Large Center Research Articles

De novo financial toxicity in patients with prostate cancer following radical prostatectomy and its impact on health-related quality of life.

318 Background: Financial toxicity (FT), a patient-reported outcome measure (PROM) is defined as the detrimental impact of financial burden caused by a cancer diagnosis on a patient’s well-being. FT is common among cancer patients, yet little is known about FT following radical prostatectomy (RP) for prostate cancer in countries with universal health coverage. We aimed to assess de novo FT and its impact on health-related quality of life (HRQOL) in a large prospective cohort of patients undergoing RP with a systematic follow-up of up to 10 yrs. Methods: 2254 consecutive patients who underwent RP at a large tertiary care center were analyzed. PROMs were prospectively assessed preoperatively, postoperatively at 3mo, then annually until a maximum follow-up of 120mo, applying the validated EORTC QLQ-C30- and the prostate cancer-specific QLQ-PR25 questionnaires. FT was assessed by the “financial toxicity subscale” (FTS) of the EORTC QLQ-C30. Based on previous reports, meaningful FT was defined as FTS ≥ 17. Multivariable regression analysis was used to identify predictors for the development of de novo FT. Separate modeling of longitudinal HRQOL was performed for patients with de novo FT (FT-cohort) and without FT (no-FT-cohort). General HRQOL was assessed by the global health status domain (GHS) of the EORTC QLQ-C30. Results: 298 patients reporting FT prior RP were excluded from further analysis. 20.3% (n=397) of the included patients reported de novo FT within 12 months after RP with a mean FTS-score of 47.3 (SD 21.9). Baseline clinicopathological characteristics did not differ between the FT-cohort and the no-FT-cohort (p-range .060-.173). Multivariable logistic regression analysis revealed subsequent therapies following RP (OR 1.981, 95%CI 1.11-3.53, p=.020), low preoperative emotional functioning (OR 0.990, 95%CI 0.92-0.99, p=.031) and low preoperative social functioning (OR 0.990, 95%CI 0.98-0.99, p=.035) to independently predict development of de novo FT after RP. In longitudinal analysis, significantly worse general HRQOL was observed for patients with de novo FT postoperatively and up to 48mo after RP (p-value each < .001). In the longer term, both cohorts reported no significant difference in general HRQOL up to 10yrs post RP (p-range: .90 - .91). Conclusions: The current study provides prospective data from a unique contemporary patient cohort, which reveals independent predictors for de novo FT in prostate cancer patients following RP. Furthermore, it displays the natural course of general HRQOL for patients who develop de novo FT.

Abstract WP60: On vs. Off-Hours Arrival to Groin Time: Identifying Gaps in a Comprehensive Stroke Center

Introduction: Timeliness of treatment for patients with acute ischemic stroke (AIS) directly correlates with outcomes. The most current AHA guidelines standard of care for patients having a large vessel occlusion (LVO) stroke is endovascular mechanical thrombectomy (MT). Earlier treatment is associated with better outcomes at 90 days. Parallel processing is paramount when executing an expedited transition from the emergency department (ED) to the MT suite. At a large academic comprehensive stroke center (CSC), as we receive a high volume of direct ED cases, we examined whether there was a difference in daytime vs. off-hour LVO cases. Methods: The MT database maintained by the CSC was queried for all cases from July 2022- July 2023. Inclusion criteria included all AIS with LVO and receiving MT that were transported by EMS directly to the CSC ED. Data was further stratified by time of day and day of the week. Cases were designated as day if they arrived Monday through Friday between 7am-5pm. Cases were considered night/weekend if they arrived 5pm-7am or anytime Saturday or Sunday. Times between groups were compared with t-test. Results: There were a total of 37 cases in the day group and 43 cases in the night/weekend group. Patients arriving during the day had a median arrival-to-groin time of 89 minutes and a mean of 93 minutes. The night/weekend group had a median of 116 minutes and a mean of 125 minutes, and the difference was statistically significant (p=0.0009). Upon further analysis, mean ED arrival to suite time was significantly longer for night/weekends, 105 vs. 76 minutes, p=0.008, but mean suite to groin puncture time was not significantly different, 18 vs. 16 minutes, p=0.24. Conclusion: There is a statistically significant difference in arrival to suite/groin times between the day and night/weekend groups, therefore putting patients with LVO arriving off hours at higher risk for poor outcomes. Historically some cardiac cath labs have utilized nursing bridge teams to help with parallel processing, and we theorize that using such a team to facilitate preparation of the patient and suite, we can reduce treatment times for off-hour’s ED MT cases and potentially improve outcomes.

