0.001) and 53.0% less likely (RR = 0.47; 95% CI = 0.27-0.80; P = 0.005) to have restrictions after the ADA guideline changes on medication and formulary levels, respectively. Decreasing trends of medications and formularies with restrictions may indicate payers are recognizing GLP1-RAs and SGLT2is as potential first-line agents, aligning with ADA recommendations.

Multi-centre Implementation of the SNAP Protocol for Paracetamol Overdose - reducing the length of stay

Aim/Objective/Background: Paracetamol stands as one of the most prevalent drugs of overdose in the UK. The conventional treatment for Paracetamol toxicity involves intravenous administration of N-acetylcysteine (NAC), typically administered over 21 hours in UK hospitals. However, an alternative 12-hour infusion, known as the &amp;apos;SNAP&amp;apos; regimen, has shown promise in reducing anaphylactoid reactions compared to the standard treatment. This study implemented the SNAP regimen in two District General Hospital Emergency Departments within the same NHS Trust as part of a quality improvement project (QIP), aiming to assess its impact on reducing adverse reactions and inpatient length of stay. Methods/Design: Trust guidelines were revised to recommend the 12-hour SNAP regimen for adult Paracetamol overdose cases, accompanied by a pre-filled prescription chart. A retrospective analysis of patient records and electronic discharge letters was conducted before and after the guideline change to identify NAC recipients and document any adverse reactions. Length of inpatient stay was also documented. Results/Conclusions: Over a three-month period from August to November 2020 across both sites, 60 adult patients received NAC for Paracetamol overdose, with four experiencing anaphylactoid reactions. Following the introduction of the SNAP regimen, spanning from April to June 2021, 36 adult patients received NAC, none of whom experienced adverse drug reactions. Before the guideline change, adult patients admitted for Paracetamol overdose had an average inpatient stay of 48.3 hours, which decreased to an average of 44.5 hours following the adoption of the SNAP regimen. The SNAP NAC regimen demonstrated comparable safety regarding adverse drug reactions while effectively reducing the length of inpatient stay for adults with Paracetamol overdose.

Традиции и новаторство горьковской стратегии книгоиздания для детей

Book publishing for children in Russia has a long and glorious history. In the first half of the 1920s, children’s literature was regularly published by two specialized publishing houses: Raduga and G. Mirimanov. Maxim Gorky, as an experienced book publisher, initiator and organizer of various publishing projects, adhered to traditions in the book business and introduced innovative approaches to children’s book publishing. The book for Gorky, a supporter of active and productive reading, has always been a work of culture and art capable of elevating a person, being an instrument of education and enlightenment. Gorky’s strategy included the preservation and enhancement of publishing experience. Gorky practiced publishing principles suitable for children’s literature in 1912 when editing Italian Fairy Tales translated by M. Andreeva. In 1917, he participated as an author and editor in the creation of a collection for children Christmas Tree in the Pams publishing house. In 1918, together with the publisher I.R. Belopolsky, the writer organized the first “pre-pioneer” Soviet magazine Severnoe siyanie. In 1933, Gorky was puzzled by the creation of a specialized children’s publishing house, for which he formed a special communicative field: he included his correspondents in the discussion of the plans of Detgiz. He turned for help in creating new children’s literature to K.I. Chukovsky, S.Ya. Marshak, M. Ilyin, S.T. Grigoriev, M. Prishvin, B. Zhitkov, Vs. Ivanov, Yu. Olesha, M. Zoshchenko, artist V. Lebedev, and others. Gorky’s appeal to children in the summer of 1933 with the question of what they read and what books they want to get was a truly innovative method of studying young readers, unique in its simplicity and effectiveness. This unique publishing strategy yielded significant results: Gorky and all those responsible for publishing books for children received reliable, truthful answers from young readers, learned the true interests and requests of Soviet children. Thus, thanks to Gorky, the interests of children began to determine the tasks and directions of the children’s publishing house, as well as the methods and forms of work of its editorial staff. In addition, involving children in discussing the problems of children’s publishing solved the problem of involving children and adolescents in reading. Gorky’s competent strategy - clear ideas about the mission, goals, objectives, orientation of the publishing house, a clear orientation to the target audience - in organizing the state children’s publishing house Detgiz, which still exists today, contributed to the formation of a special Soviet cultural space and to the change of the conceptual activity guidelines of the publishing house for children. The author declares no conflicts of interests.

