Practice Patterns In Treatment Research Articles

POS-050 SEPSIS-ASSOCIATED ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY IN SOUTH INDIA: THE PREDICTORS OF OUTCOME

Sepsis is common in critically ill patients occurring in up to 40% of patients admitted to the intensive care unit (ICU) and patients with septic shock carry high hospital mortality of up to 40%. Sepsis-associated Acute Kidney Injury (SA-AKI) requiring renal replacement therapy (RRT) carries an additional increased risk of poor outcome. The demography, the practice patterns of treatment, and outcomes in AKI vary widely across the world. The risk factors for SA-AKI are not sufficiently studied in developing countries such as India.

34414 Real-world treatment patterns of veterans with periocular basal cell carcinoma

Introduction: Few studies have examined the treatment-practice patterns of patients with periocular basal cell carcinoma (pBCC). Herein, we describe characteristics and treatment patterns of patients with pBCC in a nationwide cohort of veterans treated in the Veterans Health Administration (VHA).

Deployment of Tele-ICU Respiratory Therapy and the Creation of an eRT Service Line

Summary Penn Medicine launched a 24-7 telemedicine respiratory therapist (eRT) service as part of its tele–critical care medicine (tele-CCM) service serving seven hospitals and more than 320 critical care beds. Service line interventions were focused on protocolized evidence-based practices, safety, documentation compliance, and urgent emergent ad hoc clinical needs. Concomitantly, the eRTs were available to respond to urgent and emergent interventions on the basis of the clinical bedside situation. Their activity was triggered by Penn E-lert staff (serving the tele-ICUs), bedside staff, algorithmic trigger software, or the eRT’s own review of a patient’s clinical condition. A standardized data collection was deployed to gather information about the interventions. The value of the eRT service was defined in terms of estimated lives saved by implementing the standards of care earlier than the bedside staff would or acute respiratory distress syndrome (ARDS) algorithmic trigger and by intervening during emergent and urgent clinical request, improving care delivery, and complying with best clinical practices, and by the time freed for onsite staff to perform other duties. Between May 2020 and August 2021, eRTs registered 31,609 activities; 97.8% of interventions were related to the routine established workflows, while 1.9% were urgent and 0.3% emergent. In 51.2% of all eRT accomplished activities, no communication with other staff was needed. When communication did take place, eRTs connected with the bedside respiratory therapist in 36.7% of interactions, followed by house staff (7.2%), advanced practice providers (5.2%), and registered nurses (1.6%). The eRTs communicated via phone (81.4%), asynchronous text platform (16%), or tele-CCM software (1.4%). While prompted by staffing, safety, and logistics challenges during a Covid-19 surge, the resulting eRT service line has been well received and has become a part of the standard of care. Overall efficiency of respiratory care service delivery was increased as Penn retained staff and increased the flexibility of bedside therapists. Furthermore, the eRT service detected unfavorable practice patterns in ARDS treatment and intervened before the ARDS algorithmic trigger was activated or acted upon. Some of the tasks can be accomplished by the eRT in a shorter amount of time than it would take bedside staff. In addition, the remote staffing reduced personal protective equipment utilization. All of these gains translated into postpandemic time savings. Penn’s experience shows that the eRT care model can be transformed into a system-valued proposition and retained with sustained benefit beyond the pandemic surge.

Practice patterns in endoscopic treatment for gastric varices: A Chinese survey

Gastric varices (GV), a common complication of liver cirrhosis, often cause serious consequences. However, the management of GV remains debated. In this study we aimed to explore the practice patterns of Chinese practitioners in GV treatment and discuss whether these patterns conform to the guidelines in China and around the world. Between October 2020 and January 2021, an online questionnaire was sent to doctors from different regions in China via WeChat. Data on the practice patterns for endoscopic treatment with and without a multidisciplinary discussion team (MDT) clinic for GV were analyzed. Questionnaires were collected from 241 practitioners from 29 provinces in China. Before endoscopic treatment, 100 (41.5%) of the practitioners arranged computed tomography angiography (CTA) examination. In endoscopic tissue adhesive (ETA) treatment, 183 (75.9%) of the practitioners chose ETA combined with lauromacrogol. Approximately one-fourth of all practitioners did not prescribe drugs to reduce portal pressure. Only 75 (31.1%) of physicians preferred using early transjugular intrahepatic portosystemic shunt (TIPS) for patients at a high risk of treatment failure for GV. Compared to those without MDT clinics, practitioners with MDT clinics more often chose early TIPS for high-risk patients (39.0% vs 18.9%, P=0.001). Treatment for GV differ across China. Practitioners with MDT clinics can better use assistant strategies such as CTA to evaluate the risk and efficacy. Further clinical studies are needed, and more guidelines and consensuses are warranted to standardize clinical practice for GV.

