Percentage Of Cases Research Articles

Short communication: Association analysis of diacylglycerol acyltransferase (DGAT1) mutation on chromosome 14 for milk yield and composition traits, somatic cell score, and coagulation properties in Holstein bulls

The aim of the present study was to determine the allele frequencies of the diacylglycerol acyltransferase (DGAT1) K232A mutation in Italian Holstein bulls and to estimate the effect of the mutation on milk yield, composition, somatic cell score, and coagulation traits (rennet coagulation time and curd firmness). For this purpose, 349 Italian Holstein bulls were genotyped for the DGAT1 mutation on chromosome 14. Association analysis was performed by regressing the number of copies for the K allele on the deregressed estimated breeding value of the individual. Breeding values were calculated using field data routinely collected in Northeast Italy. The frequencies of the AA, KA, and KK genotypes were 59.6, 32.1, and 8.3%, respectively, and the minor allele frequency (K variant) was 24.7%. The K allele was significantly associated with greater fat yield and fat, protein, and casein percentages and with reduced protein:fat ratio. The association between the DGAT1 mutation and somatic cell score was not significant, whereas a favorable association between presence of the K allele and milk coagulation properties was found. Results from the present study confirmed the effect of the diallelic DGAT1 polymorphism K232A on milk production traits and, for the first time, provided evidence that this mutation also affects milk coagulation properties in the Italian Holstein breed.

Short and Long-Term Outcomes of Titanium Clip Ossiculoplasty.

To report short (∼4 mo) and long-term (>12 mo) audiometric outcomes following ossiculoplasty using a titanium clip partial ossicular reconstruction prosthesis. Case series at a single tertiary referral center reviewing 130 pediatric and adult patients with conductive hearing loss (CHL) secondary to chronic otitis media (n = 121, 93%) or traumatic ossicular disruption (n = 9, 7%) who underwent partial ossiculoplasty from January 2005 to December 2015 with the CliP prosthesis. At both short and long-term follow-up, postoperative air-bone gap (ABG) was significantly improved (18 dB HL, IQ range 13-26, p < 0.0001 and 18 dB HL, IQ range 13-29, p = 0.0002, respectively) when compared with preoperative values (29 dB HL, IQ range 19-37). No significant change in ABG was noted when comparing short and long-term intervals (18 versus 18 dB HL, p = 0.44). Fifty seven percent of cases (51/89) achieved a long-term ABG less than or equal to 20 dB at the time of their last follow-up. The extrusion and displacement rates were 1.5% (2/130), and 0.8% (1/130), respectively. There were no cases of iatrogenic sensorineural hearing loss. Partial ossiculoplasty with the titanium CliP produces good hearing outcomes with a favorable safety profile. At long-term follow-up (minimum of 12 mo), median ABG was 18 dB and remained stable when compared with short-term follow-up. The majority of patients had successful long-term results, with 57% of patients achieving an ABG is less than or equal to 20 dB. Low rates of extrusion (1.5%) and prosthesis displacement off the stapes (0.8%) support the long-term stability of the CliP prosthesis in the middle ear.

