Monthly Number Of Patients Research Articles

Meteorological Influence on Atrial Fibrillation and Flutter: A Nationwide Observational Study in South Korea (2010-2022).

Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality.

Impact of COVID-19 on stimulant use disorder treatment: A national cohort study in the Veterans Health Administration

ObjectiveRates of stimulant overdose have increased dramatically, which may have been exacerbated by treatment disruptions during the pandemic, but no recent studies have examined use of stimulant use disorder (StUD) treatment. MethodsIn this retrospective cohort study (March 2018 to February 2022) of national Veterans Health Administration patients, we use an interrupted time-series analysis to examine the impact of COVID-19 (starting in March 2020) on treatment use for StUD. ResultsThe number of patients receiving StUD care was increasing pre-COVID (22,640–23,020, February 2018-February 2020) but dropped post-pandemic to 18,578 in February 2022. The monthly number of patients receiving StUD care increased by 34.6 patients per month (95% CI, 1.1–68.0; P=0.04) before March 2020, decreased by 2803.3 patients (95% CI, −3912.3 to −1694.3; P <0.001) in March 2020, and, accounting for pre-COVID trends, further decreased by 85.85 patients per month (95% CI,−148.9.2 to −23.0; P =0.01) after March 2020. ConclusionsCare for StUD drastically declined during the COVID-19 pandemic and has yet to show signs of a return to pre-pandemic levels despite surging rates of stimulant-involved overdose deaths and a critical need to engage people with StUD in care.

Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study.

We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of chronic limb-threatening ischaemia (CLTI) patients undergoing lower-limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLTI patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%), and hospitalised patients decreased. Patients treated in ≤14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target-lesion revascularisation decreased during COVID-19. One-year mortality was significantly worse in hospitalised compared to day cases (14% vs. 43%) at similar wound healing rates (83% vs. 84%). The most frequent known cause of death was infectious disease (64%), while cardiovascular (21%) was less frequent. Despite COVID-19 restrictions, a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLTI patients need to be referred and treated more aggressively earlier.

PROJECTED HIP FRACTURE INCIDENCE IN SCOTLAND

The hip fracture burden on health and social care services in Scotland is anticipated to increase significantly, primarily driven by an ageing population. This study forecasts future hip fracture incidence and the annual number of hip fractures in Scotland until 2029.The monthly number of patients with hip fracture aged ≥ 50 admitted to a Scottish hospital between 01/01/2017 and 31/12/2021 was identified through data collected by the Scottish Hip Fracture Audit. This data was analysed using Exponential Smoothing and Auto Regressive Integrated Moving Average forecast modelling to project future hip fracture incidence and the annual number of hip fractures until 2029. Adjustments for population change were accounted for by integrating population projections published by National Records of Scotland.Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797, with a respective increase in hip fracture incidence from 313 to 350 per 100,000. By 2029, the averaged projected annual number of hip fractures is 10311, with an incidence rate of 463 per 100,000. The largest percentage increase in hip fracture occurs in the 70-79 age group (57%), with comparable increases in both sexes (30%). Based upon these projections, overall length of stay following hip fracture will increase from 142713 bed days per annum in 2021, to 203412 by 2029, incurring an additional cost of over £25 million.Forecast modelling demonstrates that the annual number of hip fractures in Scotland will rise substantially by 2029, with considerable implications for health and social care services.

A mixed effects changepoint quantile regression model for longitudinal data with application on COVID-19 data