A national survey on current clinical practice pattern of Korean Medicine doctors for treating obesity

Given the multifactorial nature of obesity, there is current interest on Korean medicine (KM) for weight loss. This survey aimed to investigate current practice patterns of KM treatment for obesity among doctors. A questionnaire on clinical practice patterns of KM treatment for obesity was constructed and distributed to 21,788 KM doctors (KMDs). The questionnaire was consisted of respondent characteristics, state of treated patient, diagnosis, treatment, and usage pattern of herbal medicine for obesity. A total of 4.9% of KMDs (n = 1,084/21,788) validly completed the survey. Patients with Obesity Class I (25 ≤ Body mass index (BMI) ≤ 29.9) are the most common in KM clinics. Bioelectric impedance and KM Obesity Pattern Identification Questionnaire were routinely used for diagnosis. The average treatment duration was 4.16 weeks, and patients visited on an average 4.25 times per month for treatment. Herbal medicine is the most commonly used for obesity treatment by KMDs, and Taeeumjowui-tang was the most frequently prescribed. Ephedrae Herba, which is identified as the most used herbs for weight loss, was prescribed 5.18 ± 2.7 g/day at minimum and 10.06 ± 4.23 g/day at maximum. A total of 62.9% of responded KMDs had ever a patient with uncomfortable symptoms due to Ephedrae Herba use, neuropsychiatric events were the most common symptoms, followed by gastrointestinal events. Taken together, this study provides information on real clinical practice patterns of KM including patients, diagnosis, treatments, and herbal medicine for obesity.

Management, surveillance patterns, and costs associated with low-grade papillary (Ta) nonmuscle-invasive bladder cancer.

464 Background: Low-risk non-muscle invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality, however, these patients may often receive non-guideline recommended and potentially costly surveillance and treatment(s). We sought to describe current surveillance and treatment practices, oncologic outcomes, and cost of care for low-grade papillary (LG Ta) NMIBC and identify predictors of increased cost of care. Methods: This population-based cohort study identified 13,054 patients diagnosed with LG Ta tumors in the Surveillance, Epidemiology and End Results-Medicare linked database from January 1, 2004 through December 31, 2013. The primary outcome was to characterize trends in population-level surveillance and treatment practice patterns over time among LG Ta patients. The secondary outcomes were recurrence, progression, and costs of care. Results: Of the 13,054 patients who met inclusion criteria, 9,596 (73.5%) were male and 3,485 (26.5%) were female, with a median age of 76 (Interquartile Range (IQR): 71–81) years. Rates of surveillance cystoscopy increased over the study period (79.3% to 81.5%, p = 0.007) with patients undergoing a median of three cystoscopies per year (IQR: 2–4). Rates of upper tract imaging utilization also increased, namely the use of computed tomography (CT) or magnetic resonance imaging (MRI) (30.4% to 47%, p < 0.001), with most patients undergoing a median of two imaging tests per year. Similarly, the use of urine cytology or other urine biomarkers also increased (44.8% to 54.9%, p < 0.001). Rates of compliance with current guidelines decreased over time suggesting overutilization of all surveillance testing modalities. A total of 17.2% of patients received intravesical bacillus-Calmette Guerin (BCG) and 6.1% received intravesical chemotherapy (excluding single perioperative dose). Among all LG Ta patients, 1.7% and 0.4% experienced disease recurrence and progression, respectively. Total annual median costs of LG Ta surveillance and care increased 1.6-fold from $34,792 to $53,986 over the study period, with increased expenditures noted among those with disease recurrence ($53,909 and $76,669). Conclusions: Despite low rates of disease recurrence or progression, rates of surveillance testing increased during the study period. Annual cost of care increased over time, particularly among patients with recurrent disease. Efforts to improve adherence to current practice guidelines, with the focus on limiting overutilization of surveillance testing and overtreatment, may mitigate associated rising costs of care.