Determinants of precancerous cervical lesions: A case-control study

Introduction Development of cervical cancer is almost precedent by cervical precancerous lesion. Lesions evolutions maybe happen by regression or aggravation. These evolutions are closely related to human papillomavirus (HPV) infection and other determinants. Our objective was to describe the determinants distribution of the cervical cancer according to presence or absence of cervical precancerous lesion in Morocco. Methods The population of our study was nested in a control population of a national case-control study on cervical cancer [1] : 108 women were selected (27 cervical precancerous lesion cases and 81 controls). The controls were selected using an individual age-matching (± 2 years). The population was included between November 2009 April 2012 in different centers of Morocco: in primary healthcare centers (in Rabat, Casa and Fes) and in gynecological public hospital (in Rabat). The target population was represented by all women's outpatient consultants for pathologies others than gynecological pathologies (gynecological infection, menstruation disorders, etc.) as well as women consultants in the context of pregnancy monitoring. The women benefited from a gynecological examination with sampling for the cervical vaginal smear and for genotype of HPV. Data were collected by a questionnaire that included socio-demographic characteristics, sexual behaviours, reproductive and contraceptive history and history of sexually transmitted diseases. Results The mean age of cases was 54.5 ± 11.2 years while the age of controls was 55.0 ± 10.6 (P = 0.8). The lesions type in the study was distributed as follows: 51.9% were low cervical precancerous lesion, 25.9% were atypical squamous cells of Undetermined Significance (ASC-US), 14.8% were malpigian cell atypia of undermined significance and 4.7% were atypical Squamous Cell evocating High-grade lesion (ASC-H). The HPV infection was positive for 11.1% cases against 13.5% for controls (the oncogenic HPV infection was identified for 11.1% of the cases against 4.9% for the controls). The multiple HPV infection was detected for the three cases while the controls had one multiple infection and eleven single infection (63.6% with HPV 33 and 27.3% with HPV 16). Most cases and controls were married (76.0%, 61.7%, respectively); 66.7% of cases were illiterate against 61.5% of controls. Concerning the reproductive characteristics 52.4% of cases had an age of menarche ≤ 12 against 40.5% of controls and 47.2% of cases had an age of menarche > 12 against 59.4% of controls. Sixty-three percent of cases used the oral contraceptives against 52.5% of controls. The duration of uses of oral contraceptives was Conclusion Only 11.1% of women with cervical precancerous lesion HPV had a positive HPV infection, while some controls had an infection with oncogenic HPV type. These results raise the importance of looking for other factors associated to appearance and/or development of cervical precancerous lesion witch will be the subject of our future research work.

Abstract 1214: Nasopharyngeal carcinoma clinical stage, histologic grade and biomarker status at presentation are usually of poor prognostic characteristics: A clinicopathologic study in a low-resource setting

Abstract Introduction: Nasopharyngeal carcinoma (NPC) is the 8th commonest malignancy in men and the commonest head and neck tumor in Ibadan Cancer Registry (IBCR). Methods: Clinical files and records of all nasopharyngeal carcinoma diagnosed at the Department of Pathology, University College Hospital affiliated with IBCR between January 2007 and December 2016 were reviewed for demographic data, clinical presentation, clinical stage, histologic grade, LMP-1 and EGFR status. Results: A total of 71 cases of nasopharyngeal carcinoma were diagnosed during the study period, comprising 44 males and 27 females with a male:female ratio of 1.6. Age ranged from 12 years to 80 years, the modal age group was 40-49 and the modal age was 45 years. Sixty-three percent of cases were non-keratinizing undifferentiated tumors, 31% were non-keratinizing differentiated, 4.2% were keratinizing tumors and 1.4% basaloid squamous cell carcinoma. In all, non-keratinizing undifferentiated tumors constituted 64% of tumors in males and 63% in females. Conversely, non-keratinizing differentiated tumor was commoner in males, accounting for 34% of tumors compared to only 26% in females. Also, keratinizing tumor was twice as common in females than males; there was only a single basaloid squamous cell carcinoma recorded. The age group 30-39 years had the highest incidence of non-keratinizing undifferentiated tumor while non-keratinizing differentiated tumor was more common in the 40-49 age group. Patients presented most frequently with stage II disease, which accounted for 62% of cases. About 20% of these patients presented with stage IV disease. Nasal and aural symptoms accounted for the commonest presenting complaint, occurring in 38% of patients. Thirty-six percent presented with nasal symptoms alone while 13% had a combination of nasal, aural and visual symptoms; this group was mainly patients with stage IV disease. LMP-1 positivity was observed in as many as 99% of all cases. EGFR was positive in 94% of cases, indicating that NPCs are usually of poor prognosis in our practice setting at presentation. Conclusion: In our practice, nasopharyngeal carcinoma is characterized by late-stage presentation, high-grade histologic characteristics and have biomarker indicators of poor prognosis. Citation Format: Aralola A. Olusanya, Gabriel O. Ogun, Adebolajo Adeyemo. Nasopharyngeal carcinoma clinical stage, histologic grade and biomarker status at presentation are usually of poor prognostic characteristics: A clinicopathologic study in a low-resource setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1214.

