Real Utilization Research Articles

Real World Utilization of a Mobile Application-Based Bowel Preparation on Quality Indicators in Colonoscopy

Introduction: Adequate bowel preparation for colorectal cancer (CRC) screening can be challenging in direct-to-procedure colonoscopy due to barriers with patient engagement and communication, which can negatively impact colonoscopy quality indicators. With widespread use of smart phones, mobile delivery of prep instructions has potential to improve the patient experience and colonoscopy outcomes. Our study aimed to assess whether the use of a mobile application to disseminate bowel prep instructions influenced patient satisfaction and quality indicators for colonoscopy. Methods: An IRB-approved prospective pilot study of Twistle mobile application was conducted at our outpatient surgical center from October 2017 to January 2018. Patients scheduled to undergo a direct-to-procedure colonoscopy for CRC screening were eligible for enrollment. Patient demographics and procedural outcomes were collected including quality of prep, cecal intubation time, scope withdrawal time, and number of polyps or adenomas detected. Patients were matched 1:1 to historical controls that received standard mailed prep instructions as a comparison group. Patients that used Twistle were asked to complete a 5-question telephone survey after their colonoscopy to assess satisfaction. Results: 133 eligible patients were contacted by phone call (n = 80; 60.2%) or invitational letter (n = 53, 39.8%) to receive bowel prep instructions via Twistle (Figure 1). 12 patients, mean age 55.2 years, completed colonoscopy prep utilizing Twistle and a post-procedure satisfaction survey (response rate = 9.0%). No statistically significant differences were demonstrated on any procedure-related parameters between those using Twistle or mailed bowel prep instructions (Table 1). A post-procedure telephone survey revealed 91.7% (n = 11) of patients considered the Twistle application easy to follow, and 83.3% (n = 10) indicated they were “very satisfied” and would be very likely to utilize again for a future colonoscopy procedure (Table 2).253_A Figure 1 No Caption available.Conclusion: In this pilot study, we have demonstrated real-world challenges of implementing a mobile application-based bowel prep program for direct colonoscopy referrals in a large academic setting. Despite a low utilization rate, patients who completed bowel prep using Twistle reported high satisfaction. Further studies are needed to evaluate the role of a mobile application-based bowel prep and to develop improved processes to successfully integrate these tools into routine practice.253_B Figure 2 No Caption available.253_C Figure 3 No Caption available.

PHP20 - Prescription Drug Use Monitoring to Check for Appropriate Use of Medicines in Korea vs. Japan and Taiwan

Prescription drug use monitoring to check for appropriate use of medicines is to ensure patients to receive appropriate medications for their clinical needs and to be safe from over/under-utilization of medications. This study aimed to compare the drug use monitoring policy between three Asian countries of Korea, Japan and Taiwan. Focusing on real-time drug use monitoring system and incentive/disincentive program for appropriate use of medicines, this study compared three Asian countries (Korea, Japan and Taiwan) based on a review of the literature (Database: Pubmed, Google Scholar, Respective institutional reports written in Korean, Japanese and English). Some sort of a real-time monitoring system is in place in all three countries. Japan collects patients’ drug records and allows physicians to review them for appropriate use. Taiwan has introduced Pharma Cloud in 2014 in order to let physicians access patients’ prescription records for prevention of overuse of medicines including duplicate prescriptions. Korea has implemented a real time drug utilization review (DUR) system to monitor for duplicate prescriptions and contraindicated combination drug therapy. Japan in 2016 has provided clinicians some incentives in place to monitor for polypharmacy. Taiwanese National Health Insurance Administration (NHIA) monitors for excessive prescribing/polypharmacy in drug therapy management of chronic diseases. NHIA adjusts medical reimbursement when physicians do not improve medication overuse. Korea in 2012 has implemented an incentive program for clinicians as well as for patients on drug therapy management of chronic diseases. Each country has a real-time drug use monitoring system and incentive/disincentive program in place to check for appropriate use of medicines. The real-time DUR system of Korea needs to include patients’ health records so that physicians’ prescribing practices improve in quality. Incentive program in Korea needs to relate effectively with quality evaluation.