Provider utilization of gestational diabetes screening methods – Have practices changed since the HAPO trial?

The 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study prompted an international change toward lowering the threshold for diagnosis and treatment of Gestational Diabetes Mellitus (GDM). However, it is unknown if this study changed practice patterns in the US. We assessed practice patterns in diagnosis and treatment of patients with GDM before and after the HAPO study.

Healthcare practitioners' diagnostic and treatment practice patterns of nonalcoholic fatty liver disease in Poland: a cross-sectional survey.

Nonalcoholic fatty liver disease (NAFLD) awareness is low. NAFLD diagnosis and management by gastroenterologists (GEs) and general practitioners (GPs) in Poland were evaluated. RESTORE was an observational, noninterventional, retrospective cross-sectional survey performed among GEs and GPs with at least 3 years' experience. Computer-assisted web interviews were completed. GEs provided information from patient records. Mean experience was 14.2 (95 GEs) and 22.6 (115 GPs) years. Mean patient numbers with liver disorders consulted per month were 36 (13%; GEs) and 51 (6%; GPs); ~50% were patients with NAFLD. All GEs/GPs used ultrasound; most evaluated transaminases and gamma-glutamyl transferase. More GEs used other imaging techniques and a larger spectrum of laboratory tests than GPs. Physician-identified NAFLD key symptoms were similar for GEs/GPs. GEs noticed less obvious symptoms (abdominal discomfort, drowsiness, fatigability, lack of energy) vs. GPs (abdominal pain/discomfort, dyspepsia). Common comorbidities in NAFLD were similar in GE/GP responses. NAFLD interventions by GEs/GPs (% patients) were diet/lifestyle/pharmacological interventions (54%/59%), diet/lifestyle changes alone (41%/31%) or pharmacological interventions alone (5%/10%). The top three criteria for supportive pharmacological selection were efficacy, tolerability and quality of life improvement for GEs/GPs. The five supportive treatments most commonly prescribed by GEs/GPs were essential phospholipids, ursodeoxycholic acid, timonacic, silybinin/silymarin and ornithine + choline. Information from patient records (n = 380) confirmed GEs responses. NAFLD is not a silent disease as physicians and patients reported many, albeit nonspecific, symptoms. This cross-sectional survey provides important insights into clinical management of NAFLD by GEs and GPs in Poland.

Dry Eye Disease Management in Portugal - Online Survey Results

Introduction: With growing prevalence, reduced quality of life, significant socioeconomic burden and a definite impact in cataract and laser vision correction surgeries, dry eye disease (DED) is currently a hot topic in ophthalmology. In recent years, several guidelines have been carried out to standardize the diagnosis and improve treatment approach. We intend to characterize current practices in Portugal, identify opportunities for improvement and delineate strategies to address them. Material and Methods: Cross-sectional online survey designed to assess the diagnostic approach and treatment of DED and made available to ophthalmologists across the country. The survey included 5 questions on ophthalmological profile of participants, 4 questions on DED diagnosis and 3 questions on DED treatment. Statistical analysis was made using SPSS version 26. Results and Discussion: One hundred twenty two ophthalmologists answered the survey (about 10% of practitioners in Portugal). A percentage of 48% observe between 20-40 patients with DED per month. A total of 67% always examine ocular surface of laser vision correction candi- dates, whereas only 30% always do it for cataract surgery patients. The most frequently identified DED symptom is foreign body sensation. The most commonly used diagnostic methods are fluo- rescein staining and tear break up time. Regarding treatment modalities, almost 50% of participants never used lacrimal plugs and very few recommended contact lenses or autologous serum. Mild DED treatment is considered to be very effective by 80% of ophthalmologists, while in severe DED by only 0.01%. 36% believe available treatment options are ineffective in severe DED. Conclusion: DED represents a high volume of patients seen in ophthalmology clinics. Our results mimic others in Europe and the United States. Overall, diagnosis and treatment practice patterns are in agreement with the current recommendations. However, there is still room for improvement. All patient prior surgery should be examined for DED, symptoms should be considered more as part of diagnosis and follow-up, and some easily available treatment options should be considered more often. Our findings also highlight the concern with treatment in severe DED, in which more effective therapies are needed.

