Preferred Use Research Articles

Allogeneic Hematopoietic Stem Cell Transplant Outcomes in Adults with Inherited Myeloid Malignancies

Recognition of hereditary hematopoietic malignancies (HHMs) has accelerated in recent years, with deleterious germline variants in more than 20 genes recognized as drivers of myeloid malignancies. Individuals with HHMs generally receive similar treatment plans as those with de novo disease. Hematopoietic stem cell transplantation (HSCT) is often employed as a curative approach for myeloid malignancies, and in those with germline pathogenic (P)/likely pathogenic (LP) predisposition variants, there is a preference for use of related donors who lack the familial variant. However, there are limited data on the outcomes of patients with HHMs who are treated in this manner. In this study, we used comprehensive clinical and genomic data to investigate the allogeneic transplant-related outcomes in the largest international myeloid HHM cohort reported to date. We performed a retrospective analysis of all patients with myeloid malignancies who underwent germline predisposition testing at The University of Chicago (UofC) or the Central Adelaide Health Network between 2010 and 2021; or were known to have deleterious germline DDX41 variants from the University of Pennsylvania and Moffitt Cancer Center. We studied 472 patients, of whom 28% (80/289) in the UofC cohort and 20% (35/175) in the Adelaide cohort had a deleterious germline variant causative of HHMs. In the UofC cohort, P/LP CHEK2 variants were the most common, whereas P/LP DDX41 variants were most common in the Adelaide cohort (Fig. 1). A total of 161 patients (34% of the entire cohort) underwent allogeneic HSCT for their myeloid neoplasm (Table 1). There were no differences in the distribution of diagnoses, donor types, disease status at the time of HSCT (remission vs active disease), conditioning regimens, or conditioning intensity. All donor cells were mobilized from peripheral blood. Almost all donors lacked the deleterious germline causative variant, with one donor sharing a deleterious familial DDX41 variant with the relative/HSCT recipient. The median time to engraftment was similar between those who had vs lacked germline HHM variants. Patients with P/LP germline DDX41 variants had higher rates of severe (stage 3-4) acute graft versus host disease (GVHD) when compared to patients with P/LP CHEK2, those with other germline variants, or those without P/LP germline variants (38% vs 0, 12%, and 9%, respectively; p=0.002). Notably, severe gastrointestinal GVHD was seen in a third of patients with P/LP germline DDX41 variants as opposed to <10% incidence in other groups (p<0.001, Table 1). Similarly, 33% of patients with P/LP germline DDX41 variants experienced moderate to severe chronic GVHD, whereas this incidence was 29% for patients with P/LP germline CHEK2 variants, 4% for patients with other P/LP germline variants, and 10% for patients without a P/LP inherited variant (p=0.008). Patients with P/LP germline DDX41 variants who received post-HSCT cyclophosphamide had lower rates of severe acute GVHD compared to those who received other forms of GVHD prophylaxis (0% vs 53%, p=0.03). To adjust for the effects of known GVHD risk factors, we performed a multivariable logistic regression analysis. Germline DDX41 status remained an independent predictor of both acute GVHD (OR: 4.76, range 1.27-17.9; p=0.01) and chronic GVHD (OR: 3.39, range 1.09-10.5; p=0.03). Importantly, post-HSCT cyclophosphamide use was associated with a reduced risk of acute GHVD when adjusted for other variables (OR: 0.10, range 0.01-0.71; p=0.008). Our data establish severe GVHD as a clinically relevant post-transplant phenomenon in germline DDX41-associated HHMs and suggest that donor-derived wild-type T-cells may become activated by a pro-inflammatory milieu conferred by P/LP germline DDX41 variants. Moreover, our observations suggest that post-HSCT cyclophosphamide is an effective strategy for GVHD prevention in these individuals. Broader confirmation of our results in other heterogeneous patient cohorts will serve to expand the spectrum of known pathogenic variants implicated in HHMs and support the development of targeted interventions for those with deleterious germline HHM alleles. Finally, these results argue for germline genetic testing in patients prior to allogeneic HSCT. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Machine learning coupled with group contribution for predicting the density of deep eutectic solvents