How Many Cases are Easy?

Judges and legal scholars have long debated how many cases are easy. Legal realists, critical legal scholars, and political scientists have contended that there are many hard cases that require judges to exercise discretion or law-making authority. Many judges and mainstream legal scholars, however, have argued that most cases are easy and only require fidelity to existing legal sources. Despite the importance of this question, legal scholars and social scientists have struggled to evaluate how many cases are easy, and the existing literature provides wildly disparate estimates. Appellate judges repeatedly report, based on their own experiences, that roughly 90 percent of cases are easy. In stark contrast, economic models on the selection of disputes for litigation predict that most cases that are litigated and appealed will be hard. Empirical indicators have yielded muddled conclusions, especially with regard to the federal courts of appeals. Scholars often cite rates of dissent and unpublished decisions, interpreting these statistics as showing that most cases are easy. On the other hand, studies that compare voting behavior among different types of appellate panels often conclude that many cases are hard. In fact, none of this research directly relates to the proportion of easy cases. This Article critically analyzes existing claims and proposes a new approach for thinking empirically about the proportion of easy cases. Starting from the basic premise that judges cannot reasonably disagree in easy cases, it shows that evidence of disagreement can be decomposed into hard cases and unreasonable errors. It then explains how to estimate the structure of judicial disagreement in the U.S. courts of appeals by examining disagreement both within and between panels. Finally, the article illustrates the framework developed here using two data sets of appeals. An analysis of appeals from the National Labor Relations Board in the D.C. Circuit demonstrates that panels would disagree on the outcome in at least 30 percent of cases. A second data set of asylum appeals in the Ninth Circuit shows that panels would disagree in at least 60 percent of cases. If 90 percent of these cases are easy, as some judges have contended, then at least 5 percent of the NLRB cases and at least 7 percent of the asylum cases must be unreasonable errors.

Secondary Bleedings in Oral Surgery Emergency Service: A Cross-Sectional Study

Introduction Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other. Materials and Methods The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients. Results The vast majority of patients took a coumarin derivative (41) and acetylsalicylic acid (27). Nine (12%) of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s). Conclusions Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90%) can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s), and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.

Young to Middle-Aged Adults and Low Education: Risk Factors of Spondylitis Tuberculosis with Neurological Deficit and Deformity at Dr. Hasan Sadikin General Hospital

Background: Incidence of tuberculosis has risen again, including extrapulmonary tuberculosis. Spondilitis tuberculosis is one the most commonly encountered which can cause disability and even death. The aim of this study was to evaluate characteristics of spondilitis tuberculosis patients and probable risk factors. Methods: This was a descriptive, cross sectional study from all medical records of spondylitis tuberculosis patients at Dr. Hasan Sadikin General Hospital from January 2012 to December 2013. Variables evaluated were demographic data, history related to tuberculosis, nutrinutional status, patient’s characteristics, and treatments received. Results: Spondylitis tuberculosis represented 65.6% of bone and joints tuberculosis. From 78 cases, the male to female ratio was 1.2:1, and mostly found in young and middle-aged adults (79.6%) between 20−64 years old. Patients’ level of education were mostly elementary school (30.8%) and unemployed. Clinical symptoms were mostly neurological disorders, deformity (kyphotic/gibbus), and tenderness. Predilections sites were thoracal and lumbal vertebrae. Forty eight percents of cases were also sufferring from TB in other organs. Treatments given for these cases were anti tuberculosis drugs (80.8%) and operative procedures (62.8%). Conclusions : Most common clinical manifestations are neurologial deficit, deformity, and tenderness; mostly have pulmonary tuberculosis as a comorbid disease; probable risk factors are young and middle-aged adults, low education level, and unemployment.