TOOLKIT FOR SOCIAL RESPONSIBILITY OF BUSINESS IN THE SYSTEM OF INCLUSIVE CORPORATE MANAGEMENT OF SUSTAINABLE DEVELOPMENT OF UKRAINIAN AGRICULTURAL COMPANIES

The research subject is the social responsibility of agribusinesses in the context of current corporate governance practices. Methodology. The study uses the following methods of economic research: content analysis method (when processing scientific sources and reviewing thematic literature); abstract and logical method (when substantiating the defining principles and criteria of social responsibility of business entities in the agricultural sector); statistical observations and economical and statistical calculations (when analysing indicators of the achieved state of social responsibility of agricultural companies); abstract and logical method (when substantiating conclusions to the study). The research is aimed at finding tools to increase the social responsibility of agrarian business through the transformation of the corporate culture of agricultural management of Ukrainian companies. Conclusion. Ukraine has a strong agricultural potential. However, achieving national and global sustainable development goals, which are relevant shortly, requires a change in business values and strategic guidelines. Such values should be aimed at solving the problems of protecting the environment, preserving natural resources, improving the quality and safety of agri-food products, and improving the quality of life of the rural population. The solution to these problems is inextricably linked to voluntary, socially responsible agribusiness initiatives. The analysis carried out showed that there is a high level of agribusiness social responsibility in the management of the activities of large-scale agricultural enterprises in Ukraine, which is reflected in the voluntary non-financial reports. In small- and medium-sized agribusinesses, the perception of the need for social responsibility is limited and constrained by a lack of financial resources. The calculated indicators show a low level of social responsibility in the agricultural business of small- and medium-sized agricultural enterprises in Ukraine. The level of chemicalisation of agricultural production and ploughing of agricultural land is high. There are significant problems with the use of rural labour resources and the development of rural areas. The main problems were identified in the spectrum of irrational use of land and labour resources and the low quality of life of the population in rural areas of Ukraine. The processes of recognition of the values and benefits of socially responsible agribusiness in Ukraine are slow. As a tool for increasing the social responsibility of agribusinesses in Ukraine, a system of principles and criteria of socially responsible business is proposed for implementation in the corporate governance of Ukrainian agribusinesses.

Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel.

Despite the progress in contemporary antiretroviral therapy (ART) and the continuous changes in treatment guidelines, virological failure (VF) is still an ongoing concern. The goal of this study was to assess factors related to VF after first-line ART. A longitudinal cohort retrospective study of individuals on first-line ART diagnosed with HIV-1 in 2010-2018 and followed-up for a median of two years was conducted. Demographics, baseline and longitudinal CD4 counts, treatment regimens, adherence and VF were recorded. The Cox proportional hazards regression and mixed models were used. A cohort of 1130 patients were included. Overall, 80% were males and 62% were Israeli-born individuals. Compared to individuals diagnosed in 2010-2014, when treatment was initiated according to CD4 levels, those diagnosed in 2015-2018 were older and had lower baseline CD4 counts. VF was recorded in 66 (5.8%) patients. Diagnosis with CD4 <200 cells/mmᶟ with AIDS-defining conditions (HR = 2.75, 95%CI:1.52-4.97, p < 0.001) and non-integrase strand transfer inhibitor regimens (non-INSTI, HR = 1.80, 95%CI:1.01-3.24, p = 0.047) increased VF risk. No impact of baseline resistance was observed. We concluded that the early detection of HIV-1 infection and usage of INSTI-based regimens are recommended to reduce VF.

A national study of postoperative thyroid hormone supplementation rates after thyroid lobectomy

BackgroundThe American Thyroid Association updated guidelines in 2015 to allow lobectomy for low-risk thyroid cancers. The objectives of this study were (1) to determine thyroid hormone supplementation rates after lobectomy and (2) to evaluate the effect of the American Thyroid Association guideline change on lobectomy and hormone supplementation rates among thyroid cancer patients. MethodsThe Merative MarketScan Databases was used to identify adult (≥age 18) patients who underwent thyroidectomy for benign nodules or thyroid cancer. The association between indication for surgery and postoperative thyroid hormone supplementation was examined using χ2 analyses and multivariable logistic regression models. Among patients with thyroid cancer, lobectomy and hormone supplementation rates were compared in the periods before (2008–2015) and after the guideline change (2016–2019). ResultsOf the 81,926 patients identified, 33,756 (41.2%) underwent thyroid lobectomy, 45,104 (55.1%) underwent total thyroidectomy, and 3,066 (3.7%) underwent completion thyroidectomy. Patients who underwent lobectomy for malignancy were significantly more likely to require hormone supplementation (59.3% vs 39.4% [P < .001], adjusted odds ratio 2.34 [95% confidence interval 2.20–2.48]) compared to those with benign disease. Compared to the 2008 to 2015 period, the proportion of patients who underwent lobectomy for thyroid cancer was higher in the 2016 to 2019 period (34.3% vs 30.3%, P < .001), with fewer patients requiring completion thyroidectomy (25.6% vs 29.8%, P < .001) and thyroid hormone supplementation (56.9% vs 60.1%, P = .04). ConclusionThe postoperative thyroid hormone supplementation rate was significantly higher in patients who had thyroid cancers compared to benign diseases. After the American Thyroid Association guidelines changed, lobectomy rates increased significantly without a concomitant increase in the completion of thyroidectomy.