Abstract WP165: Meth Use and Intracerebral Hemorrhage: Really "Breaking Bad"

Background: Unlike other stimulants, methamphetamine (meth) is highly addictive and can be injected, snorted, smoked, or ingested orally. Due to increased access, its use has increased globally. Recent studies have shown that there was no significant difference in hospital outcomes between ICH positive patients who utilize meth versus those who do not. However, there has not been a comprehensive evaluation of methamphetamine related ICH in recent times. Our objective is to determine if meth use impacts ICU length of stay/need for sedating agents, and if meth use varies by ethnicity in the ICH population. Methods: This is an IRB approved retrospective review of all patients with acute ICH at a large academic stroke center from 2017 to 2023. Data collected and analyzed include demographics, ICH score/size, intraventricular hemorrhage, location of hematoma, surgical intervention, GCS/NIHSS scores, ICU length of stay (LOS), and discharge destiny. Statistics used include Pearson’s Chi-squared test and Wilcoxon rank sum test. Results: Of 70 ICH patients with all data elements, 32 (46%) were meth users, with an average age of meth positive patients at 59. In our Hispanic population, significant meth use was seen (41% v 13%, p = 0.009). ICH patients had significant NICU LOS (10.1 v 6.1 days, p < 0.001), with longer hospital mean LOS (12.4 v 7.8 days, p = 0.007). They also required more sedatives (63% v 37%, p = 0.032). Meth use was not associated with larger ICH size (15.7 v 29.2, p = 0.406), but was associated with higher discharge mRS (4.7 v 4.3, p = 0.788). Conclusions: Our study demonstrates that in ICH positive patients, meth-use was associated with increased use of sedatives and increased length of stay, as well as higher discharge mRS. However, it was not associated with larger ICH size. Hispanic ethnicity and ICH also appear to have a relationship, although that relationship needs to be further elucidated. Discussion: Methamphetamine is easily and relatively inexpensive to make, with over-the-counter ingredients such as pseudoephedrine. With over 35 million people using meth worldwide, our data found that the average user was older than previously thought. As ICH is one of the major complications of meth use, ICH has a major impact on complexity of care and health economics.

Development of a Discharge Counseling and Medication Reconciliation Process for Pediatric Patients Within a Large, Academic Health System

OBJECTIVE This study aims to characterize the impact of a pharmacist-driven discharge medication reconciliation and counseling program targeting high-risk pediatric patients to mitigate barriers in transitions of care. METHODS This was a single-center quality improvement initiative including high-risk pediatric patients within a large academic medical center. Pharmacy, medical, and information technology team members developed a scoring system to identify patients at high risk of hospital readmission that resulted in a trigger tool built within the electronic medical record (EMR). Pharmacy workflow, the EMR documentation, and staff training were implemented. The primary end point was the number of high-risk patients with complete medication reconciliation and/or discharge counseling performed during the first 2 months after implementation. The secondary end points included quantification and qualification of the interventions conducted by a pharmacist. RESULTS Pediatric clinical pharmacists conducted discharge medication reconciliation and/or counseling for 60 patients during the first 2 months after implementation. There were 65 interventions performed, including 60 discharge medication reconciliations and 5 discharge counseling sessions. Of these interventions, 22 were recommendations on appropriate medication dosing and frequency (37%), 12 on duration of therapy (20%), and 8 were medication additions (13%). There were 6 interventions on adherence assistance (10%), 6 involved selection of medication formulation (10%), 3 involved medication discontinuation (5%), 2 involved appropriate therapy selection (3%), and 1 involved medication stability (1%). All interventions were accepted and implemented by the prescribing providers. CONCLUSIONS Pharmacist-driven discharge medication reconciliation and counseling programs targeting pediatric high-risk population might be an effective tool to mitigate gaps in transitions of care.