Real-world practice patterns in treatment of metastatic breast cancer in Washington State.

e13038 Background: Evidence-based, national guidelines for the management of metastatic breast cancer (MBC) recommend numerous treatment options that do not capture the nuances of real-world practice. Disparities may exist across Washington State with financial implications for patients and health systems. The objective of this study was to assess practice patterns around treatment of ER+/HER2- MBC in actual clinical practice. Methods: We collaborated with Hutchinson Institute for Cancer Outcomes Research (HICOR) to link enrollment and insurance claims records with Washington State cancer registries from 2008-2017. Our cohort comprised of women >18 years old with de novo ER+/HER2- MBC who met enrollment criteria in one of four payors (Premera, Regence, Medicare, or Medicaid). We identified receipt of first line treatment, categorized as CDK4/6 inhibitors plus endocrine therapy (CDKi+ET), chemotherapy (CT), or endocrine therapy alone (ET). We examined factors influencing treatment selection using Fisher's and Kruskal-Wallis tests. Total costs (defined as costs from inpatient and outpatient claims one year after diagnosis) was estimated for patients and payors. Results: We identified 140 patients with de novo ER+/HER2- MBC with median age of 64 (range 28-95). The majority of the cohort were Caucasian (90%) with the rest comprising of Asian, Black, American Indian, and Hispanic patients. Based on the Rural Urban Commuting Area (RUCA) classification, patients predominantly lived in metropolitan neighborhoods (96%). Over 20% of patients lived in areas of high deprivation (area of deprivation index, ADI, 8-10). Patients had either Commercial (40.7%), Medicaid/Medicare (43.6%) or multiple (15.7%) insurance. Our data show that 17 patients (12%) received first line therapy with CDKi + ET, 64 patients (46%) with CT, and 59 patients (42%) with ET alone. Factors influencing treatment selection include age, co-morbidity score, and payor type. Older patients (>65 years old) were more likely to receive ET alone compared to younger patients (56% vs 44%, p value <0.001). Patients with high co-morbidity score were more likely to receive ET (30%) compared to CT (5%) or CDKi + ET (23%), p value <0.001. Patients with commercial insurance made up over 50% of patients in our cohort who received CDKi +ET, while Medicare-insured patients were most likely to receive ET alone (p value <0.001). We estimated the mean cost of receiving first line therapy with CDKi +ET ($20,368 and $175,932), CT ($10,624 and $117,847) and ET alone ($13,292 and $60,338) for patients and payors, respectively (costs inflated to December 2019). Conclusions: Our study shows substantial variation across Washington state in treatment selection and costs for patients with metastatic breast cancer in the first-line setting. Our findings demonstrate the need for initiatives to standardize quality of care relative to clinical guidelines in metastatic breast cancer care.

Abstract No. 196 Percutaneous ablation of lung tumors has failed to gain traction: Medicare volume and physician reimbursement trends from 2012 to 2018

To analyze trends in Medicare volume and physician reimbursement for percutaneous lung ablation versus resection from 2012 to 2018 Claims from the Medicare Part B PSPSMF for the years 2012 to 2018 were extracted using the CPT codes for percutaneous ablation of lung tumors as well as video-assisted thoracoscopic (VATS) and open wedge resection and segmentectomy. Total volumes and physician payments were analyzed. Unexpectedly, from 2012 to 2018, overall volume of percutaneous ablation decreased from 652 to 518 procedures (-20.6%). In 2018, 317 were coded as radiofrequency ablation (RFA) and 201 as cryoablation. A large majority were performed by radiology (92.2% in 2012 and 96.3% in 2018) with only a small minority performed by thoracic surgery. Volume of wedge resection and segmentectomy also decreased from 16,488 to 14,619 procedures (-11.3%). Specifically, the volume of open resection decreased from 6,249 to 3,183 (-49.1%), while the volume of VATS resection increased from 10,239 to 11,436 (11.7%). In 2018, average physician reimbursement was $372.28 and $417.38 for percutaneous RFA and cryoablation, respectively. Reimbursement was $573.14 for open resection and $626.75 for VATS. Despite a growing body of evidence in favor of percutaneous ablation of lower stage lung tumors, its use in Medicare patients has declined from 2012 to 2018. This minimally invasive procedure is particularly important in this population that includes older patients with more comorbidities. The findings of this study suggest that evidence-based medicine has not impacted entrenched practice patterns in treatment of lower stage lung tumors.