Deep Eutectic Solvents (DESs) are a recently introduced class of green solvents with unique and favorable characteristics. Despite their recent debut, the scientific community has begun to place greater emphasis on them as alternatives to ionic liquids (ILs). Knowledge of the various physical properties of DESs is essential for various applications in the chemical industries and related fields. In this study, a comprehensive database including 1410 density data points, from 166 different DESs at various temperatures and atmospheric pressure, were retrieved from open literature to develop models to increase the accuracy of density predictions. The densities of DESs were used to develop two commonly used machine learning models, namely Multilayer Perceptron Artificial Neural Network (MLPANN) and Least Square Support Vector Machine (LSSVM), in conjunction with the group contribution (GC) method. Based on the GC method, each fragment of a compound contributes a specific amount to the physical property's value. By considering this, the prediction ability was improved by applying the GC method in the model development procedure. Both models predict the DES densities by taking into account the effect of 35 functional groups, the temperature, and the HBA/HBD molar ratios. The optimum MLPANN model structure consists of a single hidden layer with five neurons and a logarithmic sigmoid transfer function. By employing this MLPANN-GC model, the values of the squared correlation coefficient, R2, and absolute average relative deviation percent, AARD%, were 0.99 and 0.61%, respectively, while for the LSSVM-GC model (with the radial basis function (RBF) kernel), they were 0.99 and 0.56%, respectively. Also, K-fold cross-validation was used to assess the performance of the LSSVM-GC model. The presented machine learning models in this study were found to perform more accurately than those obtained using the best current correlations and GC models for DES densities in the open literature. The more accurate results, in addition to the enhanced predictability behavior of the developed models, give these models a preference for use in industrial and academic applications.

13 FIGHTING FRAILTY FROM FOUNDATION UP

Abstract Background In 2021 the UK Foundation Programme introduced a new curriculum for UK Foundation Doctors (FDs). For the first time, frailty has been designated as a core learning topic. This means that all FDs are expected to undertake dedicated frailty training. Subsequently, a virtual frailty workshop was developed and delivered by Zoom to all F2 doctors in Northern Ireland. Entitled ‘Taking a Better Approach to the Frailer Adult’, the three hour workshop familiarises FDs with core frailty concepts including Comprehensive Geriatric Assessment (CGA), delirium, and deprescribing. Methods All attendees completed an online survey after workshops. They were asked to provide free text comments about what they felt were the most successful and useful aspects of the workshop. Attendees were also were asked to numerically rate the workshop relevance, handout quality and venue suitability. Results The frailty workshop was delivered to 222 F2 doctors over eight months. On average, attendees rated the relevance of the workshop as 4.8/5. Attendees rated the quality of the handouts and the venue suitability at 4.4/5 and 4.2/5 respectively. Thematic analysis of qualitative feedback on the most successful elements of the workshop showed that attendees found the session to be useful, relevant, and engaging, with particular preference for use of cases. For example, one attendee wrote that, ‘use of cases and breakout rooms to discuss CGA [allowed] us to get a feel of how this applies to patients in clinical settings”. Thematic analysis of qualitative feedback on what could be done to make the workshop better showed attendees had preferences for greater use of cases and smaller breakout rooms. This feedback was used to develop and improve the workshop. Conclusion FDs value teaching on frailty and consider it highly relevant for clinical practice. Frailty education can be delivered successfully in a virtual setting. Junior doctors prefer interactive case based learning, with use of breakout rooms with small numbers of participants in each room.

PATIENT'S OPINION ON THE MAINTENANCE OF THE TELEMEDICINE MODALITY IN THE POST-PANDEMIC TIME

During the COVID -19 pandemic, telemedicine became the most widely used medical care modality. Carrying out a “stay at home” medical consultation was a safe and beneficial way for both, patients and doctors, to maintain health controls. With the end of the pandemic, it is necessary to define whether this tool can continue to be used and how it will be implemented by health institutions. We aimed to determine how patients value telemedicine, and to investigate the reasons that influence the decision to continue using this type of medical care definitively. A mixed-type questionnaire of 17 questions was designed (segmentation and questions about preferences of use, reasons why they use/do not use the tool, predisposition to continue using it) that was distributed to different sectors of society through social networks. The survey was answered by people of both sexes over 16 years of age from 17 provinces of Argentina. All responses were collected using the SurveyMonkey platform and analyzed using calculation programs and statistical tools (Excel, Statistica 8.0) and the results processed using graphic programs (Excel, Power Point, Sigma Plot). A total of 491 responses were obtained, 77.39% were women, mostly between 21 and 40 years old (49.49%). 59.27% stated that they had used telemedicine during the pandemic, valuing the experience on average 4/5. Currently, 47.33% continue to use it, while the remaining 52.67% no longer do so. The reasons why people stopped using this tool were: the social inssurance no longer pays for this type of care (31.39%), the perception of a lower quality of attention when it is done through video calls (21. 9%) and the lack of offer from the doctor or the institution for this type of modality (18.25%). Of all those surveyed, 83.51% stated that they would like telemedicine to be permanently installed. In this sense, 38.48% would be willing to change their clinic or doctor to support the possibility of using telemedicine, and 52.53% would be willing to pay for the consultation outside of their traditional medical coverage (private/private), regardless of the channel used to make it (phone call/video call). Telemedicine represents a valuable tool for communication between patients and doctors. In general, the majority of patients value the experience as positive and express a clear intention to continue using this modality even when face-to-face care is once again allowed. A significant percentage of patients are willing to pay more to obtain this service or even change their doctor and primary institution to maintain it. These data are extremely important when making institutional decisions on how to maintain the continuity of telemedicine and which are the points that should be improved.