A clinicopathological study of carcinoma penis in a rural population in Southern India

Background: Carcinoma penis is not an uncommon malignancy in rural population. The various epidemiological, clinical and pathological factors were analysed and compared with the global standards. To analyse the epidemiological, clinical, and pathological characteristics of carcinoma penis and their influence on the outcome of management strategies adopted.Methods: This prospective study was conducted in government Villupuram medical college hospital Villupuram between July 2015 and July 2017 over 42 new carcinoma penis cases that were treated in the department of general surgery. Particularly about the site of origin of the lesion whether prepuce, glans, corona, or shaft.Results: The most common presenting symptom in our study was the growth. It constitutes about 71% of the cases. Ulcer and discharge are seen in 24 and 3 percent of cases respectively. Most of the cases present with multiple symptoms. Apart from these symptoms urinary disturbance and weight loss are the most common associated symptom. Pain is absent in most of the cases unless there is a superadded infection. Nodal disease as a presenting symptom is not seen in our study. But 3 patients present recurrence as nodal disease after treatment of primary.Conclusions: Screening of the high-risk age group will decrease in unnecessary delay in presentation of the disease. Educating about the personal hygiene will decrease the possible etiology of the disease. Improving the self-discipline by cessation of smoking and avoiding extramarital contact will significantly decrease the disease frequency.

Effect of casein and inulin addition on physico-chemical characteristics of low fat camel dairy cream

The effect of the addition of the camel casein fraction on some physico-chemical properties of low fat camel milk cream was studied. Oil-in-water emulsions, 25, 30, and 35 (w/w) fat, were prepared using inulin, camel skim milk, milk fat and variable percentages of casein (1, 2, and 3% w/w). The droplet size, ζ-potential, surface protein concentration, viscosity and surface tension of low fat dairy creams was measured. Cream containing 2% (w/w) casein had better stability. The modifications in physico-chemical properties appeared to be driven by changes in particle size distribution caused by droplet aggregation. The cream containing 2% casein leads to a gradual decrease in droplet size, as the particle size decreased, apparent viscosity increased. When casein concentration increased, ζ-potential decreased due to combination of c terminal (negative charge) with the surface of fat particles but steric repulsion improved textural properties. Cream with 30% fat and 2% casein had the best result.

5000 Free Flaps and Counting: A 10-Year Review of a Single Academic Institution's Microsurgical Development and Outcomes.

The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity. A 10-year retrospective institutional review was performed from fiscal years 2006 to 2016. Microsurgical flap type and operative volume were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons. Univariate and multivariable predictors of flap salvage were determined. The 5000th flap was performed in December of 2015 within this institutional study period. Looking at the six highest volume surgeons, free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53 percent and flap loss rate of 0.55 percent across all participating hospitals. Overall, 74.4 percent of cases were breast flaps, and the remaining cases were extremity and head and neck flaps. Focused faculty and trainee recruitment has resulted in an academically and clinically productive practice. Collaboration among faculty, staff, and residents contributes to continual learning, innovation, and quality patient care. This established framework, constructed based on experience, offers a workable and reproducible model for other academic plastic surgery institutions. Therapeutic, IV.

Genotyping and spatial analysis of pulmonary tuberculosis and diabetes cases in the state of Veracruz, Mexico.