Adjuvant radiotherapy for cervical cancer in South Korea: a radiation oncology survey of the Korean Radiation Oncology Group (KROG 20-06).

Radiation therapy plays an important role in adjuvant treatment for surgically treated cervical cancer with adverse pathological findings. This was the first study to evaluate current practices of adjuvant radiation therapy among centres affiliated with the Korean Radiation Oncology Group. A survey containing specific questions on the demographics in 2019, indications of adjuvant treatment, radiation therapy field, prescription radiation therapy dose, boost radiation therapy and chemotherapy was sent out by e-mail to 93 centres. The overall response rate was 62.4%. Regarding radiation therapy techniques, intensity-modulated radiation therapy was adopted in most institutions (41/58, 70.7%). Various risk group criteria were selected for adjuvant radiation therapy and concurrent chemoradiation therapy. One or two risk factors among tumour size, depth of invasion and lymphovascular invasion were considered for adjuvant radiation therapy by 20.7 and 60.3% of the respondents, respectively. The following criteria for concurrent chemoradiation therapy were considered by 60.3% of the respondents: parametrial extension, positive resection margin or lymph node metastasis. Various upper borders were preferred for pelvic radiation therapy by the institutions, and a total dose of 50.4Gy in 28 fractions was the most prescribed dose scheme (37/58, 63.8%). Lymph node bed boost radiation therapy and vaginal cuff brachytherapy were considered for selected patients by 22.4% (13/58) and 60.3% (35/58) of the institutions. This survey demonstrated the practice patterns of adjuvant treatment that are prevalent in the field of radiation oncology among members of the Korean Radiation Oncology Group. These findings warrant further consensus on radiation therapy guidelines in the context of adjuvant treatment for cervical cancer.

Adult Pleomorphic Rhabdomyosarcomas: Assessing Outcomes Associated with Radiotherapy and Chemotherapy Use in the National Cancer Database.

Purpose Practice patterns for treatment of localized adult pleomorphic rhabdomyosarcoma (PRMS) remain quite variable given its rarity. Current national guidelines recommend management similar to that of other high-grade soft tissue sarcomas (STS), which include surgery with perioperative radiation (RT) with or without chemotherapy. Using the National Cancer Database (NCDB), we assessed practice patterns and overall outcomes of patients with localized PRMS. Patients and Methods. Patients with stage II/III PRMS treated with surgical resection from 2004 to 2015 were identified from the NCDB. Predictors of RT and chemotherapy use were assessed using multivariable logistic regression analysis. The association of radiation and chemotherapy status on overall survival was assessed using Kaplan–Meier and Cox proportional hazards analyses. Results Of 243 total patients, RT and chemotherapy were not uniformly utilized, with 44% receiving chemotherapy and in those who did not undergo amputation 62% receiving RT. In those who did not undergo amputation, RT was associated with improved survival on both univariate (HR: 0.49, 95% CI 0.32–0.73, P < 0.001) and multivariate analysis (HR: 0.40, 95% CI 0.26–0.62, P < 0.001), corresponding to greater 5-year overall survival (59% vs. 38%, P < 0.001). Chemotherapy was associated with a higher rate of 5-year overall survival (63% vs. 39%, P < 0.001). However, the survival benefit of chemotherapy did not reach statistical significance on multivariate analysis (HR: 0.65, 95% CI 0.41–1.03, P=0.064). Notable predictors of omission of RT included female gender (OR: 0.40, 95% CI 0.22–0.74, P < 0.01) and age ≥ 70 (OR: 0.55, 95% CI 0.30–1.00, P=0.05). Correspondingly, factors associated with omission of chemotherapy included age ≥70 (OR: 0.17, 95% CI 0.08–0.39, P < 0.001). Conclusions A significant proportion of patients with localized adult PRMS are not receiving RT. Likewise, use of chemotherapy was heterogeneous. Our findings note potential benefits and underutilization of RT, for which further investigation is warranted.