Evaluating an epilepsy clinical nurse specialist development programme

There is a demand across the country for highly trained epilepsy specialist nurses (ESNs) due to the increasing number of patients that this long-term condition affects. It is estimated that 65 million people worldwide are affected by epilepsy. If not treated and supported effectively, epilepsy comes with high risk of mortality, comorbidities, stigma and high potential costs to the NHS. Patients who do not have access to a highly trained ESNs can be significantly and negatively affected by wrong diagnosis, gaps in knowledge when facing general care, incorrect and, on occasion, detrimental treatment options, poor epilepsy education and advocacy. Furthermore, patients living in rural areas often do not have access to large tertiary centres or neurologists with an interest in epilepsy. Due to this, access to ESNs running nurse-led clinics in smaller hospitals and community settings is vital to improving patient care. Nonetheless, there is a shortage of highly trained ESNs. The ESN development programme discussed in this article was formed as a concerted action to address recruitment challenges and widen the area and scope of care for people with an epilepsy diagnosis.

De novo hepatitis B infection following liver transplantation with core antibody positive grafts: The role of surface antibody status in guiding long-term prophylaxis.

Liver transplantation (LT) with hepatitis B core antibody (anti-HBc) positive grafts to hepatitis B surface-antigen (HBsAg) negative recipients is safe and has likely contributed to improvements in organ access over the years. The incidence of de novo hepatitis B infection (HBV) in these instances is low with appropriate prophylaxis and is affected by recipient immunologic status. There is debate as to whether hepatitis B surface antibody (anti-HBs) positivity may safely inform prophylaxis discontinuation post-LT. In this retrospective study of all hepatitis B surface antigen (HBsAg) negative recipients of anti-HBc positive organs at three large academic centers between January 2014 and December 2019, nine LT recipients discontinued prophylaxis after developing anti-HBs antibodies 1 year or later post-LT. Three of the nine patients (33%) developed de novo HBV, defined by positive HBsAg or hepatitis B virus (HBV) DNA, during the study period. The remaining six patients had no evidence of HBV infection after a mean follow-up of 37 months. The patients without de novo HBV had higher anti-HBs titers at the time of prophylaxis discontinuation and were less likely to have negative anti-HBs at the time of transplant or negative anti-HBc at any time point. These results suggest that quantitative anti-HBs titer thresholds rather than qualitative anti-HBs positivity at 1 year or later after LT should be used to identify patients at decreased risk of de novo infection and help guide prophylaxis duration.