Do eHealth literacy and socio-demographics predict patients' preferences for use of eHealth programmes after percutaneous coronary intervention?

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority Background Evidence supports the use of electronic health (eHealth) programmes for patients with coronary artery disease. To date, there has been little attention toward patients’ preferences for the use of eHealth programmes, and their associations with eHealth literacy and socio-demographic factors post percutaneous coronary intervention (PCI). Purpose To determine how eHealth literacy and socio-demographics are associated with patients’ preferences for use of eHealth programmes assessed 12-month post PCI. Methods An observational cohort study recruited 3417 adult patients treated by PCI at three Norwegian and four Danish university hospitals, June 2017-May 2019. Socio-demographic data and self-reported outcomes on eHealth literacy (eHealth literacy scale) were assessed at baseline. De novo questions on preferences for use of eHealth programmes were collected 12-month post PCI. Hierarchical logistic regression models were performed. Results The majority of patients were men (78%), and the mean age was 66 years. Almost 40% were interested in participating in eHealth programmes. The odds of being interested in accessing a webpage with quality ensured information, health applications and online chat function with healthcare providers increased with 2-3% for each point higher eHealth literacy score, which indicates better eHealth literacy. After controlling for age, education and gender (Step 2), eHealth literacy no longer remained a significant predictor for patients’ preferences. Males had 49% higher odds for interest in a webpage with quality ensured information than females. Females had 33-34% higher odds for interest in an online chat function with healthcare providers and an individually tailored text message. The odds for interest in a webpage with quality ensured information, health applications, online chat function with healthcare providers and individually tailored text messages, decreased with 2-5% per year higher age. For individual tailored feedback on email, the odds for interes was 1% higher per year higher age. Educational level above primary school was a robust predictor for the interest in a webpage with quality ensured information (63-240%). Compared to those with primary school education level, those with college/university education had 67% higher odds for interest in short online information videos, 123% higher odds for interest in online chat function with healthcare providers and 61% higher odds for interest in individually tailored feedback on email compared to patients’ whit primary school. Patients with high school and college/university education had 34-57% lower odds for interest in individually tailored text messages than those with primary school. Conclusions Age, educational level and gender were important predictors of patients’ preferences for using eHealth programmes post PCI. These results are important for the further development of personalized eHealth programmes.

Comparison of the properties of the English and Spanish versions of the Patient Satisfaction with Pharmacist Services Questionnaire 2.0

BackgroundPharmacists provide direct patient care services such as chronic disease management and medication therapy management services. Patient satisfaction measures are valuable tools to assess outcomes. Therefore, measuring patient satisfaction with pharmacist services, using tools such as the Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0), is important to ensure service quality. ObjectiveThe objective of the study was to evaluate the descriptive properties and reliability of the original English and newly translated Spanish versions of the PSPSQ 2.0 in a larger sample. MethodsThis project evaluated the functioning of the Spanish translation of the PSPSQ 2.0 compared to the English version. Demographic characteristics were analyzed to determine whether the instrument functioned differently for English- and Spanish-speaking groups. Psychometric properties were analyzed. ResultsCompleted data for both PSPSQ 2.0 versions were available for 337 patients (English, n = 187; Spanish, n = 150) enrolled. In the English data set, no items had a ceiling or a floor effect, while in the Spanish data set, all items had a ceiling effect, but no items had a floor effect. In both the English and Spanish versions, nearly all the items had a strong, positive correlation with one another (greater than 0.30), indicating the measure was unidimensional. The pattern of the estimated loading indicated the items were assigned as expected. The items functioned differently in the English and Spanish instruments, and there was a statistically significant difference in Wald values between the 2 versions (P > 0.05). ConclusionThe PSPSQ 2.0 demonstrated reliability for this setting and population. However, regarding demonstration of validity, the response categories in the instrument seem not to capture the views of the Spanish-speaking respondents. Further work may focus on uncovering the preferences for use of Likert scale response categories by Spanish speakers to ensure greater cultural fidelity in the translation.

Cancer Patients' Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia.