BackgroundGenotyping and georeferencing in tuberculosis (TB) have been used to characterize the distribution of the disease and occurrence of transmission within specific groups and communities.ObjectiveThe objective of this study was to test the hypothesis that diabetes mellitus (DM) and pulmonary TB may occur in spatial and molecular aggregations.Material and methodsRetrospective cohort study of patients with pulmonary TB. The study area included 12 municipalities in the Sanitary Jurisdiction of Orizaba, Veracruz, México. Patients with acid-fast bacilli in sputum smears and/or Mycobacterium tuberculosis in sputum cultures were recruited from 1995 to 2010. Clinical (standardized questionnaire, physical examination, chest X-ray, blood glucose test and HIV test), microbiological, epidemiological, and molecular evaluations were carried out. Patients were considered “genotype-clustered” if two or more isolates from different patients were identified within 12 months of each other and had six or more IS6110 bands in an identical pattern, or < 6 bands with identical IS6110 RFLP patterns and spoligotype with the same spacer oligonucleotides. Residential and health care centers addresses were georeferenced. We used a Jeep hand GPS. The coordinates were transferred from the GPS files to ArcGIS using ArcMap 9.3. We evaluated global spatial aggregation of patients in IS6110-RFLP/ spoligotype clusters using global Moran´s I. Since global distribution was not random, we evaluated “hotspots” using Getis-Ord Gi* statistic. Using bivariate and multivariate analysis we analyzed sociodemographic, behavioral, clinic and bacteriological conditions associated with “hotspots”. We used STATA® v13.1 for all statistical analysis.ResultsFrom 1995 to 2010, 1,370 patients >20 years were diagnosed with pulmonary TB; 33% had DM. The proportion of isolates that were genotyped was 80.7% (n = 1105), of which 31% (n = 342) were grouped in 91 genotype clusters with 2 to 23 patients each; 65.9% of total clusters were small (2 members) involving 35.08% of patients. Twenty three (22.7) percent of cases were classified as recent transmission. Moran`s I indicated that distribution of patients in IS6110-RFLP/spoligotype clusters was not random (Moran`s I = 0.035468, Z value = 7.0, p = 0.00). Local spatial analysis showed statistically significant spatial aggregation of patients in IS6110-RFLP/spoligotype clusters identifying “hotspots” and “coldspots”. GI* statistic showed that the hotspot for spatial clustering was located in Camerino Z. Mendoza municipality; 14.6% (50/342) of patients in genotype clusters were located in a hotspot; of these, 60% (30/50) lived with DM. Using logistic regression the statistically significant variables associated with hotspots were: DM [adjusted Odds Ratio (aOR) 7.04, 95% Confidence interval (CI) 3.03–16.38] and attending the health center in Camerino Z. Mendoza (aOR18.04, 95% CI 7.35–44.28).ConclusionsThe combination of molecular and epidemiological information with geospatial data allowed us to identify the concurrence of molecular clustering and spatial aggregation of patients with DM and TB. This information may be highly useful for TB control programs.

Hearing loss before and after cisplatin-based chemotherapy in testicular cancer survivors: a longitudinal study

Background: Hearing loss is a well-known long-term effect after cisplatin-based chemotherapy (CBCT) in testicular cancer survivors (TCS), but longitudinal data are sparse. We evaluate hearing loss and the impact of age in TCS treated with CBCT in this longitudinal study.Material and methods: Forty-six TCS treated with CBCT 1980–1994 with audiograms (0.25–8 kHz) pre-chemotherapy (PRE) and at a follow-up survey (SURV) after median 10 years were included (cases). Audiograms at SURV from 46 age-matched TCS without CBCT were included as controls. Linear regression was performed to evaluate predictors for change in the hearing threshold level (HTL) from PRE to SURV. Two definitions of a audiogram-defined hearing loss was applied if: (1) mean HTL for both ears exceeded 20 dB at any frequency 0.25–8 kHz (American Speech-Language-Hearing Association (ASHA) definition) and (2) average HTL for the frequencies 0.5, 1, 2 and 4 kHz exceeded 20 dB (WHO-M4 definition). Self-reported hearing impairment (SURV) was assessed by a questionnaire.Results: Age and cisplatin dose was significantly associated with a greater change in HTL for the frequencies 2–8 kHz. For the 8 kHz frequency, each 100 mg increase in cumulative cisplatin dose was associated with a deterioration of 3.6 dB (95% CI 1.8–5.3, p < .001). The prevalence of hearing loss (ASHA) among cases was 33% PRE, 70% at SURV and 65% among controls at SURV (cases vs. controls, p = .66). According to M4, the prevalence of hearing loss among cases was 6.5% PRE, 13% at SURV and 2.2% among controls at SURV (cases vs. controls, p = .049). Twenty-nine percent of cases, and 33% of controls (p = .70) reported hearing impairment at SURV.Conclusion: Cisplatin is associated with a hearing loss particularly at higher frequencies. Age appear to be an important factor for hearing loss regardless of treatment. The ASHA definition overestimates the hearing problem.