Real-Time Facial Features Detection from Low Resolution Thermal Images with Deep Classification Models

Deep networks have already shown a spectacular success for object classification and detection for various applications from everyday use cases to advanced medical problems. The main advantage of the classification models over the detection models is less time and effort needed for dataset preparation, because classification networks do not require bounding box annotations, but labels at the image level only. Yet, after passing the image through a stack of convolutions followed by stride and pooling operations the full image is reduced into a single vector of class probabilities and the spatial arrangement of pixels is completely lost. Our proposed approach shows how to localize objects by restoring the spatial information about features distribution from the classification network. The presented modifications of architecture are limited to the inference phase only. As a result, we are able to combine the simplicity and short time required for dataset preparation with the results similar to the output from the detection model. Additionally, we showcased that it is possible to repurpose the existing network, originally trained on RGB images, to a novel task of facial features detection from low resolution thermal images, while preserving the high precision (>99%). The proposed facial features detection system can be potentially combined with wearable devices that will collect data and send it to the server for more computationally expensive analysis, e.g., calculation of the respiratory rate form the detected nostril area. Real time performance and small resource utilization proved that the presented approach can be used to serve multiple patients without any impact on the latency, e.g., as a centralized monitoring station for the home healthcare. The combination of wearable devices with machine learning algorithms run on the remote and more powerful platforms could revolutionize the practice of medicine by delivering healthcare to patients anywhere in the world.

Residual compensation extreme learning machine for regression

Abstract Extreme learning machine (ELM) was proposed for training single hidden layer feedforward neural networks (SLFNs), and can provide an efficient learning solution for regression problem. However, the prediction error of ELM is unavoidable due to its limited modeling capability, and the nonlinear and stochastic nature of the regression problem. In this paper, a novel ELM, residual compensation ELM (RC-ELM), is proposed for regression problem by employing a multilayer structure with the baseline layer for building the feature mapping between the input and the output, and the other layers for residual compensation layer by layer iteratively. Two real world applications, device-free localization (DFL) and gas utilization ratio (GUR) prediction in blast furnace, are used for experimental testing of the proposed RC-ELM. Experimental results show that RC-ELM has better generalization performance and robustness than other machine learning approaches, including the classic ELM, weighted K-nearest neighbor (WKNN), support vector machine (SVM), and back propagation neural network (BPNN).

Real world survival rates and healthcare utilization among SEER-Medicare patients treated with hematopoietic stem cell transplant (HSCT) for relapsed/refractory diffuse large b-cell lymphoma (RR-DLBCL).

e19502Background: Few elderly patients with RR-DLBCL are offered HSCT and little is known about their overall survival (OS) rates or economic burden. This study evaluated OS rates and healthcare re...

Studies on energy consumption of crude oil pipeline transportation process based on the unavoidable exergy loss rate

In order to ensure the crude oil pipeline process smoothly, the driving force has a certain exergy loss. Based on the exergy analysis method, according to the required minimum potential difference of pipeline transportation, the unavoidable exergy loss is defined in the process. In order to reflect the real effective utilization degree of energy consumption, the unavoidable exergy loss rate is put forward as the evaluation index. And it is calculated by the ratio of related the unavoidable exergy loss and the exergy loss. The crude oil pipeline exergy loss rate is calculated under different conditions. The orthogonal experiment analysis used to compare the influence degree of different operating parameters on the pipeline unavoidable exergy loss rate show that the influence degree on the unavoidable exergy loss rate in turn is: outbound temperature, flow and outbound pressure. It also provide the reference for the energy-saving transportation of crude oil pipeline.

Comparative Effects of the Application of Prilled Urea and Urea Supergranules on Flooded Rice in Madagascar

Applying urea supergranules to flooded rice (10 cm deep, 3 weeks after transplantation) is associated with yield increases of 17%, 23%, 22% and 16% (for doses of 27, 54, 81 and 108 units of nitrogen per hectare) compared with prilled urea. Nitrogen-15 can be used to establish the real nitrogen utilization coefficients for the aerial parts of the plant. While the figures are very low for prilled urea (between 4% and 9%), they exceed 25% and 38% for supergranules on the sites studied. The effect of fertilizer form is greater than the dosage factor. The results are discussed in terms of apparent utilization coefficients and mechanism used.