Background: Patients have had their cancer care either postponed or changed to telehealth visits to reduce exposure to COVID-19. However, it is unclear how these changes may have affected their experiences. We aim to identify patient characteristics that affect telehealth experiences and evaluate their preferences for using telehealth in the future. Methods: Patients who completed the Outpatient Cancer Care (OCC) Patient Experience Survey were invited to participate. They comepleted the modified OCC Survey, which focused on telehealth during the pandemic. Linear and logistic regression analyses were used to identify patient characteristics that influenced telehealth experiences and preferences for future telehealth use. Results: Perceived ease of participation in telehealth is a significant predictor of the change in patients’ ratings of their telehealth experience. We found that cancer patients had lower preferences for using telehealth in the future if they were older, female, or non-white; resided in an urban area; had no previous telehealth experience; had lower education; and had poorer mental health. Conclusions: To optimize cancer care and improve equitable access to high-quality telehealth care during the pandemic and beyond, clinicians and policymakers will need to consider patients’ self-reported experiences and their personal characteristics.

P205 Patient preference for different devices for delivery of subcutaneous methotrexate when switching from oral therapy: findings from a pilot study comparing a button-free auto-injector pen and a button-activated auto-injector pen

Abstract Background/Aims Subcutaneous (SC) injection of methotrexate (MTX) can offer advantages when compared to oral MTX in the management of rheumatic diseases such as rheumatoid arthritis (RA). Patient choice is an important factor to consider when initiating new treatments as it may lead to improved compliance. This pilot study evaluated patient preference between two MTX auto-injector pens and the important features that influenced the choice of device. Methods Rheumatology patients making the switch from oral MTX to SC MTX were invited to take part in structured consultation (using a 3-page questionnaire) to discuss their preferences regarding the use of a pre-filled, auto-injector pen. Patients were shown a button-free dummy pen and a button-activated dummy pen and asked to indicate their preference. Patients were asked to rate the relative importance of 7 features of their chosen auto-injector pen on a scale of 1 to 4 where 1 = “not important” and 4 = “very important”. The nurse leading the consultation alternated the order in which the auto-injector pens were presented to minimise bias. Results Thirty patients have switched to SC MTX to date. The majority of patients were female (80%) and aged over 40 years (73%). The majority (60%) had been prescribed MTX for the treatment of rheumatoid arthritis (RA) and been using oral MTX for more than 12 months (60%). The main reasons for switching to SC MTX were concerns about treatment side effects (50%) and/or effectiveness (50%). Twenty-five (83%) patients chose the button-free, auto-injector pen and 4 (13%) chose the button-activated, auto-injector pen. One patient had no preference but decided to use the button-free, auto-injector pen. Twenty-eight (93%) patients ranked “button/no button to press to activate the injection” as important (“important” or “very important”) when choosing. Of these, 22 (79%) indicated a preference for “no button” to activate the injection. Ninety percent of patients ranked a “system of recognition at the start and end of the injection process”, “easy to grip”, and “easy to uncap” as highly important; 84% ranked “visibility/invisibility of the needle” as highly important. Simplicity and ease-of-use were described as the main advantages by those patients choosing the button-free option (n = 25, 52% and 32% respectively). Conclusion The findings of this pilot patient preference study show that ease of use of the auto-injector pen is an important factor when patients are switching from oral MTX to SC MTX. Although multiple features contribute to ease of use, the absence of a button was identified as the most important feature and likely contributed to a greater preference for use of the button-free, auto-injector pen. Disclosure J. Lartey: None.

Utilizing Mediterranean Plants to Remove Contaminants from the Soil Environment: A Short Review

The use of contaminated soils in food production imposes the need for the reduction in heavy metals concentrations, using various techniques, in order to eliminate the toxic effects of pollution and ensure safety in the consumption of agricultural products. Phytoremediation is a promising, effective, and publicly acceptable method to remove soils’ toxicity. This study aims to investigate the current knowledge on plants’ metal tolerance mechanisms, the use of Mediterranean plants in phytoremediation, and the economic perspective for its application on large scales. A total of 166 research studies were systematically reviewed, based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The findings indicate that phytoremediation has more advantages compared to other techniques. It can be a sustainable and affordable option, especially for developing countries, due to the relatively low application and maintenance costs. Many hyperaccumulating plants have been identified that can be used in soil cleansing, enhancing the applicability and replicability of the method. The selection of the appropriate plant species is based on their specific physiological characteristics to remove undesirable elements from the soils and, in certain cases, there is a preference for use of non-native species. However, such species may exhibit invasive behaviors, introducing high uncertainties and risks in the preservation of local ecosystems, especially in the Mediterranean zone, since they can have a serious impact on the environmental and ecological dynamics of the local plant communities. The use of native plants is generally more advantageous since they are better acclimated, have no effects on the local ecological balance, and can eliminate the legal restrictions for their use (seed availability, planting, etc.).