Abstract TP138: The Clinical Features and the Long-Term Outcomes of Carotid Symptomatic Low-Grade Stenosis

Background: Ischemic events caused by carotid artery stenosis are affected not only by stenosis but also by the instability of plaque. In symptomatic low-grade stenosis cases medical treatment is generally performed, but there are cases with repeated recurrence. The purpose of this study is to clarify the clinical features and long-term outcomes in cases of symptomatic low-grade stenosis. Methods: We included seventy-one symptomatic patients with carotid low-grade stenosis (&lt;NASCET 50%) who were admitted to our hospital from 2005 to 2016. The relative plaque signal intensity (rSI) with reference to muscle and expansive remodeling rate (ERR) were measured using carotid MRI. Antiplatelet therapy and treatment for atherosclerosis risk factors were administered in all cases. Carotid endarterectomy (CEA) was performed when ischemic symptoms appeared or the stenosis rate progressed despite medical treatment. Results: The mean stenosis rate, rSI and ERR on admission were 20.4, 1.75 and 1.96, respectively. Seventy percent of cases involved intraplaque hemorrhage and positive remodeling. During a mean of 52-months follow-up, a recurrence of ischemic events was confirmed in 33 cases (46%), from which the duration until recurrence was within 7 days (33%), 3 months (18%), 1 year (18%), 2 years (21%), and over 2 years (15%). Nine cases had impending stroke, 3 of which were associated with major artery occlusion. CEA was performed in 28 cases (39%) for impending stroke (25%), recurrence of ischemic events (46%), asymptomatic infarction (7%), and stenosis rate progression (11%). During a mean of 47-months follow-up after CEA, 2 cases of death (fetal intracerebral hemorrhage, asphyxia) and one case of brain stem lacunar infarction were observed, but an ipsilateral ischemic event was not observed. Conclusion: Most of the symptomatic patients with low-grade stenosis had both intraplaque hemorrhage and positive remodeling. The risk of recurrence and stenosis progression was high. CEA might have had a preventive effect against ischemic events in low-grade stenosis.

Abstract WP361: Nursing Education improves activation of Code Stroke in Cardiac Patients with Inhospital Stroke

Background: Inhospital stroke (IHS) is defined as an acute ischemic infarction that occurs during hospitalization in a patient originally admitted for another diagnosis or procedure. Approximately 4 to 17 percent of all adult strokes are IHS, and most IHS occurs in cardiologic and cardiosurgical patients after catheterization or surgery. Time to brain imaging is longer in IHS vs community onset strokes (COS) due to delayed symptom recognition, and consequently, IHS patients have greater disability and increased mortality comparted to their COS counterparts. Purpose: The purpose of this project was to educate cardiac nurses to more rapidly and accurately recognize symptoms of acute ischemic stroke. We hypothesized that this education would shorten evaluation time for inpatient strokes and result in faster activation of the Code Stroke team. Methods: Two 4-hour “Heart to Brain Connection” seminars were offered. Course objectives targeted development of critical thinking regarding the relationship of cardiovascular and cerebrovascular disease. Content included cardiac and cerebral anatomy, recognition of ischemic stroke syndromes and NIH Stroke Scale review. All cardiac nurses completed NIH Stroke Scale Certification. Nurses were empowered to call a “Code Stroke” and educated on appropriate criteria. NIH Stroke Scale pocket cards and pencils with the code stroke number were distributed through the cardiac units. Results: We compared the median time from stroke symptom recognition to activation of “Code Stroke” before and after our interventions. Prior to the interventions, in 2014, the median time was 20 minutes; however, this time was decreased to 6.5 minutes in 2016 following our interventions. Further, in 2014, only 36 percent of “Code Strokes” were called by nurses. Following the interventions, “Code Strokes” were called by cardiac nurses in 75 percent of cases in 2016. Conclusions: Empowering cardiac nurses to call a “Code Stroke“ through targeted education and training increases the number of “Code Strokes” called by nurses and decreases the time from recognition to activation of the Code Stroke team thereby optimizing the patient’s potential outcome.