IntroductionLongitudinal individual response profiles could exhibit a mixture of two or more phases of increase or decrease in trend throughout the follow-up period, with one or more unknown transition points (changepoints). The detection and estimation of these changepoints is crucial. Most of the proposed statistical methods for detecting and estimating changepoints in literature rely on distributional assumptions that may not hold. In this case, a good alternative is to use a robust approach; the quantile regression model. There are methods in the literature to deal with quantile regression models with a changepoint. These methods ignore the within-subject dependence of longitudinal data.MethodsWe propose a mixed effects quantile regression model with changepoints to account for dependence structure in the longitudinal data. Fixed effects parameters, in addition to the location of the changepoint, are estimated using the profile estimation method. The stochastic approximation EM algorithm is proposed to estimate the fixed effects parameters exploiting the link between an asymmetric Laplace distribution and the quantile regression. In addition, the location of the changepoint is estimated using the usual optimization methods.Results and discussionA simulation study shows that the proposed estimation and inferential procedures perform reasonably well in finite samples. The practical use of the proposed model is illustrated using COVID-19 data. The data focus on the effect of global economic and health factors on the monthly death rate due to COVID-19 from 1 April 2020 to 30th April 2021. the results show a positive effect on the monthly number of patients with COVID-19 in intensive care units (ICUs) for both 0.5th and 0.8th quantiles of new monthly deaths per million. The stringency index, hospital beds, and diabetes prevalence have no significant effect on both 0.5th and 0.8th quantiles of new monthly deaths per million.

Regulatory Approval, Reimbursement, and Clinical Use of Cyclin-Dependent Kinase 4/6 Inhibitors in Metastatic Breast Cancer in the Netherlands

This study found that CDK4/6 inhibitors rapidly reached many eligible patients with metastatic breast cancer and were adopted gradually over time in the Netherlands. Adoption of innovative medicines may be further optimized, and better transparency of the availability of new medicines during different phases of the postapproval access pathway is needed. This cohort study reviewed approval and reimbursement decisions of the CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib and estimated the number of patients with metastatic breast cancer who were eligible for these medicines compared with the actual use in clinical practice. The study used nationwide claims data that were obtained from the Dutch Hospital Data. Claims and early access data for patients with hormone receptor-positive and ERBB2 (formerly HER2)-negative metastatic breast cancer who were treated with CDK4/6 inhibitors from November 1, 2016, to December 31, 2021, were included. The number of new cancer medicines that are being approved by regulatory agents is increasing exponentially. Yet little is known about the pace at which these medicines reach eligible patients in daily clinical practice during different phases of the postapproval access pathway. Description of the postapproval access pathway, monthly number of patients who were treated with CDK4/6 inhibitors in clinical practice, and estimated number of patients who were eligible for treatment. Aggregated claims data were used, and patient characteristics and outcomes data were not collected. To describe the entire postapproval access pathway of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in the Netherlands, from regulatory approval to reimbursement and to investigate the adoption of these medicines in clinical practice among patients with metastatic breast cancer. Three CDK4/6 inhibitors have received European Union-wide regulatory approval for the treatment of HR-positive and ERBB2-negative metastatic breast cancer since November 2016. In the Netherlands, the number of patients who have been treated with these medicines increased to approximately 1847 (based on 1 624 665 claims over the entire study period) from approval to the end of 2021. Reimbursement for these medicines was granted between 9 and 11 months after approval. While awaiting reimbursement decisions, 492 patients received palbociclib, the first approved medicine of this class, via an expanded access program. By the end of the study period, 1616 patients (87%) were treated with palbociclib, whereas 157 patients (7%) received ribociclib, and 74 patients (4%) received abemaciclib. The CKD4/6 inhibitor was combined with an aromatase inhibitor in 708 patients (38%) and with fulvestrant in 1139 patients (62%). The pattern of use over time appeared to be somewhat lower compared with the estimated number of eligible patients (1847 vs 1915 in December 2021), especially in the first 2.5 years after approval.

Multivariate [formula omitted]-stable distributions: VAR(1) processes, measures of dependence and their estimations

Measuring the dependency between lagged random vectors in time series is extremely important to detect appropriate models for fitting real data. Vector autoregressive processes (VAR), in particular, are among the most popular multivariate time series that allow modeling schemes for two or more random variables. However, if the series of innovations process does not have finite second-order moments, the classical analysis that uses the empirical auto-covariance function is not adequate as its theoretical counterpart is not defined. After perceiving the lack of a suitable multivariate version of the codifference function, we propose an adaptation of this tool to measure interdependence in multivariate α-stable processes. We establish such a function based on notions presented in the existing literature. We also show some of its properties and give an estimator based on the empirical characteristic function. Subsequently, we evaluate another measure of dependence with different properties but similar usage for comparison reasons. These two measures are computed for VAR(1) processes with α-stable innovations, proving to be useful in the identification of associated patterns related to them. Finally, we demonstrate how these measures can be applied with real data sets by analyzing the monthly number of patients with community-acquired pneumonia and the registered values of PM10 in the city of São Paulo, Brazil, from January 2008 to December 2021.