Testing links between unfavorable living conditions, fast life-history strategy adoption, and overeating: a four-wave longitudinal study.

Although overeating increases risk for chronic illness and premature mortality, evolutionary life-history theorists posit that such behaviors arise as a potential outcome of using fast life-history strategies to function in environments that are harsh or unpredictable. To test this premise, we examined links between harsh, unpredictable living conditions (HULC), the adoption of fast life-history (LH) strategies, and overeating among early adolescents using a four-wave longitudinal design. Participants were 2547 Chinese adolescents (1202 girls, 1345 boys) who completed baseline questionnaires assessing experiences of HULC, preferences for use of fast LH strategies, and overeating. Measures were re-administered in follow-ups 7, 13, and 20 months later. Analyses indicated HULC predicted increased use of fast LH strategies within each gender. However, fast LH strategy adoption contributed to increases in overeating only among girls. Findings supported specific tenets of life-history theory and underscored gender as an important consideration in understanding links between living conditions, the adoption of fast LH strategies, and risk for overeating. Interventions focused on reducing poverty and increasing stable, nurturing family, and community environments may aid in reducing overeating and obesity for adolescents.

Crosslinguistic Corpus Studies in Linguistic Typology

Corpus-based studies have become increasingly common in linguistic typology over recent years, amounting to the emergence of a new field that we call corpus-based typology. The core idea of corpus-based typology is to take languages as populations of utterances and to systematically investigate text production across languages in this sense. From a usage-based perspective, investigations of variation and preferences of use are at the core of understanding the distribution of conventionalized structures and their diachronic development across languages. Specific findings of corpus-based typological studies pertain to universals of text production, for example, in prosodic partitioning; to cognitive biases constraining diverse patterns of use, for example, in constituent order; and to correlations of diverse patterns of use with language-specific structures and conventions. We also consider remaining challenges for corpus-based typology, in particular the development of crosslinguistically more representative corpora that include spoken (or signed) texts, and its vast potential in the future.

Towards integrating quality in theoretical models of acceptance: An extended proposed model applied to e‐learning services

AbstractThe use of e‐learning services is growing in different contexts, especially in the COVID‐19 pandemic. This study aims to examine students’ acceptance of and intention to use Learning Management Systems (LMSs) for university education in Brazil using the extended technology acceptance model, unified theory of acceptance and use of technology (UTAUT), integrating quality construct adapted from the Service Quality Evaluation Model (ServQual). Examining a large sample (n = 1237) of students in Brazil through questionnaires, we investigate the behaviour of the users concerning the factors that influence the technology acceptance and the intention of the use in an e‐learning system. Results show that intention to use an LMS is affected by the facilitating conditions (skilful, workable and easy to use), social influence (remarkable, preference for use and relevance), habit (routine, enjoyable and entertaining) and quality (reliable, tangibility, responsiveness and assurance), but not for effort expectancy (agility, knowledge and productivity). Our research findings suggest fostering replicate the model in different universities and countries understanding potential differences. Practitioner notesWhat is already known about this topic E‐learning is growing, and its success is directly related to students’ intention and retention of users. Unified theory of acceptance and use of technology (UTAUT) is an approved model that explains new system adoption and use. There are several tools to evaluate the quality of e‐learning. ServQual is an approved model that explains the perceived quality service. What this paper adds The results of this research proved that facility conditions, social influence, habit and quality were the key and fundamental characteristics of Learning Management Systems. This paper provides advice for decision makers in universities who want to integrate quality in Learning Management Systems. A new validated model extending the UTAUT and ServQual models applied for acceptance, adoptions and use intention for e‐learning services. E‐learning resources should include quality content beyond technology facilities to increase students’ adoption and use intention successfully. Implications for practice and/or policy The paper concludes with advice for decision makers in universities who want to implement or maintain an e‐learning programme. Managers must pay attention not only to the Learning Management Systems’ information technology attributes (eg, ease of use of the systems, fast access, speed of access and navigation of the systems, training, etc) but also to how to improve quality in e‐learning resources like manuals, an online FAQ, forums, professor support to strengthen the acceptance and e‐learning adoption. Facility conditions, social influence, habit and quality are important constructs that support students’ Learning Management System use intention.