Abstract WMP30: Real World Experience With Tenecteplase on a Mobile Stroke Unit

Background: Tenecteplase (TNK) administered on a mobile stroke unit (MSU) has demonstrated superior rates of early reperfusion compared to alteplase. Current guidelines include TNK as a second-tier option for large vessel occlusions as TNK has many benefits, including rapid IV administration and ease of dosing. The objective of this study was to describe real world utilization of TNK on a MSU. Methods: This was a retrospective observational study of patients receiving TNK as compared to alteplase between February 2021 and April 2023 at a large academic comprehensive stroke center. Baseline demographics, GCS, NIHSS, as well as time of initial imaging were collected. Primary endpoint was time from MSU door to thrombolytic administration. Secondary endpoints included: MSU door to imaging interpretation, dispatch to thrombolytic administration, and provider decision time to thrombolytic administration. Safety endpoints included symptomatic ICH within 24 hours. Results: During the studied time period 40 patients received alteplase and 32 patients received TNK on the MSU. The median age was 65.7 years and median NIHSS score was 9. There was no difference in time from MSU door to thrombolytic administration (15 vs 17.5, p=0.30). There was also no difference in time from MSU door to imaging interpretation, dispatch to thrombolytic administration, or provider decision time to thrombolytic administration. No hemorrhagic conversion occurred. Conclusion: This is the largest series to date describing real-world utilization of TNK administration in a MSU. There were no significant differences in time to therapy in any of the time points evaluated. This data is promising for the treatment of ischemic stroke in which time to administration of thrombolytic therapy is paramount and TNK is administered as a rapid IV injection as compared to alteplase infusion.

Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer.

Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records. Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, p = 0.003). This difference was driven by the group who required insulin at baseline (n = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy. Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications.

Abstract TP190: Higher Pre-Hospital Blood Pressure is Associated With Lower Mismatch Volume and Poorer Collateral Status in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusions

Introduction: Immediately after AIS onset, blood pressure variability (BPV) arises as the result of a complex interplay between brain and systemic physiological hemodynamic responses. In this study, we examined the effect of BPV on early infarct growth in patients with large vessel occlusions (LVO) during their prehospital transfer. Methods: We included consecutive patients with AIS-LVO from 2 large comprehensive stroke centers. We collected the BP values from emergency medical services arrival to hospital admission. Patients with <3 BP recordings were excluded. BPV was assessed using the standard deviation (SD) of the systolic (SBPv), diastolic (DBPv), and mean BP (MBPv). Initial infarct volume (IIV) was defined as rCBF <30%, penumbra area as time to maximum concentration (Tmax) >6s, and mismatch volume as the difference between these two volumes (Tmax 6 - rCBF<30%). Collateral status was evaluated using the hypoperfusion intensity ratio (HIR), defined as the Tmax>10s/Tmax>6s ratio. We used linear regression to investigate associations between these variables, using log-transformation to achieve normality, and final exponentiation for a better interpretability of the results. Results: We included 171 patients, mean age was 70.9± 13.7, 51.5% female, 88.3% white, median NIHSS was 15. Mean BP: SBP=12.37 + 6.8, DBP=10.2 + 7.1, and MBP=8.9 + 5.9. CTP values: rCBF >30% (5 [IQR 0.001 - 22]), Tmax >6s (103 [60.5 - 158.5]), and HIR (0.38 [0.17 - 0.54]). Higher SBP variability was significantly associated with lower mismatch volumes. Furthermore, higher SBP tertiles were associated with worse collaterals (high HIR) (Figure) . Conclusion: Pre-hospital BPV is associated with lower mismatch volume, likely mediated by the effect of BP on collateral status. Our findings are consistent with previous studies; the association between higher pre-treatment blood pressure and poorer collaterals might be due to an imbalance in the need of increasing perfusion to the ischemic tissue.

Factors associated with reporting left ventricular ejection fraction with 3D echocardiography in real-world practice.