Alternative za izlazak iz zone gubitka srednjih poljoprivrednih preduzeća u Republici Srbiji

The research objective is to identify causes and alternatives for exiting the loss zone for agricultural enterprises in Serbia. The subject of the research is financial performance of agricultural enterprises in 2010-2014. Economic and financial power of all mediumsized agricultural enterprises was determined by applying financial analysis. Based on the sample of least successful entities, the causes and alternatives for exiting the loss zone were identified. The results show that loss appears due to a reduction in operating income or in contribution margin, or due to an increase in financial expenses. The first suggested alternative refers to increasing the volume of production and sales at current global price parity, while the second assumes shifting global price parity in favour of sales prices at current real capacity utilization rate. The effects of proposed alternatives are evaluated by two measures of profitability - return on assets and return on equity.

Price and Assortment Optimization for Reusable Resources

We develop techniques for price and assortment optimization in systems of reusable resources with heterogeneous customer preferences when customer arrival rates vary over time. Our results are applicable in both the case of a finite-time horizon and an infinite time horizon in which customer arrival rates vary periodically. In the assortment-only setting we develop a randomized policy attaining a constant-factor guarantee with respect to the optimal dynamic policy. Our proposed algorithm is computationally feasible and allows an operator to trade-off between theoretical guarantees and computational effort. We extend these results to the joint pricing and assortment problem however we also demonstrate that computing these policies can be computationally challenging in general. Despite this we demonstrate techniques to develop joint pricing and assortment strategies in practically relevant special cases. We further propose dynamic policies that in contrast to a greedy policy effective account for the value of resources over time. Our computational experiments based on real world parking bay utilization, demonstrate the importance of accounting for this value in making operational decisions.

OssERvare Project: direct observation of use of the Safety Surgery CheckList in the operating room.

Safety Surgery CheckList (SSCL) is a support tool for operating teams, used to carry out safety checks while also encouraging compliance with the implementation of recommended quality and safety standards. In Emilia-Romagna it was deemed appropriate to check actual surgical team compliance with correct checklist application in the operating theatre, through a project called "OssERvare". Direct observation was identified as the preferred inspection method. With the use of special report sheets, observers proceeded with the guided observation of behaviour in the operating room, recording any inconsistencies with correct SSCL use methods. The project began in January 2017 and all observations were carried out from 1st January-15th April 2017. In 43% of observed operation sign in, all three team members were not present, whereas in 7% of observed cases, sign out was not carried out. All three team members were present in 88% of observed operation time out. There are two evidently critical phases: sign in and sign out. Results obtained for time out were better. Compliance data collected from observations differed markedly from reported compliance in administrative flow records. The results of the observational study indicate that the SSCL is not properly filled in many times; there is also a great possibility to improve the correct use of this tool. In conclusion, we think that the combined approach of use of administrative data and assessing compliance appeared to be a useful instrument to investigate the implementation and to promote the real utilization of safety tools such as the SSCL.

TCT-234 Trends Of Access And Operative Volume Of Transcatheter Aortic Valve Replacement In The Unites States- Descriptive Analysis

Transfemoral (TF) and transapical (TA) approaches are the two most common routs for transcatheter aortic valve replacement (TAVR). There is little known about the real world utilization of these approaches and their in-hospital clinical outcomes. Patients who underwent TAVR (n=40900) between 2012

1129P - Real world treatment costs and resource utilization among patients with metastatic bladder cancer

1129P - Real world treatment costs and resource utilization among patients with metastatic bladder cancer