Perspectives on Telemedicine from a National Study of Youth in the United States

Introduction: Telemedicine is increasingly popular with the recent surge in use due to the COVID-19 pandemic. Despite youth status as "tech natives," limited data are available on their perspectives on telemedicine. Our study seeks to understand youth telemedicine knowledge, prior experiences, preferences for use, and the impact of COVID-19 on these perspectives. Methods: Participants in MyVoice, a national text message cohort of U.S. youth age 14-24, were sent five open-ended questions in October 2019 and October 2020. A codebook was iteratively developed by using inductive analysis. Responses were independently coded by two investigators, with discrepancies resolved by discussion or a third investigator. Results: Sixty-five percent (836/1,283) and 77% (887/1,129) of participants responded to at least 1 question in 2019 and 2020, respectively. Most youth reported awareness of telemedicine and although many have not used it, COVID-19 has increased use. Further, many are willing to try telemedicine services. Most youth noted a preference for video rather than phone visits, but they believe both to be less effective than in person. Youth also reported varied preferences on services best suited for telemedicine, with COVID-19 positively impacting their views. Discussion: Youth are aware of and willing to use telemedicine services, with many reporting use during the COVID-19 pandemic. Youth are willing to accept a wide variety of telemedicine services, though they still desire in-person options. Health systems and clinics should offer a wide range of services via telemedicine to fit the varying needs of youth both during and after the COVID-19 pandemic.

Persistence of statin treatment – the impact of analytic method when estimating drug survival

Background: There is ample evidence for several pharmaceutical treatments that adherence in terms oftreatment duration and dose is suboptimal. The actual drug intake cannot be observed directly in prescriptiondatabases, which only register drug redeemed and a limited number of patient characteristics. Consequently,the actual dose and duration of treatment must be inferred from observed redemptions. Persistence can thenbe expressed as treatment duration (also referred to as drug survival).Method: We used data from the Norwegian Prescription Database (NorPD) on redemptions of statins (ATCcodeC10AA) for the period 2010-2019 to explore three methods for determining prescription durations andin turn persistence (treatment duration): (i) The DDD-method using the number of DDD redeemed; (ii) Thedose-unit approach using the number of tablets redeemed; (iii) The reverse waiting time distribution method(WTD), which estimates prescription duration as the 90th percentile of the distribution within which patientsin ongoing treatment will have a new subsequent redemption. The three methods for estimating prescriptionduration were then used to estimate treatment duration using Kaplan Meier (KM) survival functions. For theDDD-method and the dose-unit approach we conducted sensitivity analyses assuming that one DDD or onetablet would last for 1.00, 1.25 or 2.00 days. We also tested the impact of grace periods in sensitivity analyses.Results: Treatment duration and drug survival varied substantially for the same patients depending on thechosen method, duration of a DDD or a tablet, and inclusion of grace periods. The 25th percentile of treatmentduration was 100 days for the DDD approach with one DDD per day, 100 days with the dose-unit approachwith one tablet per day and 453 days with the WTD approach.Conclusion: When estimating treatment duration from prescription databases one should be aware that thesemeasures of persistence are highly influenced by the chosen methodology. The choice of method should beinformed by the clinical context with a preference for use of methods based on a formal model.