National health registries – a ‘goldmine’ for studying non-communicable disease occurrence in Norway – the NCDNOR project

To estimate occurrence of non-communicable diseases (NCDs) over the life-course in the Norwegian population, national health registries are a vital source of information since they fully represent the entire non-institutionalised population. However, as they are mainly established for administrative purposes, more knowledge about how NCDs are recorded in the registries is needed. To establish this, we begin by counting the number of individuals registered annually with one or more NCDs in any of the registries. The study population includes all inhabitants who lived in Norway from 2004 to 2020 ( N~6.4m). The NCD outcomes are diabetes, cardiovascular diseases, chronic obstructive lung diseases, cancer and mental disorders/substance use disorders. Further, we included hip fractures in our NCD concept. The data sources used to identify individuals with NCDs, including detailed information on diagnoses in primary and secondary health care and dispensings of prescription drugs, are the Cancer Registry of Norway, The Norwegian Patient Registry, The Norwegian Control and Payment of Health Reimbursement database, and The Norwegian Prescription Database. The number of individuals registered annually with an NCD diagnosis and/or a dispensed NCD drug increased over the study period. Changes over time may reflect changes in disease incidence and prevalence, but also changes in disease-specific guidelines, reimbursement schemes and access to and use of health services. Data from more than one health registry to identify individuals with NCDs are needed since the registries reflect different levels of health care services and therefore may reflect disease severity.

A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade.

Acute lymphocytic leukemia (ALL) is a commonly diagnosed cancer in children.Despite technological advancements to improvetreatment and survival rates, there has been a steady increase in the incidence of ALL and treatment failures. This paper discusses the pathogenic interaction between genetic and environmental factors leading to childhood ALL. It evaluates the current treatment guidelines and notable obstacles leading to resistance, relapse, and treatment toxicities. The reviewevaluates a 10-year trend in the management guidelines of pediatric ALL through asystematic literature review of recordsfrom 2012 to 2023. Findings show that improvement in the five-year survival rates, notwithstandingrates of relapse and incurable diseases, is still high. Furthermore, several risk factors, including an interplay between genetic and environmental factors, are largely contributory to the outcome of ALL treatments and its overall incidence. Moreover, huge financial costs have remained a significant challengein outcomes. There remains a need to provide individualized treatment plans, shared decision-making, and goals of care as parts of the management guidelines for the best possible outcomes. We expect that future advancements will increase overall survival rates and disease-free years.

The impact of maternal pertussis vaccination recommendation on infant pertussis incidence and mortality in the USA: an interrupted time series analysis.

Pertussis is a contagious respiratory disease. Maternal tetanus-diphtheria-acellular pertussis vaccination during pregnancy has been recommended by the United States Centres for Disease Control (US CDC) Advisory Committee on Immunization Practices (ACIP) for unvaccinated pregnant women since October 2011 to prevent infection among infants; in 2012, ACIP extended this recommendation to every pregnancy, regardless of previous vaccination status. The population-level effect of these recommendations on infant pertussis is unknown. This study aimed to examine the impact of the 2011/2012 ACIP pertussis recommendation on pertussis incidence and mortality among US infants. We used monthly data on pertussis deaths among infants aged <1 year between January 2005 and December 2017 in the CDC Death Data and yearly infant pertussis incidence data from the CDC National Notifiable Disease Surveillance System to perform an interrupted time series analysis, accounting for the passage of the Affordable Care Act. This study included 156 months of data. A potential decline in trend in infant pertussis incidence was noted during the post-recommendations period. No appreciable differences in trend were found in population-level infant pertussis mortality after the guideline changes in both adjusted and unadjusted models. Results were similar for all mortality sensitivity analyses. The 2011/2012 ACIP maternal pertussis vaccination recommendations were not associated with a population-level change in the trend in mortality, but were potentially associated with a decrease in incidence in the USA between 2005 and 2017.