Guidelines recommend 3D echocardiography (3DE) to assess left ventricular ejection fraction (LVEF) on transthoracic echocardiogram (TTE) when possible, but it is unclear which factors are most strongly associated with reporting 3DE LVEF in real-world practice. We evaluated 3DE LVEF reporting by age, sex, BMI, TTE location and variation in reporting by sonographer and reader. All TTEs were performed without contrast enhancement agent at a large medical center from 9/2015 to 12/2020 using ultrasound machines capable of 3DE. We used multivariable logistic regression to assess which factors were most associated with reporting 3DE LVEF. Among 35641 TTEs included in this study, 57.4% were performed on women. 3DE LVEF was reported on 18391 TTEs (51.6% of cohort; 50.5% for women and 52.4% for men). Portable inpatient TTEs (n=5569) had the lowest rates of 3DE LVEF reporting (30.9%), while general outpatient TTEs (n=15933) had greater reporting (56.9%). Outpatient TTEs with an indication for chemotherapy (n=3244) had the highest rates of 3DE LVEF (87.2%). The median (IQR) percentage of TTEs reporting 3D LVEF was 52.7% (43.1%-68.1%) among sonographers and 51.6% (46.5%-59.6%) among readers. Among 20082 (56.3%) TTEs with 3DE LVEF measured by sonographers, 91.6% were included by readers in the final report. After adjustment, performing sonographer in the highest reporting quartile was most strongly associated with reporting 3DE LVEF (OR 7.04, 95% CI 6.55-7.56), while an inpatient portable study had the strongest negative association for reporting (OR .38, 95% CI .35-.40). Use of 3DE LVEF in real-world practice varies substantially based on performing sonographer and is low for hospitalized patients, but can be frequently used for chemotherapy. Initiatives are needed to increase sonographer 3DE acquisition in most clinical settings.

Abstract WP32: A Dissection of Spinal Cord Infarction: Cases With Rare Features and Innovative Treatments

Spinal cord infarction (SCI) poses a unique set of diagnostic and therapeutic challenges to clinicians. The condition carries high risk for severe disability if not promptly addressed, yet there is no consensus on the threshold for patients to be screened with emergent MRI or receive acute interventions such as IV-thrombolysis or endovascular therapy, in large part due to limited case data and a lack of statistically powered trials or formal guidelines. Moreover, multiple distinct pathologic processes can cause SCI, and there remains limited understanding of which patient cohorts may be most susceptible to each stroke mechanism or respond favorably to the various possible treatments. Here, we present an in-depth analysis of a series of 11 SCI cases presenting to a network of 3 hospitals at a large academic center in New York City over a 5-year period to compare presenting symptoms, etiology, acute treatment strategy, and clinical outcome. We review the results of 9 patients who were evaluated with digital subtraction angiography (DSA), including 2 patients receiving different multiple drug regimens of acute intra-arterial therapies. One patient was also found eligible and treated with IV-thrombolysis. In these data we also identify multiple patients who experienced SCI in the setting of sickle cell disease and track their functional outcomes after being treated with exchange transfusion or anticoagulation, as well as 2 young patients with apparent heritable causes of hypercoagulability leading to their ischemic events. These preliminary data suggest that underlying conditions of hypercoagulability and arterial dissection are more predominant drivers of SCI than traditional mechanisms of cerebral ischemic stroke such as large vessel atherosclerosis or cardioembolism, and that heritable causes may be more prevalent in patients with SCI compared to other stroke patients. We propose these findings as a basis for designing a larger scale study for result confirmation.

Implementation of rapid genomic sequencing in safety-net neonatal intensive care units: protocol for the VIrtual GenOme CenteR (VIGOR) proof-of-concept study

IntroductionRapid genomic sequencing (rGS) in critically ill infants with suspected genetic disorders has high diagnostic and clinical utility. However, rGS has primarily been available at large referral centres with the...

Abstract WMP36: Quality Improvement for Improved Ischemic Stroke Large Vessel Occlusion Door-In-Door-Out Times at an Urban Primary Stroke Center Integrated Health System