Impact of the 24-hour time target policy for emergency departments in South Korea: a mixed method study in a single medical center

BackgroundIn South Korea, after the spread of the Middle East Respiratory Syndrome epidemic was aggravated by long stays in crowded emergency departments (EDs), a 24-hour target policy for EDs was introduced to prevent crowding and reduce patients' length of stay (LOS). The policy requires at least 95% of all patients to be admitted, discharged or transferred from an ED within 24 hours of arrival. This study analyzes the effects of the 24-hour target policy on ED LOS and compliance rates and describes the consequences of the policy.MethodsA mixed-methods approach was applied to a retrospective observational study of ED visits combined with a survey of medical professionals. The primary measure was ED LOS, and the secondary measure was policy compliance rate which refers to the proportion of patient visits with a LOS shorter than 24 hours. Patient flow, quality of care, patient safety, staff workload, and staff satisfaction were also investigated through surveys. Mann–Whitney U and χ2 tests were used to compare variables before and after the introduction of the policy.ResultsThe median ED LOS increased from 3.9 hours (interquartile range [IQR] = 2.1–7.6) to 4.5 hours (IQR = 2.5–8.5) after the policy was introduced. This was likely influenced by the average monthly number of patients, which greatly increased from 4819 (SD = 340) to 5870 (SD = 462) during the same period. The proportion of patients with ED LOS greater than 24 hours remained below5% only after 6 months of policy implementation, but the number of patients whose disposition was decided at 23 hours increased by 4.84 times. Survey results suggested that patient flow and quality of care improved slightly, while the workload of medical staff worsened.ConclusionsAfter implementing the 24-hour target policy, the proportion of patients whose ED LOS exceeded 24 hours decreased, even though the median ED LOS increased. However, the unintended consequences of the policy were observed such as increased medical professional workload and abrupt expulsion of patients before 24 hours.

An increasing tendency of precocious puberty among Korean children from the perspective of COVID-19 pandemic effect.

IntroductionThis study was conducted to investigate changes and new trends over the past 6 years by analyzing the current status of precocious puberty (PP) treatment and treatment costs in Korea between 2016 and 2021.Materials and methodsAnnual and monthly number of patients diagnosed with PP from 2016 to 2021 were reviewed using the data from Healthcare Bigdata Hub. Annual medical insurance expenses for the treatment of PP were also reviewed. The data were compared by the gender of the patients.ResultsThe number of patients diagnosed with PP rose from 86,352 in 2016 to 166,645 in 2021, while medical expenses rose from KRW 64,111,689,000 in 2016 to KRW 134,642,100,000 in 2021. The percentage of male PP patients increased from 9.21% in 2016 to 19.55% in 2021.ConclusionIncreasing numbers of Korean patients diagnosed with PP. Consistent with the situation in other countries, the rapid increase in the number of cases since April 2020 appears to be a result of the COVID-19 pandemic. In Korea, this is considered a nationwide phenomenon. Also on the rise is the incidence of PP in males, which appears to be due to an increased awareness of the phenomenon. Further investigations are required to determine the possible causes in increasing prevalence of PP.

Trends in hospital presentations following analytically confirmed synthetic cannabinoid receptor agonist exposure before and after implementation of the 2016 UK Psychoactive Substances Act.