Abstract WP358: Lightning Fast Stroke Treatment: Recognition Makes a Difference

Background: For acute ischemic stroke patients, reduced door-to-needle (DTN) times are associated with better clinical outcomes. Our Stroke Center evaluated DTN time for thrombolysis cases since 2004 to identify opportunities to reduce time to treatment. In October 2014, the American Heart Association/American Stroke Association introduced Target: Stroke Phase II to challenge Get With the Guidelines-Stroke participating hospitals to reduce time to tPA. In January 2015 our center adopted the goal DTN time of 45 minutes. Many best practice strategies outlined in Target: Stroke Phase II were previously implemented, including: EMS pre-notification, single call activation, rapid evaluation by the Stroke Team, and rapid completion and interpretation of brain imaging. In 2015, our stroke center was able to administer tPA within 45 minutes of Emergency Department (ED) arrival in 29% of cases (n=35). Purpose: The purpose of this project is reduce DTN times by recognizing the efforts of the interdisciplinary team in cases of timely thrombolysis. Methods: A team-based approach is used for all ED Stroke Alerts. Starting January 2016, for each case of tPA administration within 45 minutes of arrival, every team member was recognized for their contribution in providing “Lightning Fast Stroke Care.” A flyer was developed highlighting details of the case, clinical outcome, and recognizing every team member who participated in the care of the patient. Persons recognized include: EMS, ED nurses, techs and physicians, registration, radiology techs, laboratory staff, pharmacists, Stroke Team physicians and trainees. Flyers were distributed and displayed publically. Each team member recognized received a lightning bolt pin, in addition to a copy of the flyer. Results: In 2016, over 500 pins were awarded for Lightning Fast Stroke Treatment, and the lightning bolt pin became a badge of honor recognized throughout the medical center. Our Stroke Center was able to administer tPA within 45 minutes of ED arrival in 58% of cases (n=40). Without making other changes to the process our percent of cases achieving DTN within 45 minutes doubled. Conclusion: Recognition and feedback are important to providing team-based care and have made a significant sustainable impact on DTN times.

Respiratory Aspects of Approach to Neonatal Resuscitation

Introduction: Around 10% of live births globally require immediate intervention, and 4 million neonatal deaths happen in a year, where one fourth of them are due to asphyxia. Regular respiration may fail to achieve spontaneously in about ten percent of live births, with one percent of cases needing resuscitation with chest compressions, and about 0.06% needing epinephrine. The target in neonatal resuscitation is to achieve sufficient functional residual capacity, while avoiding pulmonary damage, and to optimize the tissue delivery of oxygen without causing toxicity Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: neonatal asphyxia, neonatal resuscitation, neonatal intensive care, respiratory distress syndrome, complications of prematurity, oxygen therapy, neonatal ventilation Aim: In this review, we aim to study the various approach taken to provide immediate resuscitation to neonates with respect to respiratory distress. Conclusion: With advancing research, physicians should have more devices to decrease the mortality rates among infants. We also need more research to establish best recommendations and guidelines on the use of best interventions especially in clinical setting with limited resources.

TELE-EXPERTISE SYSTEM BASED ON THE USE OF THE ELECTRONIC PATIENT RECORD TO SUPPORT REAL-TIME ANTIMICROBIAL USE.

The aims of this study are (i) to present the design of a tele-expertise system, based on the telephone and electronic patient record (EPR), which supports the counseling of the infectious diseases specialist (IDS) for appropriate antimicrobial use, in a French University hospital; and (ii) to assess the diffusion of the system, the users' adherence, and their perceived utility. A prospective observational study was conducted to measure (i) the number and patterns of telephone calls for tele-expertise council, the number of initial and secondary assessments from the IDS and multidisciplinary meetings; (ii) the clinicians' adherence rate to therapeutic proposals by the IDS and the number of clinical situations for which the IDS decided to move to bedside; and (iii) the perceived utility of the system by the medical managers of the most demanding departments. The review of patients' records for 1 year period indicates that 87 percent of the therapeutic recommendations were fully followed. The adherence was high, despite the IDS moving to the bedside only in 6 percent of cases. Medical managers of the most demanding departments considered the system to be useful. Moreover, 6,994 tele-expertise notifications have been recorded into the EPR for 48 months. The tele-expertise system is an original way to design information technology supported antimicrobial stewardship intervention based on the remote access to relevant information by the IDS and on the traceability of the medical counseling for the clinicians.