Проституция и оказание сексуальных услуг: актуальные вопросы регулирования в мире и в России

Introduction. In the modern world, the public understanding of sexual mania, sexual freedom, and erotic preferences is undergoing significant changes caused by the influence of telecommunications systems, the modernization of moral values, and a change in moral guidelines. The tolerance of prostitution and sexual deviations has a negative impact on the normal physical, mental, spiritual, and moral development of citizens, distorts the consciousness of society, and especially affects minors, which can have an extremely negative impact on their further social adaptation in society. These phenomena are one of the most pressing and acute problems of Russian society, since the deformation of the physical and mental development of civil society threatens the health of the nation. A particular danger is the moral corruption of children and adolescents, the formation of premature unhealthy sexual interest in them, the development of a misconception about sexual relationships, and unnatural norms of sexual life. In the paper, the authors examined the specifics of the regulation of prostitution in certain foreign countries and in Russia and proposed some measures to improve the legislation. The purpose of the research is to study the legal regulation of prostitution in foreign countries and in Russia, as well as to improve the current Russian legislation. Methods. The methodological framework for the study was the comparative legal method. The methods of induction and deduction used contributed to obtaining most of the formulated conclusions. Results. Based on the research conducted, some measures are proposed to tighten the current Russian legislation aimed at preventing prostitution. The authors’ definitions of the concepts of “prostitution” and “sexual services” are formulated. Conclusions. It is proposed to distinguish the concepts of “prostitution” and “sexual services,” taking as a basis the fundamental concept of service.

Abstract C111: Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women?

Abstract Background: Breast and Cervical Cancer screening (BCS and CCS) are essential tools to prevent cancer. Yet, non-Hispanic Black (NHB) women die at a much higher rate from Breast and Cervical cancer than non-Hispanic White (NHW) women. Thus, it is important that providers recommend BCS (Mammogram) and CCS (Pap test), equitably, for maximum cancer prevention. Meaningful Use (MU), as part of the HITECH Act, incentivized providers to utilize electronic health records (EHR) not only for billing, but to increase the quality of patient care. MU also included an aim to reduce health disparities using EHR. The intent of this study was to evaluate BCS and CCS rates before and after the advent of MU to examine potential cancer screening disparities between NHW and NHB. It is imperative that cancer screenings are recommended, equally, to address grave disparities for NHB cancer mortality. Methods: Using a pre-post design, we examined BCS and CCS rates before the enactment of MU (2013) in a Medicaid population and after MU implementation for years 2014-2016. Medicaid data were extracted from the Michigan Department of Health &amp; Human Services data warehouse for Medicaid enrollees. Inclusion criteria were physicians who were continually enrolled in MU from 2014-2016 who saw women of BCS and CCS screening age. Odds Ratios were used to examine differences in screening rates over time between Black and White women. Results: For BCS, no differences were detected between NHW and NHB women, although a trend was observed for post-MU for 2015 (OR = 1.167, 95% CI [0.876, 1.580]). Analyses of CCS rates post-MU showed differences (p&amp;lt;0.01) between NHW and NHB for 2014 (OR = 1.211, 95% CI [1.079, 1.377] and 2015 (OR = 1.141, 95% CI [1.029, 1.266], respectively. Regression analyses from 2013 to 2016 showed differences between NHW and NHB women for both BCS and CCS over time with NHW and NHB screening rates converging in 2016 (p&amp;lt;0.05). Conclusion: We did not find any discernable differences in BCS between NHW and NHB women after providers subscribed to MU. CCS screening rates for NHB were higher than NHW in 2014-2015, but not in 2016. However, changes in BCS and CCS rates were significant by year and over time. For both BCS and CCS, rates converged over time for both NHW and NHB reducing screening disparities, but screening rates decreased over time. This decrease over time was attributable to changes in screening recommendations for both BCS and CCS (ACOG, ACS, CDC). Notably, the guidelines changed from yearly CCS to every three years for women at low-risk for cervical cancer. Further analyses are warranted to adjust for the change in screening guidelines. These findings are complex and will be fully discussed to discern screening differences between NHW and NHB women, and use of EHR as a tool to reduce health disparities. Citation Format: Sabrina Ford, Laura Houdeshell-Putt, Molly Polverento, Kevin Brooks. Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C111.