Current practice patterns of osteoporosis treatment in cancer patients and effects of therapeutic interventions in a tertiary center.

Cancer and osteoporosis have high incidence rates in older populations. However, the treatment of osteoporosis among cancer patients has not been adequately described. Our purpose was to clarify the current practice patterns of osteoporosis treatment among cancer patients in an academic cancer center, and to analyze the efficacy of treatment interventions. Patient records from April 2009 to March 2018 were retrospectively reviewed, and the study included a total of 316 cancer patients with osteoporosis. After patients' data extraction, the patients were divided into two groups, with (n = 144) or without treatment (n = 172), and compared the outcomes of these groups to evaluate the medication effect. The primary outcome was new radiographic fragility fractures during the study period. The related factors associated with fracture injuries and the rate of adverse events, such as osteonecrosis in the jaw and atypical femoral fractures, were analyzed. The rate of treatment intervention was 45.6% among the patient groups. Among patients in the study group, breast cancer patients (n = 107) were mostly treated (n = 79, 73.8%) with oral bisphosphonate. A significant difference in new fracture rate was observed between the two groups (treatment group, 30.6%; non-treatment group, 54.7%), and the risk of fracture was 42% lower in the treatment group (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; p<0.05). Previous chemotherapy, steroid use, and older age were significantly associated with increased rate of new fragility fractures. The adverse event rate was 3.5% (presented in five cases). Older cancer patients who receive chemotherapy or steroids are strongly recommended undergo bone quality assessment and appropriate osteoporosis treatment to improve their prognosis.

Novel prospective umbrella-type lung cancer registry study for clarifying clinical practice patterns: CS-Lung-003 study protocol.

IntroductionConventional cancer registries are suitable for simple surveillance of cancer patients, including disease frequency and distribution, demographics, and prognosis; however, the collected data are inadequate to clarify comprehensively diverse clinical questions in daily practice.MethodsWe constructed an umbrella‐type lung cancer patient registry (CS‐Lung‐003) integrating multiple related prospective observational studies (linked studies) that reflect clinical questions about lung cancer treatment. The primary endpoint of this registry is to clarify daily clinical practice patterns in lung cancer treatment; a key inclusion criterion is pathologically diagnosed lung cancer. Under this registry, indispensable clinical items are detected in advance across all active linked studies and gathered prospectively and systematically to avoid excessive or insufficient data collection. Researchers are to input information mutually, irrespective of the relevance to each researcher's own study. Linked studies under the umbrella of the CS‐Lung‐003 registry will be updated annually with newly raised clinical questions; some linked studies will be newly created, while others will be deleted after the completion of the analysis. Enrollment began in July 2017.DiscussionWe successfully launched the umbrella‐type CS‐Lung‐003 registry. Under this single registry, researchers collaborate on patient registration and data provision for their own and other studies. Thus, the registry will produce results for multiple domains of study, providing answers to questions about lung cancer treatment raised by other researchers. Through such analysis of each linked study, this registry will contribute to the comprehensive elucidation of actual daily practice patterns in lung cancer treatment.Key points CS‐Lung‐003 registry directly integrates multiple linked studies created under the umbrella of this cancer registry to solve various clinical questions regarding daily practice patterns of lung cancer treatment.

The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study.

In Ukraine, the 1-year mortality for colorectal cancer is much higher than that seen in high-income countries. We investigated practice patterns of colorectal cancer treatment in a region of Ukraine to account for high mortality rates. An explanatory sequential mixed methods design was used. Data from patients who underwent surgery for colorectal cancer in Ivano-Frankivsk from 2011 to 2015 were collected via retrospective chart review, and descriptive statistics were calculated. Semi-structured interviews were performed with local practicing surgeons and oncologists until thematic saturation was reached. A total of 960 patients who underwent surgery were identified in the Ivano-Frankivsk region with colon (689) or rectal (271) cancer. 11.7% of patients underwent preoperative CT of the abdomen and pelvis, and only 1.7% underwent CT of the chest. 4.1% of patients underwent a complete preoperative colonoscopy, while 31.0% had incomplete colonoscopies. Postoperatively, 31.1% of patients with stage II colon cancer and 43.9% of patients with stage III colon cancer underwent adjuvant chemotherapy. For patients with stage II and III rectal cancers, 20.9% and 33.3% underwent chemotherapy, while 68.4% and 66.7% underwent radiation therapy, respectively. Fifteen physicians completed interviews. Two major themes emerged regarding physician perceptions on providing colorectal cancer care: lack of resources and systems level issues negatively impacting patient care. In this region in Ukraine, staging practices for colorectal malignancies are inconsistent and inadequate, and adjuvant treatments are varied. This is likely attributable to the lack of resources facing providers and the prohibitively high cost of care to patients.