Self managed virtual machine scheduling in Cloud systems

In Cloud systems, Virtual Machines (VMs) are scheduled to hosts according to their instant resource usage (e.g. to hosts with most available RAM) without considering their overall and long-term utilization. Also, in many cases, the scheduling and placement processes are computational expensive and affect performance of deployed VMs. In this work, we present a Cloud VM scheduling algorithm that takes into account already running VM resource usage over time by analyzing past VM utilization levels in order to schedule VMs by optimizing performance. We observe that Cloud management processes, like VM placement, affect already deployed systems (for example this could involve throughput drop in a database cluster), so we aim to minimize such performance degradation. Moreover, overloaded VMs tend to steal resources (e.g. CPU) from neighbouring VMs, so our work maximizes VMs real CPU utilization. Based on these, we provide an experimental analysis to compare our solution with traditional schedulers used in OpenStack by exploring the behaviour of different NoSQL (MongoDB, Apache Cassandra and Elasticsearch). The results show that our solution refines traditional instant-based physical machine selection as it learns the system behaviour as well as it adapts over time. The analysis is prosperous as for the selected setting we approximately minimize performance degradation by 19% and we maximize CPU real time by 2% when using real world workloads.

Real world treatment utilization and outcomes of patients with metastatic bladder cancer by cisplatin eligibility in U.S. community oncology practice.

e16016 Background: Cisplatin(cis)-based therapy is standard first-line (1L) treatment for patients (pts) with metastatic bladder cancer (mBC). Many pts are cis-ineligible mostly due to reduced renal function (creatinine clearance (CrCl) < 60) or ECOG PS of 2 or greater (ECOG2+). Methods: We retrospectively identified mBC pts treated from Jan 2010 – June 2014 fromelectronic health records of McKesson Specialty Health/US Oncology, with follow-up through July 2016. Cis-ineligibility was identified using a consensus-based algorithm (pts with CrCl < 60 and/or ECOG2+ classified cis-ineligible). Results: 1155 pts received 1L treatment; median age 72 yrs (range 26-90+). The most common 1L regimens were cis/gemcitabine (gem) (26.8%), carboplatin (carbo)/gem (26.5%), carbo/paclitaxel (8.9%), and gem alone (8.3%). Among all pts, 55.2% were cis-ineligible. Cis-ineligible pts were older (mean 74.4 yrs vs 66.5 yrs; p < 0.0001). 48.7% of eligible pts did not receive cis, and 25.4% of cis-ineligible pts received cis-based therapy. Interestingly, among 1L cis/gem pts, 34.5 % had CrCl < 60 and 11.5% had ECOG2+. Median (95% CI) overall survival (OS) was affected by cis-eligibility and by 1L cis receipt as follows: eligible/received cis, 17.6 mos (15.1-23.6); eligible/no cis, 14.6 mos (11.5-16.7); ineligible/received cis, 13.4 mos (10.6-16.8); ineligible/no cis, 9.5 mos (8.2-11.4); (p < 0.0001). Conclusions: To date, this is the largest reported cohort of real-world mBC pts. Both cis-eligibility classification and 1L cis receipt were associated with longer OS, and both were approximately equivalent and additive in their magnitude of effect. Most pts were cis-ineligible; nonetheless, cis was used in one fourth of all cis-ineligible pts despite their classification. Cis-ineligible pts have high unmet medical need given their inferior survival.

An observational study of patients with advanced melanoma receiving pembrolizumab in a real-world U.S. community oncology practice.