Dengue Virus and Its Inhibitors: A Brief Review.

The global occurrence of viral infectious diseases poses a significant threat to human health. Dengue virus (DENV) infection is one of the most noteworthy of these infections. According to a WHO survey, approximately 400 million people are infected annually; symptoms deteriorate in approximately one percent of cases. Numerous foundational and clinical investigations on viral epidemiology, structure and function analysis, infection source and route, therapeutic targets, vaccines, and therapeutic drugs have been conducted by both academic and industrial researchers. At present, CYD-TDV or Dengvaxia® is the only approved vaccine, but potent inhibitors are currently under development. In this review, an overview of the viral life circle and the history of DENVs is presented, and the most recently reported antiviral candidates and newly discovered promising targets are focused and summarized. We believe that these successes and failures have enabled progress in anti-DENV drug discovery and hope that our review will stimulate further innovation in this area.

Vitamin B12 deficiency associated with hyperbilirubinemia and cholestasis in infants.

Objective:To study the correlation between vitamin B12 deficiency and hyperbilirubinemia and cholestasis in infants.Methods:The study group consisted of 215 infants who were tested for serum B12 and bilirubin levels out of 335 cases referred to the Centre from June 2011 to 2016 as a part of the screening program established by the Ministry of Health. The following information was obtained from the case files: demographic data; background; family history; serum vitamin B12, folate, plasma homocysteine, and urine methylmalonic acid (MMA) levels; and direct, indirect, and total bilirubin levels.Results:About 48.8 percent of cases had vitamin B12 deficiency. No significant differences were found when those cases with vitamin B12 deficiency and those without vitamin B12 deficiency were compared in terms of total, direct, or indirect bilirubin levels. Only two cases (0.9 percent) had cholestasis.Conclusion:The study suggests vitamin B12 deficiency is a common phenomenon (48.4 percent), similar to what has been suggested by other studies conducted in Turkey. Therefore, the presence of vitamin B12 deficiency in cases with cholestasis or hyperbilirubinemia may show an association. To prove the correlation between them, more studies are required.

OP35 Integrated Knowledge Translation In Policy Development

Introduction:Immune globulin (IG) is a publicly funded blood product with high utilization rates and rapidly rising costs. Inappropriate use of IG, particularly in dose and treatment duration, is observed in about 10 percent of cases, and the national guidelines for IG treatment are outdated. To develop a utilization management policy for IG, the Alberta, Manitoba and Saskatchewan Ministries of Health collaborated with health technology assessment (HTA) researchers and clinicians to develop evidence-based guideline recommendations for IG treatment to inform an authorization policy for IG utilization in the provinces.Methods:A multidisciplinary committee comprising HTA researchers and 22 physicians from seven medical specialties adapted recommendations from 43 “seed” guidelines into one locally contextualized IG guideline. HTA methods and rapid review products were used extensively to update gaps in the evidence base. The guideline recommendation document was used to develop a provincial IG utilization management policy. The challenges of achieving a methodologically rigorous guideline development process will be discussed.Results:The guideline contained over 60 recommendations for IG use in different medical specialties. The health ministries used the guideline recommendations to develop an IG authorization policy. The clinician-sanctioned review criteria were used to construct a conditional reimbursement system for generating outcome data from controlled off-label IG use for conditions where evidence gaps existed, and were built into policies for benchmarking compliance.Conclusions:Three provinces successfully collaborated to develop an IG utilization management policy. The unique approach involved a credible and transparent process that incorporated key review elements for compliance benchmarking and reimbursement, promoted clinician buy-in, and created a cadre of clinical champions willing to assist in policy development and implementation. The proactive, rather than retroactive, incorporation of clinician-sanctioned benchmarking and review criteria into policy will help bridge the know-do gap and foster a stronger, more direct link between health policy and evidence.