224. Utilization of an automated SMS-based electronic patient-reported outcome tool in spinal surgery patients

<h3>BACKGROUND CONTEXT</h3> Recent evidence suggests that collecting and tracking patient-reported outcomes (PROs) are correlated with improved patient quality of life, patient satisfaction and physician-patient communication. With the ongoing shift in the health care industry to value-based care, more emphasis is placed on patient-reported measures as well as clinical outcomes and cost reduction methods. Typically, PROs are collected via paper forms, but this method has been shown to be difficult to incorporate and a burden on clinical staff and patients. The literature is scarce regarding the value of using electronic Patient Reported Outcome (ePRO) systems in nonclinical trial settings, and much of the existing literature focuses on phone applications that require installation. We sought to assess the usability of an automated app-less SMS-based electronic tool to collect spine PROs. <h3>PURPOSE</h3> To assess the feasibility of implementing an automated SMS-based electronic Patient Reported Outcome (ePRO) tool for clinical outcome assessment in spinal surgery patients. <h3>STUDY DESIGN/SETTING</h3> Patients receiving the SMS HIPAA-compliant survey link were prospectively enrolled in the ePRO tool's administrative web portal from June 1, 2020, to October 1, 2020. Outcome data for patients receiving either the SMS or paper survey was retrospectively analyzed. <h3>PATIENT SAMPLE</h3> A total of 204 patients were included in this study. Group1 included 88 patients who underwent either a microdiscectomy (9), lumbar fusion (42), or anterior cervical fusion (37) from June 1, 2020, to October 1, 2020, and were sent an outcome survey via a SMS HIPAA-compliant link. Group 2 included 116 patients who received either a microdiscectomy (14), lumbar fusion (69) or anterior cervical fusion (34) from November 1, 2019 to March 1, 2020, and were administered an in-office paper outcome survey. <h3>OUTCOME MEASURES</h3> Two outcomes were investigated in this study: survey compliance rate (response rate) and total mean time required for patient outcome assessment (includes mean survey response time and mean staff administration time). <h3>METHODS</h3> A total of 88 patients undergoing microdiscectomies (9), lumbar fusions (42), and anterior cervical fusions (37) from June 1, 2020, to October 1, 2020 were prospectively enrolled in the tool's administrative web portal. Patients received automated outcome assessment surveys via a HIPAA-compliant SMS link at 1 week, 1 month, and 3 months post-surgery. Once the patient clicked on the SMS link, they were led to a secure web browser in which they were able to complete the survey. All survey responses were captured in a secure web portal which allowed physicians and associated staff to view responses. Prior to the application of the ePRO tool, outcome information was collected at the aforementioned timepoints via paper for 116 patients who received microdiscectomies (14), lumbar fusions (69) and anterior cervical fusions (34) from November 1, 2019 to March 1, 2020. In this study, compliance rate and the mean time required for outcome assessment were compared between patients receiving SMS surveys and patients receiving paper surveys. Both groups of patients (SMS vs paper) had analogous demographic, medical history, and surgical characteristics. Data analysis was conducted in SPSS 20.0 (SPSS, Inc. Chicago, IL) and included one-way ANOVAs and two-tailed t-tests. <h3>RESULTS</h3> The PRO data capture rate was 52% with SMS surveys (146/279) and 26% (94/356) with paper surveys (p < 0.05). The total mean time associated with capturing outcomes via SMS surveys (19 hours) was one-third of the time associated with the paper survey method (57 hours) (p < 0.05). Use of the ePRO tool resulted in a reduction in both the mean survey completion time (SMS: 5 minutes, paper: 7.5 minutes) and mean administration time spent by staff on each patient (SMS: 5 minutes, Paper: 17 minutes). Minimal time effort was required from staff after initial patient enrollment. A survey assessing usability was administered to clinical staff (n=10) and patients (n=88); all staff and patients indicated a preference for use of the ePRO tool compared to the in-office paper survey. <h3>CONCLUSIONS</h3> Initial results indicate that implementation of an app-less SMS-based ePRO tool in a spine practice setting is feasible and mutually beneficial to patients and providers. SMS survey administration of PROs for spine surgery patients increased the capture rate of clinical outcomes, allowed for data collection in the absence of an office visit, and decreased the total mean time associated with PRO collection. The ePRO tool allowed for large-scale and timely data collection, and we believe use of such a tool can potentially facilitate early detection of patient issues and complications. Future studies would benefit by examining the value of using such a tool to identify patient complications in a timely manner. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Maternal Preferences for Approach and Language Use During Antenatal Counseling at Extreme Prematurity: A Pilot Study

Introduction: Counseling families at risk for extremely preterm birth presents significant challenges to providers due to the uncertainty of infant outcomes. Aim: To determine lay-public parental preferences for approaches to prenatal counseling and preferred descriptive terminology usage by providers when discussing an anticipated extremely preterm delivery. Methods: This exploratory pilot study recruited parents through social media to participate in a survey centered around a hypothetical delivery at 23 weeks. Questions assessed participants’ understanding of medical terminology and preferences for terminology, discussion topics, and approaches to decision-making related to anticipated extremely preterm birth. Results: A total of 142 (72%) parents participated. Understanding of medical compared with nonmedical terminology was limited ( P &lt; .01). Parents had stronger preferences for the use of certain words and terminology over others. They preferred discussions focused on the possibility of infant survival and information about intensive care, over general statistics, and outcome percentages. Most would choose attempted stabilization and neonatal intensive care unit care in this hypothetical case. Discussion/Conclusions: Parents have preferences regarding physician communication and approaches to decision-making around extremely preterm delivery, which may offer guidance to providers during counseling.

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment.

ObjectiveVirtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.MethodsPrevious research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.ResultsSixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation.ConclusionsThis conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

924-P: A Latent Class Analysis of Adolescent Preferences on Social Media Use by Diabetes Care Teams to Support Type 1 Diabetes Management

Objective: To identify latent classes of adolescents with type 1 diabetes (T1D) based on their interest in receiving diabetes management support from their diabetes care team via social media (SM). Methods: 227 adolescents with T1D (13-18 years old) in Seattle, WA completed a survey about their interest in communicating with their care team over SM. Latent class analysis was used to identify latent groups based on their stated preferences. Results: A 3-class solution was identified that minimized AIC (2042.1), BIC (2131.1), and maximized entropy (0.88) and the value of log-likelihood (-995.0). Over half the sample (n=114, 50.2%) belonged to Class 1, which was defined by a positive view of using SM to support diabetes management and a strong preference for using direct messaging options to communicate over social media (see Figure). Adolescents in Class 2 (n=47, 20.7%) had a similar outlook with respect to impact on communication but reported a preference for private social media communication options. Class 3 (n=66, 29.1%) accounted for adolescents not interested in communicating over SM. Conclusions: The majority of adolescents with T1D endorsed the use of SM communication tools to support diabetes management. Findings from this latent class analysis can be used to provide tailored strategies to meet adolescent preferences for SM use with the diabetes care team. Disclosure F. Malik: None. A. M. Ellyson: None. D. Christakis: None. R. Mangione-smith: None. C. Pihoker: None. M. A. Moreno: None. Funding National Institutes of Health (K23DK119465)

PCN35 Systematic and Structured Reviews of the Disease Burden in Patients with Microsatellite Instability High (MSI-H) or Mismatch Repair Deficient (DMMR) Colorectal Cancer (CRC)

Literature reviews were undertaken to assess global disease burden of MSI-H/dMMR CRC Medline®, Embase®, Cochrane, EconLit, CRD York databases and select conferences were searched for studies reporting burden of MSI-H/dMMR CRC globally. Evidence was searched during 2009-19 (economic burden) and 2014-19 (epidemiology, treatment patterns and humanistic burden). Of 41,296 records screened - epidemiology (N=41), economic (N=2) humanistic burden (N=2) and treatment patterns (N=4) studies were reported for MSI-H/dMMR CRC. Included evidence showed prevalence of MSI-H/dMMR CRC ranged from 5.8% to 22% across disease stages with rates higher in earlier stages, >50 years of age, females, and Caucasians. Three country-specific real world studies reported common use of 5-FU- based treatments with either irinotecan, or oxaliplatin and with or without an EGFR or VEGF inhibitor for 1L MSI-H CRC. In response to a 2018 survey of global healthcare practitioners on their intended treatment plan for various case scenarios, 43%(1st line), 62%(2nd line) and 54%(3rd line) indicated preference for use of an immune checkpoint inhibitor. In a single institution, non-randomized study of 5-FU-treated patients, overall symptom burden (OR 2.48; 95% CI, 1.29-4.74) pain (3.06 [1.61-5.84]), fatigue (2.78 [1.41-5.49]), sleep (2.52 [1.32-4.08]); and drowsiness (2.51 [1.32-4.78]) was greater among those with MSI-H versus microsatellite stable tumors. Published evidence on the disease burden of MSI-H/dMMR CRC is sparse. Given the recent approvals and increased clinical development of immune checkpoint inhibitors in this high unmet need area, real-world and economic studies could further help to assess the disease burden.

Patient preferences for using technology in communication about symptoms post hospital discharge

BackgroundTechnology is increasingly transforming the way we interact with others and undertake activities in our daily lives. The healthcare setting has, however, not yet realised the potential of technology solutions to facilitate communication between patients and healthcare providers. While the procedural and policy requirements of healthcare systems will ultimately drive such solutions, understanding the preferences and attitudes of patients is essential to ensure that technology implemented in the healthcare setting facilitates communication in safe, acceptable, and appropriate ways. Therefore, the purpose of this study was to examine patient preferences for using technology to communicate with health service providers about symptoms experienced following discharge from the hospital.MethodsPrimary data were collected from patients admitted to a large metropolitan hospital in Australia during three consecutive months in 2018. Participants were asked about their daily use of technology including use of computers, email, phone, text messaging, mobile applications, social media, online discussion forums, and videoconference. They were then asked about their use of technologies in managing their health, and preferences for use when communicating about symptoms with health service providers following discharge from hospital.ResultsFive hundred and twenty-five patients with a wide range of differing clinical conditions and demographics participated. Patients indicated they used a range of technologies in their everyday lives and to manage their health. Almost 60% of patients would prefer to return to hospital if they were experiencing symptoms of concern. However, if patients experienced symptoms that were not of concern, over 60% would prefer to communicate with the hospital via telephone or using technology. Admitting condition, income, and age were significantly associated with preferences for communication about symptoms following hospital discharge.ConclusionsPatients have varied preferences for communicating with their health service providers post-hospital discharge. Findings suggest that some, but not all patients, would prefer to use technology to traditional methods of communicating with the healthcare team. Health services should offer patients multiple options for communicating about their recovery to ensure individual needs are appropriately met.