e21015 Background: PD-1 monoclonal antibodies are promising immunotherapies approved for treatment of patients (pts) with advanced melanoma. As the first US FDA approved PD-1 antibody, pembrolizumab (pembro) has demonstrated efficacy and safety in clinical trial settings. However, patterns of real world utilization and pt outcomes associated with pembro are limited. Methods: Adult pts with advanced melanoma who initiated pembro between 9/1/ 2014-3/31/2016 were identified retrospectively fromelectronic health records (EHR) of McKesson Specialty Health and followed through 9/ 30/2016. Pts in clinical trials were excluded. Demographic, disease, treatment characteristics and reasons for treatment discontinuation of pembro were abstracted from structured data elements of the EHR with further supplementation of unstructured data within the patient chart (progress notes, radiology scan reports). Overall survival (OS) and physician-reported progression free survival (PFS) from pembro initiation were analyzed using Kaplan Meier analysis. Results: 182 pts, with a median follow-up of 9.9 mos (range = 0.0-25.0), were included. Median age at pembro initiation was 66.0 yrs; 30.8% had an elevated lactate dehydrogenase (LDH); 23.6% had brain metastases and 65.4% had an ECOG performance status of 0 or 1. The most common reason for pembro discontinuation was progression (45.5%) followed by treatment-related toxicity (24.4%). In the overall population, median PFS from pembro initiation was 4.2 mos (95% CI = 3.2-5.3). Median OS was 19.4 mos (14.0-NR) with 12 and 24-month survival probabilities of 61.4% (95% CI = 53.4-68.5) and 43.9% (95% CI = 31.1-55.9). In multivariable analyses, characteristics predictive of worse survival included receipt of pembro at a later line of therapy (HR = 3.36, p = 0.0013 for 3L+), presence of brain metastases (HR = 2.67, p = 0.0007) and elevated LDH (HR = 4.10, p < 0.0001). Conclusions: The study results are consistent with those from pembro clinical trials (KeyNote001) and are in support of the effectiveness of pembro in real world treatment of advanced melanoma. Presence of brain metastases, elevated LDH, and use of pembro 3L+ were associated with worse survival outcome.

A secure cloud-assisted urban data sharing framework for ubiquitous-cities

With the accelerated process of urbanization, more and more people tend to live in cities. In order to deal with the big data that are generated by citizens and public city departments, new information and communication technologies are utilized to process the urban data, which makes it more easier to manage. Cloud computing is a novel computation technology. After cloud computing was commercialized, there have been lot of cloud-based applications. Since the cloud service is provided by the third party, the cloud is semi-trusted. Due to the features of cloud computing, there are many security issues in cloud computing. Attribute-based encryption (ABE) is a promising cryptography technique which can be used in the cloud to solve many security issues. In this paper, we propose a framework for urban data sharing by exploiting the attribute-based cryptography. In order to fit the real world ubiquitous-cities utilization, we extend our scheme to support dynamic operations. In particular, from the part of performance analysis, it can be concluded that our scheme is secure and can resist possible attacks. Moreover, experimental results and comparisons show that our scheme is more efficient in terms of computation.

Sa1479 - 3 Times Higher Healthcare Cost in Chronic Hepatitis B Patients Compared to Non-Chronic Hepatitis B Controls Especially Those with Decompensated Liver Disease: United States Real World Healthcare Utilization and Cost Analysis

Sa1479 - 3 Times Higher Healthcare Cost in Chronic Hepatitis B Patients Compared to Non-Chronic Hepatitis B Controls Especially Those with Decompensated Liver Disease: United States Real World Healthcare Utilization and Cost Analysis

Economic Evaluation of Unused Space PV System Using the RETScreen Model - A Case Study of Busan, Gangseo-gu -

Recently, There has been much discussed about unused space. This space can be used in a variety of ways. Utilizing it as a facility, craft shop, and utilizing renewable energy generation facilities. Especially, in terms of climate change should be supplied renewable energy. Renewable energy needs to be developed in terms of responding to climate change, and the recent Paris agreement is also emphasizing the importance of renewable energy. In particular, renewable energy needs to be widely disseminated. And renewable energy is limited space. In this regard, idle land can provide opportunities for securing new renewable energy generation facilities. The introduction of new and renewable energy facilities in idle space can enhance the self-sufficiency rate of the local community, which is significant in terms of responding to climate. In this study, to investigate the possibility of utilizing a unused space for a photovoltaic power generation facility, we investigated the amount of electricity which could be generated through photovoltaic power generation, and the economic effects, using a RETScreen model. The results showed that 9,738 MWh of power can be generated and that 4,540 tCO2eqcan be saved. Regarding the economic effect, the net present value of the facility was shown to be 2,247,389,020 KRW. As the net present value was shown to be positive, we believe that the installation of a photovoltaic power generation facility in an unused space would have a positive economic effect. We found the net present value following the fluctuation of the SMP price to be positive, though there was some variation. However, as the economic efficiency was shown to be low because the net present value in relation to the maintenance costs was negative, we believe that maintenance costs must be taken fully into account when evaluating economic efficiency. In particular, as subsidies can be used to cover maintenance costs which must be factored into photovoltaic power generation, we believe that photovoltaic power generation can have an economic effect. Because spaces not currently in use can have a positive economic effect as renewable energy power generation facilities, and can also contribute to the reduction of greenhouse gas emissions, unused spaces are thought to greatly help local governments to cope with climate change as well as reinforcing their related capabilities. We believe our study will help local governments with decisions relating to unused real estate utilization in the future.

Real world utilization and impact of the wearable cardioverter-defibrillator in a community setting

IntroductionThe wearable cardioverter-defibrillator (WCD) is used in patients at risk for sudden cardiac death (SCD) but not immediate candidates for intracardiac defibrillator (ICD) implantation. MethodsWe performed a single center retrospective study of patients prescribed WCD upon hospital discharge from January 2002 to October 2015. Clinical characteristics were obtained from the hospital electronic database and device data from Zoll LifeVest database. ResultsOf 140 patients, 62% were men, 85.9% were African-American and mean age was 58.2 ± 15.5 years. Ischemic cardiomyopathy was present in 45 (32%) and non-ischemic cardiomyopathy in 64 patients (46%). Mean left ventricular ejection fraction (EF) was 0.28 ± 0.4. WCD was worn for 7657 patient-days (21 patient-years), with each patient using WCD for median of 43 days (IQR: 7–83 days), and daily mean use 17.3 ± 7.5 h. There were a total of 6 (4.2%) WCD shocks of which 2 (1.4%) were appropriate (one for VT, one for VF) and 4 (2.8%) were inappropriate (2 had supraventricular tachycardia, 2 had artifact). Two patients who received appropriate shocks were African-American with non-ischemic cardiomyopathy (EF<20%), non-sustained VT and wide QRS duration. Upon termination of WCD use, 45 (32%) received ICD while EF improved in 34 patients (32%). ConclusionsIn a predominantly minority, community setting, WCD compliance is high and use is effective in aborting SCD. However, inappropriate shocks do occur. A significant proportion of patients did not ultimately require ICD implantation suggesting this may be a cost-effective strategy in patients at risk of SCD.

VP116 Comparison Between Time To Off Treatment And Italian Medicines Agency Registries Treatment Duration

INTRODUCTION:The Italian Medicines Agency Registry represents a tool that could be a precious source of information regarding the mean treatment duration of a drug in a real world context. Monitoring registries are applied at the national level after market authorization and are designed not only to apply the Managed Entry Agreements (MEAs) but also to collect Real World Data on drugs safety, effectiveness and real life utilization. The purpose of this analysis was to compare the treatment duration from clinical trials and the mean treatment duration calculated using data from monitoring registries (1).METHODS:For each drug included in the analysis it was collected the treatment duration from Time To Off Treatment curves for the experimental drug (eTTOT) from Phase III clinical trials and the mean treatment duration data calculated by using the number of cycles (converted in months of treatment) of all treated patients extracted from AIFA registries (TTAR). The mean ratios between the Time of Treatment of Italian Medicines Agency and Experimental arm time to off treatment were calculated to identify potential correlations. High level of correlation was expected if Time to Payment By Result /Time To Off Treatment ratio was close to 1 (±.2).RESULTS:Six Roche products or different indications of the same product were identified as candidates for the analysis from 2013 to 2016. The mean TTAR/eTTOT ratio observed in patients treated from 2013 to 2016 was .97 (±.10), meaning that the mean treatment duration calculated from AIFA Registries is strongly comparable with the treatment duration observed in clinical trials. In one case the TTAR is even more major than eTTOT.CONCLUSIONS:A high level of correlation between TTAR and eTTOT was found. Additional analyses considering different cohorts of patients over time could be useful to have a more precise estimate of real world drug utilization. Even though RCTs remain the gold standard for demonstrating clinical efficacy in restricted trial setting, Real World Evidence from AIFA registries can contribute to the evidence base needed for healthcare decisions.