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

BackgroundFlow modulation is the newest endovascular technique for treatment of cerebral aneurysms.ObjectiveTo investigate changes in aneurysm treatment practice patterns in the USA.MethodsFrom the 2007 to 2016, the National Inpatient Sample...

Urinary Tract Infection in Young Infants: Practice Patterns in Evaluation and Treatment.

No clear guidelines exist for the management of infants ≤60 days old with urinary tract infection (UTI), although this condition represents a significant percentage of serious bacterial infection in this age group. We examined patterns of UTI management in infants ≤60 days at a tertiary care children's hospital and hypothesized that younger infants would be hospitalized longer. We reviewed electronic health records of infants age ≤60 days with diagnostic codes of UTI or fever hospitalized from January 2013 to January 2017 with urine culture obtained and UTI diagnosis documented. Outcomes were duration of parenteral antibiotic therapy, length of stay (LOS), and hospital readmission. One hundred ninety-three infants met criteria. Median age at admission was 37 days (interquartile range [IQR]: 22-48). Median duration of parenteral antibiotics was 59 hours (IQR 43-114) and median LOS was 71 hours (IQR 57 127). Infants age ≤28 days, with fever duration ≥24 hours, irritability or lethargy on initial examination, and bacteremia received longer parenteral therapy and had longer LOS. In multivariate analysis, age, irritability or lethargy, and presence of bacteremia remained independently related to parenteral therapy duration and LOS. In young infants with UTI, patients aged ≤28 days had longer duration of IV antibiotic therapy and LOS, independent of other clinical characteristics of their illness. The duration of parenteral therapy and LOS was relatively short, although significant variability still existed.

503P The Screening and COnsensus based on Practices and Evidence (SCOPE) survey: Treatment goals and practice patterns in third- and fourth-line metastatic colorectal cancer

503P The Screening and COnsensus based on Practices and Evidence (SCOPE) survey: Treatment goals and practice patterns in third- and fourth-line metastatic colorectal cancer

Management of idiopathic pulmonary fibrosis: A survey of Canadian respirologists

RATIONALE: International consensus guidelines provide both strong and conditional recommendations for treatment of idiopathic pulmonary fibrosis (IPF), but many recommendations are based on limited evidence. We aimed to characterize the practice patterns of IPF treatment by Canadian Respirologists and their opinions regarding the need for future clinical trials. METHODS: We conducted a cross-sectional survey of Canadian Respirologists who are members of the Canadian Thoracic Society or attended the 2018 Canadian Respiratory Conference. Survey domains were related to guideline recommendations and other challenging aspects of IPF care. We evaluated physician confidence and analyzed associations between responses and demographics. MEASUREMENTS AND MAIN RESULTS: Sixty-three Respirologists completed the survey (17% response rate). Corticosteroids were unanimously prescribed (100%) for treatment of IPF exacerbations but with substantial variability in dose and duration. Most respondents believe that placebo-controlled trials of corticosteroid treatment for IPF exacerbations are needed (92%) and ethical (83%). Pulmonary rehabilitation was always or often recommended by 67% of Respirologists; however, 25% reported poor access to exercise programs as a key barrier to participation. In patients with preserved (FVC > 90%) and severely reduced (FVC < 50%) lung function, 62% and 78% of respondents reported recommending antifibrotic therapy, respectively. For patients experiencing a decline in lung function on antifibrotics, most physicians (63%) recommend switching to the alternative antifibrotic, whereas some recommended discontinuing antifibrotic therapy (6%) or dual antifibrotics (5%). CONCLUSIONS: Despite treatment guidelines, Canadian Respirologists have diverse opinions regarding IPF treatments. This survey provides insight into the frequency of particular treatment strategies and may guide future trial design.