Background: Stroke patients who present to an Emergency Department (ED) with an acute ischemic stroke (AIS) due to a large vessel occlusion (LVO) and are eligible for endovascular stroke therapy (EST) require rapid transfer to a facility capable of EST. Nationwide data for 2022 suggest that 19% of LVO patients are transferred for EST within 90 minutes. Our practice center is a large urban community-based Primary Stroke Center, part of a spoke and hub integrated system. In 2022, we had a median door-in-door-out (DIDO) time of 98 min with 33% percent of cases under 90 min (n = 12). Purpose: Knowing the importance of early reperfusion, we implemented a quality improvement project using a pre-post design to improve our DIDO times for patients with AIS due to LVO, with a goal of achieving a median DIDO time of 75 min or less. Methods: Our approach was multidisciplinary. We completed comprehensive chart reviews focusing on critical time points and reviewed recent literature (2022 - 2023) for best practices. We created an ED interdisciplinary DIDO workgroup which developed and implemented a DIDO checklist after education and socialization. In March 2023, we created a dedicated regional neuro transfer hub to address changes with EMS notification and response to expedite LVO transfers. Other DIDO literature recommendations were already in place, including the use of a regionalized telestroke program. Best practices identified but not implemented focused on Emergency Medical Services (EMS), such as holding a rig while completing imaging, providing enroute reports, and conducting joint drills post-COVID. Results: After the implementation of the DIDO checklist, DIDO times decreased to 82 minutes from August 2022 to July 2023 (a decrease of 16 min), with 44% of cases under 75 mins (n = 9). Our median time for 2023 (January - July) is 68 min (n = 2). Conclusion: Transfer of LVO patients is a low-volume, high-risk event, but one where every minute matters for optimal patient outcomes. The DIDO checklist was a helpful aid for staff to ensure key steps were completed timely, leading to a decrease in DIDO times.

Clinical Utility and Evaluation of the Alinity m STI assay at a Large Academic Medical Center in the Southeastern United States

Clinical Utility and Evaluation of the Alinity m STI assay at a Large Academic Medical Center in the Southeastern United States

Abstract WMP7: Impact of Telestroke Access in a Rural Setting

Background: Despite decades long adoption as the standard-of-care for ischemic stroke, the majority of eligible patients do not receive intravenous thrombolysis (IVT), with underutilization especially pronounced in rural areas. Telestroke, however, may help alleviate this geographical healthcare disparity. The current study aims to identify the impact of implementing a mature telestroke network within a rural setting. Methods: Retrospective review of a prospectively maintained telestroke database from a large rural tertiary care comprehensive stroke center covering 31 spoke hospitals spanning critical access hospitals to primary stroke centers between 10/2021-02/2023. Data was compared to a previous review period (01/2016-12/2018; comprised of 8 spokes) and the statewide IVT rates recorded in GWTG. Data analysis conducted via descriptive statistics and Fisher’s (two-tailed) exact test. Results: 1801 telestroke consults were performed; 41.4% (746/1801) were ineligible for acute stroke intervention. 39% (410/1055) of eligible patients were treated with IVT (vs. 33% [317/959] previously, p = 0.068), representing 58% (410/708; vs 24% [107/448] previously, p < 0.001) of statewide total IVT administration. Symptomatic hemorrhage (sICH) was 3.0%, overall 30-day mortality was 5.6%, and sICH mortality was 1.0%. IVT deferred most commonly: low NIH (44%), mimics (21%), coagulopathy (8%), followed by other. 22% (396/1801) of total consults were transferred from the originating site (vs. 34% [305/890] previously, p < 0.0001) of which 10% (42/396) underwent EVT. Discussion: The impact of expanding a rural telestroke network continued to produce high IVT rates (nearly double the national average) with safety outcomes (sICH, mortality) at or below national standards. Additionally, a large network has significantly increased the proportion of patients remaining at originating sites, optimizing both tertiary and local centers’ resources. The value of a regional telestroke hub is further underscored by the significant increase in statewide IVT attributed to network consults. However, further strategies are needed to better educate rural providers on acute stroke to reduce the rate of ineligible consults and streamline use of telestroke services.