The United Kingdom (UK) Psychoactive Substances Act (PSA), implemented on the 26th May 2016, made the production, supply and sale of all non-exempted psychoactive substances illegal. The aim of this study was to measure trends in hospital presentations for severe toxicity following analytically confirmed synthetic cannabinoid receptor agonist (SCRA) exposure before and after implementation of the PSA. Observational study. Thirty-four hospitals across the UK participating in the Identification of Novel Psychoactive Substances (IONA)study. A total of 627 (79.9% male) consenting individuals who presented to participating hospitals between July 2015 and December 2019 with severe acute toxicity and suspected novel psychoactive substances exposure. Toxicological analyses of patient samples were conducted using liquid-chromatography tandem mass-spectrometry. Time-series analysis was conducted on the monthly number of patients with and without analytically confirmed SCRA exposure using Poisson segmented regression. SCRAs were detected in 35.7% (n =224) of patients. After adjusting for seasonality and the number of active sites, models showed no clear evidence of an upward or downward trend in the number of SCRA exposure cases in the period before (incidence rate ratio [IRR], 1.12; 95% CI, 0.99-1.26; P = 0.068) or after (IRR, 0.97; 95% CI, 0.94-1.01; P= 0.202) the implementation of the PSA. There was also no clear evidence of an upward or downward trend in non-SCRA exposure cases before (IRR, 1.12; 95% CI, 0.98-1.27; P = 0.105) or after (IRR, 1.01; 95% CI, 0.98-1.04; P = 0.478) implementation of the PSA. There is no clear evidence of an upward or downward trend in the number of patients presenting to UK hospitals with severe acute toxicity following analytically confirmed synthetic cannabinoid receptor agonist exposure since the implementation of the Psychoactive Substances Act.

Characteristics of Rosacea and Similar Diseases in Patients Wearing Face Masks

Introduction: The present study aimed to obtain fundamental data, including climate conditions and Demodex mites, on rosacea and similar diseases in the situation where the wearing of face masks is mandatory due to the coronavirus disease 2019 pandemic. Methods: We enrolled 86 Japanese patients habitually wearing face masks with rosacea and similar diseases. Disease severity was assessed using the Investigator Global Assessment. The presence of Demodex mites was examined microscopically. Treatment involved acaricidal and antibiotic agents. Results: The numbers of male and female patients enrolled were 11 and 75, respectively. Among these patients, 85 (98.8%), 57 (66.3%), and 76 (88.4%) had rosacea, rosacea-like dermatitis (RLD), and demodicosis, respectively. The monthly number of patients with rosacea and demodicosis showed two peaks from May to June and in October, during which monthly mean temperature was approximately 20°C (68°F). Improvement rates in rosacea, RLD, and demodicosis were significantly higher when Demodex mites were no longer detected after treatment. Conclusion: The present results suggest that a season with a mean temperature of approximately 20°C is a risk factor for rosacea and similar diseases in individuals wearing face masks in Japan, and a decrease in Demodex mites is associated with the attenuation of symptoms.

How Did the COVID-19 Pandemic Affect the Use of Emergency Medical Services by Patients Experiencing Mental Health Crises?

The COVID-19 pandemic and its resulting social restrictions have significant implications for mental health. The objective of this study was to determine the monthly trends and types of patients experiencing a mental health crisis (MHC) who used emergency medical services (EMSs) before and during the COVID-19 pandemic. A retrospective observational study was conducted using EMS data. During the study period, 8577 patients used EMSs for MHCs. EMS dispatches for MHCs and suicide completion after the COVID-19 pandemic were decreased by 12.4% and 12.7%, respectively, compared to those before the COVID-19 pandemic. Segmented regression analysis found that the number of patients per month was 6.79 before the COVID-19 pandemic. The number decreased to 4.52 patients per month during the COVID-19 pandemic, although the decrease was not statistically significant. The monthly number of patients experiencing an MHC decreased during strict social distancing measures but increased during relaxed social distancing measures. The percentage of hanging increased from 14.20% before the COVID-19 pandemic to 14.30% (p = 0.03) during the COVID-19 pandemic, whereas the percentages of jumping (from 15.55% to 15.28%, p = 0.01) and self-harm by smoke (from 4.59% to 3.84%, p < 0.001) during the COVID-19 pandemic were decreased compared to those before COVID-19. However, the effect size for the above findings was small (below 0.20). More than 25% of the patients experiencing an MHC who used EMSs refused to transfer to the ED over both study periods (26.49% in the pre-COVID-19 period and 28.53% in the COVID-19 period). The COVID-19 pandemic and social restrictions seemed to have some effects on the use of EMSs by MHC patients. Hanging is mainly performed indoors and is not found easily if social distancing persists, and a patient experiencing an MHC who refuses to be transferred could potentially attempt suicide. Subsequent studies should be performed to determine whether these findings are temporary during the COVID-19 pandemic or whether they will show different aspects after the COVID-19 pandemic.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania.

Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania. Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive. Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive. Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.

Decline in Hospital Visits by Patients with Schizophrenia Early in the COVID-19 Outbreak in Korea.

ObjectiveThis study investigated trends in hospital utilization by patients with schizophrenia during the first wave of the COVID-19 outbreak in Korea.MethodsThe Prophet algorithm was used to predict the monthly number of patients with schizophrenia in 2020 based on medical insurance data between 2010 and 2019. The projected expectations were compared with the actual number of patients receiving outpatient and inpatient treatment each month in the first half of 2020. We conduct interrupted time series analyses of short-term data to determine the significance of recent changes in the trend of hospital visits by patients with schizophrenia.ResultsThe prediction model showed that the actual number of patients receiving treatment each month during the early COVID-19 outbreak decreased by up to 3.6% compared to the projected expectations. The interrupted time series model also revealed a significant change in hospital utilization compared to the year before the onset of COVID-19 in Korea (F = 8.961, p = 0.010).ConclusionThis suggests that many patients with schizophrenia were not receiving adequate treatment during the COVID-19 outbreak. A strategy should be developed to keep treating patients with schizophrenia during the COVID-19 pandemic.

Abstract P1-18-31: Accessibility of CDK4/6 inhibitors for breast cancer patients in the Netherlands

Abstract Background: Before new cancer drugs are available to patients, they must obtain regulatory approval by international authorities. In many countries new drugs are also subject to health technology assessment procedures to decide on the reimbursement. When these procedures are completed, new drugs need to be adopted into clinical practice. All these processes take time and may delay or hamper patient access. In this study we investigated the access to CDK4/6 inhibitors for HR+Her2- metastatic breast cancer patients in daily practice in the Netherlands and explored whether certain policy procedures may have influenced accessibility. Method: For this study we used a mixed method approach. For our qualitative analysis, we used publicly available documents describing drug approval and reimbursement decisions and clinical practice recommendations. Information from these documents were used to provide a timeline of procedures involved and decisions made to make CDK4/6 inhibitors available to patients in the Netherlands. For our quantitative analysis we used monthly prescription data to calculate the number of patients treated with CDK4/6 inhibitors each month, to describe the trends over time and to calculate annual drug expenses. The monthly number of patients treated were compared to an estimated number of patients eligible for the drugs as per European Medicine Association (EMA) label. The trends were compared to the decision timeline in order to identify as to whether certain procedures and/or decisions may have been associated with accessibility to CDK4/6 inhibitors in the Netherlands. Results: In June 2017, the first approved CDK4/6 inhibitor - palbociclib - was prescribed for breast cancer for the first time in the Netherlands. This was approximately 7 months after the EMA gave a positive opinion for marketing authorization. This delay was caused by pricing and reimbursement procedures which involved a thorough evaluation of the costs and effects of the drug and negotiations with the manufacturer. After prescribing palbociclib for the first time, the utilization of CDK4/6 inhibitors in clinical practice increased rapidly with a gradual increase from zero to approximately 1400 patients over a period of 30 months. The majority of patients were treated with palbociclib even after the approval of other drugs of this class (i.e. in December 2019: palbociclib 94% ribociclib 6% and abemaciclib &amp;lt;1%). In addition, approximately 63% of patients were treated with a CKD4/6 inhibitor combined with fulvestrant. The pattern of utilization over time appeared to correspond quite well to the estimated number of patients eligible but these estimates were surrounded by a substantial amount of uncertainty. The total expenses of the CDK4/6 inhibitors from 2017 to 2019 were approximately 3.5 times smaller than the estimates made by the health authorities in the Netherlands prior to the decision to reimburse the drugs. Conclusion: Pricing and reimbursement decisions caused a significant delay in access to the newest drugs for HR+/HER2- metastatic breast cancer. Nevertheless, after palbociclib - the first approved CDK4/6 inhibitor - received a positive reimbursement decision, the prescription in daily practice increased rapidly, a pattern not seen in the other drugs of this class. Though the number of patients treated appeared to be in line with the projected number of patients eligible for these drugs, detailed information regarding metastatic breast cancer patients, their treatments and the decision making process in daily practice is needed to fully understand access to the newest drugs. Citation Format: Marianne Luyendijk, Hedwig Blommestein, Agnes Jager, Sabine Siesling, Carin Uyl-de Groot. Accessibility of CDK4/6 inhibitors for breast cancer patients in the Netherlands [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-31.