Abstract WP153: Factors Affecting Length of ICU Stay After Endovascular Thrombectomy for Acute Large Vessel Ischemic Stroke

Introduction: The advent of endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) ischemic stroke has reduced the overall ICU length of stay (LoS), especially for patients undergoing successful reperfusion. Prolonged ICU LoS is reported to be associated with worse clinical outcomes, but factors associated with prolonged LoS after MT are not established. Methods: A retrospective analysis of 499 patients undergoing EVT at a single large comprehensive stroke center from January 2015 to May 2020 was performed. Demographics, procedure variables, ICU LoS, ICU complications, and modified Rankin scale at discharge were collected. Multiple regression was used to identify independent variables affecting the ICU LoS. Additional analysis using t-test assuming unequal variances was performed for select variables. Results: The median age was 72 [61-82], 254 (51%) male & median NIHSS was 16 [10-20]. The average door-to-puncture time was 104 ±28 mins and the average procedure time 43.9 ±28.7. General anesthesia (GA) was administered in 257 (51%) patients. Successful reperfusion (TICI 2c-3) was achieved in 334 (67%) patients. Median ICU LoS was 3 days [1-5]. Patients with mRS 0-2 at discharge (33%) had shorter ICU LoS (2.8 vs 5.7, P<0.001). ASPECTS < 7 (6.9 vs 4.6, P=0.03), use of GA (6.2 vs 3.3 days, P<0.001) and ICU complications such as pulmonary embolism (PE) and pneumonia (10 vs 4 days; p <0.001) significantly increased the ICU LoS. Successful reperfusion significantly reduced ICU LoS (4.2 vs 5.8 days, p=0.015). After adjusting for age, sex, baseline NIHSS and ASPECTS, both the procedure time (b= 0.03, P=0.02) and final TICI score (b= -0.76, P=0.001) were independently associated with prolonged ICU LoS (R2=0.1, F=4, P<0.001). Conclusion: Pre-procedural factors such as poor ASPECTS (< 7), procedural factors such as the use of GA, prolonged procedure time, and TICI 0-2b reperfusion, and ICU complications such as pneumonia and PE are associated with prolonged ICU LoS.

Abstract WP222: Basilar Artery Stenosis in Children With Moyamoya

Introduction: Moyamoya is a progressive cerebrovascular disease characterized by stenosis of the cerebral arteries in the anterior circulation and less often the posterior circulation. To our knowledge, studies examining the prevalence of basilar artery stenosis do not exist outside of case reports. Methods: We retrospectively examined children with moyamoya followed at a single institution from November 2011 through August 2023. Children with moyamoya and basilar stenosis mentioned in their chart were initially included. A pediatric neurologist reviewed all records and neuroimaging to verify diagnosis of basilar artery stenosis. Results: Out of our cohort of 331 children with moyamoya, 24 (7.2%) children had basilar artery stenosis. In the group of 24 children with moyamoya and basilar artery stenosis 63% were females. The median age at moyamoya diagnosis was 4.8 years (interquartile range [IQR] 2.2,8.3). At time of diagnosis 16 children (67%) had basilar artery stenosis. The median time from diagnosis was 0 years (IQR 0, 1.3). At time of diagnosis all children had anterior circulation stenosis (internal carotid artery, middle cerebral artery and/or anterior cerebral artery), 13 (54%) had posterior cerebral artery stenosis and 6 (25%) had vertebral artery stenosis. Post-operative strokes following revascularization surgery occurred in 8 (33%) out of the 24 children. An associated disorder was found in 11 (46%) including ACTA2, PHACE syndrome, cranial radiation, trisomy 21, sickle cell disease, neurofibromatosis type 1 and morning glory disc. Conclusion: To our knowledge we present the first study to examine prevalence of basilar artery stenosis in a large single center cohort of children with moyamoya. In our cohort 7.2% of children with moyamoya had basilar artery stenosis. A large proportion of children with basilar artery stenosis developed stroke post-operatively. Genetic evaluation may be warranted in children with moyamoya and basilar artery stenosis given that 46% of the children had an associated disorder identified.

Patient symptoms, self-management, and unscheduled healthcare use during the first 6 months of targeted oral anticancer agent therapy: protocol for a mixed-methods US study

IntroductionTargeted oral anticancer agents (OAAs) are increasingly used to treat cancer, including haematological malignancies and ovarian cancer, but they can cause serious symptomatic side effects such as arrhythmias, hypertension, and...