A major increase of thromboembolic events in total hip and knee arthroplasty patients during the COVID-19 pandemic

Objectives The first known COVID-19 patient in the United States was reported on 1/20/2020. Since then, we noted increased thromboembolic events among our THA/TKA patients. Therefore, we sought to determine: (1) monthly incidences of pulmonary embolism (PE)/deep vein thrombosis (DVT) before and after January/2020 and (2) thromboembolic event rates for primary and revision patients. Methods We retrospectively obtained from our electronic-medical-records the total monthly number of patients (December/2018-March/2021) who underwent primary or revision THA/TKA, and among them, those who had PE/DVT during each month. Monthly rates of thromboembolic events were calculated and figures were created showing rates throughout time. The cutoff month to define before and after COVID-19 was January/2020. Results During the study period, 1.6% of patients (312/19068) had PE/DVT [PE (n=102), DVT (n=242), both (n=32)]. Overall rate of PE/DVT before January/2020 was 1.2% (119/9545) and it was 2.0% (193/9523) after that month. Incidences of PE/DVT on April/June/July of 2020 were 3.4%, 3%, 3.4%, respectively. A major increase, when compared to 2019 (1.3%, 1%, 1%, respectively). An unusually high rate of PE was observed on April/2020 (3.4%), more than three times the one observed in any other month. After January/2020, there was an overall major increase of PE/DVT rates, but particularly among revision patients: 6% in five different months including 11.5% on November/2020. Conclusion There was a major increase of thromboembolic events among THA/TKA patients during the COVID-19 pandemic, predominantly in revision patients. Patients need counseling about this increased risk. It remains uncertain whether more aggressive thromboprophylactic regimes should be followed.

The Public Health Insurance Coverage of Novel Targeted Anticancer Medicines in China-In Favor of Whom? A Retrospective Analysis of the Insurance Claim Data.

Objectives: This study took Fuzhou city as a case, described how the public health insurance coverage policy in 2016 of novel anti-lung cancer medicines benefited patients, and who benefited the most from the policy in China. Methods: This was a retrospective study based on health insurance claim data with a longitudinal analysis of the level and trend changes of the monthly number of patients to initiate treatment with the novel targeted anti-lung cancer medicines gefitinib and icotinib before and after health insurance coverage. The study also conducted a multivariate linear regression analysis to predict the potential determinants of the share of patient out-of-pocket (OOP) expenditure for lung cancer treatment with the study medicines. Results: The monthly number of the insured patients in Fuzhou who initiated the treatment with the studied novel targeted anti-lung cancer medication abruptly increased by 26 in the month of the health insurance coverage (95% CI: 14–37, p < 0.01) and kept at an increasing level afterward (p < 0.01). By controlling the other factors, the shares of OOP expenditure for lung cancer treatment of the patients who were formal employee program enrollees not entitled to government-funded supplementary health insurance coverage and resident program enrollees were 18.3% (95% CI: 14.1–22.6) and 26.7% (95% CI: 21.0–32.4) higher than that of the patients who were formal employee program enrollees with government-funded supplementary health insurance coverage. Conclusion: The public health insurance coverage of novel anti-lung cancer medicines benefited patients generally. To enable that patients benefit from this policy more equally and thoroughly, in order to achieve the policy goal of not to leave anyone behind, it is necessary to strengthen the benefits package of the resident program and to optimize the current financing mechanism of the public health insurance system.

1125. Decreasing Concomitant Vancomycin and Piperacillin-Tazobactam Use in Children to Reduce Incidence of Acute Kidney Injury

Abstract Background Concomitant use of vancomycin (V) and piperacillin-tazobactam (PT) is associated with increased incidence of acute kidney injury (AKI). AKI develops 3 times faster on this combination compared to alternative vancomycin combinations. We sought to reduce AKI in our patients by reducing concomitant use of V/PT using a QI framework. Methods We implemented several PDSA cycles to reduce concomitant V/PT use at a 415-bed quaternary children’s hospital in Boston, MA. Interventions included substitution of PT with other agents in surgical prophylaxis guidelines and order sets starting in February 2020 and in the hospital-wide sepsis order set in March 2021. The Antimicrobial Stewardship Program reinforced these changes during daily audit-and-feedback reviews. In November 2020, we implemented an electronic alert that apprises clinicians of the AKI risk when V/PT are ordered and recommends an alternative regimen. We measured the monthly number of patients on combination V/PT, new exposures to nephrotoxic medications, AKI events, and the percentage of days with serum creatinine monitoring for patients on ≥2 nephrotoxic medications. Results From 02/01/20 to 05/31/21, the number of patients exposed to combination V/PT decreased from 23 to 6 per month (Figure 1). New nephrotoxic medication exposures declined from 17.1 to 7.7 per 1,000 patient days, and AKI events dropped from 2.8 to 0.6 per 1,000 patient days (Figures 2 and 3). The percentage of days with serum creatinine monitoring increased from 60% to 66%. Rate of New Exposures to Nephrotoxic Medications per 1000 Patient Days Conclusion Revising guidelines and electronic order sets and implementing an order alert led to marked decreases in exposures to V/PT and nephrotoxic medications overall and was associated with reduced AKI events. Use of electronic health record tools is an effective way to drive safer antimicrobial use. Disclosures Gabriella S. Lamb, MD, MPH, Nothing to disclose

Impact of COVID-19 on angioplasty service and outcome of patients treated for critical limb ischaemia

Abstract Background Peripheral artery disease (PAD) is a major challenge worldwide and endovascular revascularization is an important component of treatment that is affected by COVID-19 restrictions. Purpose Here, we evaluated the impact of COVID-19 restriction on angioplasty service and outcome of patients undergoing lower limb angioplasty. Methods Consecutive patients undergoing endovascular revascularisation between August 2018-March 2021 in a UK district general hospital were analysed retrospectively. Indications for angioplasty of all patients were discussed and agreed upon in multi-disciplinary teams. We compared time from referral to angioplasty, patient and procedural characteristics, technical success, peri-procedural complications, and outcome (wound healing, major amputation, target lesion revascularization, death) in patients treated 'before' and after February 2020 (“during COVID-19”). Results One hundred nineteen patients were treated 'before' (92% critical limb ischaemia [CLI]; 60% diabetes mellitus) and 72 were treated 'during COVID-19' (96% CLI; 61% diabetes mellitus). While the total monthly number of patients treated did not change, the number of outpatients treated as day cases increased (40% to 72%) and overnight stays for social reasons decreased (16% to 10%). Treatment of hospitalized patients decreased from 44% to 18%. The percentage of outpatients treated at &amp;lt;14 days after referral increased from 39% to 63% and hospitalized patients treated &amp;lt;5 days from 47% to 54%. Neither COVID-19 nor time to procedure affected wound healing (p(log Rank) = 0.451; median time to healing 168±25 days) and amputation free survival (p(log Rank) = 0.924; median survival 368±30 days) in all CLI patients significantly. However, amputation-free survival was significantly worse in hospitalized as compared to outpatients (p(log Rank) &amp;lt;0.001; median survival 155±20 vs 368±30 days) with similar wound healing in those that survived (p(log Rank) = 0.340; median time to wound healing 168±25 days). Of note, the known causes of death were sepsis (32%), pneumonia (18%), COVID pneumonia (18%), cardiac (16%) and stroke (8%). Conclusions Adapting to COVID-19 restriction we maintained a safe and effective angioplasty service while shortening waiting times. Very high mortality rates in patients after hospitalization indicated that CLI need to be treated much earlier and more aggressively to avoid disease progression requiring hospitalization. Funding Acknowledgement Type of funding sources: None.

67 The Evolution of A Frailty Service

Abstract Introduction In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including: We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population. Method The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance. Results With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit. Conclusion Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.