Abstract A081: Real-world treatment patterns and clinical outcomes in patients with HER2+ metastatic breast cancer receiving systemic therapy in Ontario, Canada

Abstract Background: Real-world data on treatment patterns and prevalence of brain metastases in patients with HER2+ metastatic breast cancer (mBC) are limited. This study described treatment patterns and clinical outcomes among patients with HER2+ mBC in Canada. Methods: This was a retrospective chart review of adult patients diagnosed with de-novo or recurrent HER2+ mBC between Jan 1, 2014 and Mar 1, 2021 (prior to wide availability of new treatments) at Sunnybrook Research Institute and Sinai Health, two large BC treatment centres in Canada. Data on patient characteristics and treatment regimens were extracted. Treatment patterns, time to next treatment (TTNT; as a proxy for progression-free survival), and presence of brain metastases were assessed in the first-line (1L), second-line (2L), and third-line (3L) settings. TTNT analyses used Kaplan-Meier methodology to account for censoring. Results: Of 121 patients with HER2+ mBC, the median (IQR) age was 54.0 (17.0) years. 38.0% of patients had de-novo disease and 62.0% had recurrent mBC; 12 (9.9%) had brain metastases at the time of mBC diagnosis. Systemic therapies generally aligned with Canadian funded regimens for 1L (101 of 121 patients [83.5%] received trastuzumab + pertuzumab ± chemotherapy ± subsequent endocrine therapy; 8/121 [6.6%] received endocrine therapy only) and 2L (50/68 [73.5%] received T-DM1 ± endocrine therapy; 9/68 [13.2%] received endocrine therapy only). However, treatment patterns were heterogeneous in the 3L setting (14/46 [30.4%] received anti-HER2 TKI + chemotherapy ± trastuzumab; 10/46 [21.7%] received endocrine therapy only; 10/46 [21.7%] received chemotherapy). Median (95% CI) TTNT in months was 21.4 (16.1, 27.2) in 1L, 11.0 (8.5, 16.5) in 2L, and 8.7 (5.4, 15.6) in 3L. Median (IQR) follow-up was 29.9 (25.2) months. In total, 57 patients (47.1%) were diagnosed with brain metastases during the study period (17 pre-1L, 24 post-1L/pre-2L, 6 post-2L/pre-3L) and of these, 73.7% received radiation therapy. Conclusions: In patients with HER2+ mBC in Canada, 3L treatment patterns are heterogeneous, median TTNT is <1 year, and almost half develop brain metastases. These data from two large treating centres in Ontario suggest a high unmet need for more effective treatment regimens in later lines of therapy, particularly 3L, for patients with HER2+ mBC. Citation Format: Katarzyna J Jerzak, Ruth Moulson, Ling-I Hsu, Chris Lenhu, Dhivo Krishnathasan, Jessica Weiss, Christine Brezden-Masley. Real-world treatment patterns and clinical outcomes in patients with HER2+ metastatic breast cancer receiving systemic therapy in Ontario, Canada [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A081.

COVID-19 and collective trauma: Implementing a trauma-informed model of care for post-COVID patients.

To describe the implementation of a trauma-informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. Discussion paper. Evidence gathered from a literature search (2008-2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. The literature highlights the high prevalence of trauma in patients following COVID-19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma-informed model of care was implemented. Reconceptualizing COVID-19 as a 'collective trauma' can help healthcare workers understand the needs of post-COVID patients and enable them to respond empathetically. A trauma-informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. Frontline healthcare workers, particularly nurses, are well positioned to implement trauma-informed care due to their high-level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. The COVID-19 pandemic has led to adverse physical and mental health outcomes for many. Trauma-informed care is a way to promote reengagement with the healthcare system in this group. Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post-COVID patient.