Real-world Management Research Articles

Real-World Clinical Management of Patients with Primary Biliary Cholangitis-A Retrospective Multicenter Study from Germany.

Background: Clinical practice guidelines for patients with primary biliary cholangitis (PBC) have been recently revised and implemented for well-established response criteria to standard first-line ursodeoxycholic acid (UDCA) therapy at 12 months after treatment initiation for the early identification of high-risk patients with inadequate treatment responses who may require treatment modification. However, there are only very limited data concerning the real-world clinical management of patients with PBC in Germany. Objective: The aim of this retrospective multicenter study was to evaluate response rates to standard first-line UDCA therapy and subsequent Second-line treatment regimens in a large cohort of well-characterized patients with PBC from 10 independent hepatological referral centers in Germany prior to the introduction of obeticholic acid as a licensed second-line treatment option. Methods: Diagnostic confirmation of PBC, standard first-line UDCA treatment regimens and response rates at 12 months according to Paris-I, Paris-II, and Barcelona criteria, the follow-up cut-off alkaline phosphatase (ALP) ≤ 1.67 × upper limit of normal (ULN) and the normalization of bilirubin (bilirubin ≤ 1 × ULN) were retrospectively examined between June 1986 and March 2017. The management and hitherto applied second-line treatment regimens in patients with an inadequate response to UDCA and subsequent response rates at 12 months were also evaluated. Results: Overall, 480 PBC patients were included in this study. The median UDCA dosage was 13.2 mg UDCA/kg bodyweight (BW)/d. Adequate UDCA treatment response rates according to Paris-I, Paris-II, and Barcelona criteria were observed in 91, 71.3, and 61.3% of patients, respectively. In 83.8% of patients, ALP ≤ 1.67 × ULN were achieved. A total of 116 patients (24.2%) showed an inadequate response to UDCA according to at least one criterion. The diverse second-line treatment regimens applied led to significantly higher response rates according to Paris-II (35 vs. 60%, p = 0.005), Barcelona (13 vs. 34%, p = 0.0005), ALP ≤ 1.67 × ULN and bilirubin ≤ 1 × ULN (52.1 vs. 75%, p = 0.002). The addition of bezafibrates appeared to induce the strongest beneficial effect in this cohort (Paris II: 24 vs. 74%, p = 0.004; Barcelona: 50 vs. 84%, p = 0.046; ALP < 1.67 × ULN and bilirubin ≤ 1 × ULN: 33 vs. 86%, p = 0.001). Conclusion: Our large retrospective multicenter study confirms high response rates following UDCA first-line standard treatment in patients with PBC and highlights the need for close monitoring and early treatment modification in high-risk patients with an insufficient response to UDCA since early treatment modification significantly increases subsequent response rates of these patients.

An inquiry into machine learning-based automatic configuration tuning services on real-world database management systems

Modern database management systems (DBMS) expose dozens of configurable knobs that control their runtime behavior. Setting these knobs correctly for an application's workload can improve the performance and efficiency of the DBMS. But because of their complexity, tuning a DBMS often requires considerable effort from experienced database administrators (DBAs). Recent work on automated tuning methods using machine learning (ML) have shown to achieve better performance compared with expert DBAs. These ML-based methods, however, were evaluated on synthetic workloads with limited tuning opportunities, and thus it is unknown whether they provide the same benefit in a production environment. To better understand ML-based tuning, we conducted a thorough evaluation of ML-based DBMS knob tuning methods on an enterprise database application. We use the OtterTune tuning service to compare three state-of-the-art ML algorithms on an Oracle installation with a real workload trace. Our results with OtterTune show that these algorithms generate knob configurations that improve performance by 45% over enterprise-grade configurations. We also identify deployment and measurement issues that were overlooked by previous research in automated DBMS tuning services.

Immune Checkpoint Inhibitor-Related Pneumonitis in Lung Cancer: Real-World Incidence, Risk Factors, and Management Practices Across Six Health Care Centers in North Carolina

Immune checkpoint inhibitors (ICIs) are standard treatments for advanced non-small cell lung cancer and have expanded use in small cell lung cancer. Although generally better tolerated than traditional chemotherapy, immune-related adverse events, such as immune checkpoint inhibitor-related pneumonitis (ICI-P), remain poorly understood toxicities that limit ICI treatment and can result in considerable morbidity. In this retrospective case-control study, we assessed a lung cancer cohort to identify ICI-P risk factors. What are the risk factors, clinical presentations, radiographic findings, and outcomes for ICI-P in a real-world lung cancer cohort? Do chronic pulmonary diseases confer increased risk for ICI-P? Medical records from lung cancer patients receiving nivolumab, pembrolizumab, or combination ipilimumab and nivolumab at six centers in North Carolina were reviewed (January 2004-July 2017). Patients with ICI-P and control participants were characterized, and logistic regression was used to assess for ICI-P risk factors. Three hundred fifteen lung cancer patients who predominantly received nivolumab (76.5%) or pembrolizumab (22%) were included. The incidence of ICI-P was 9.5%, with a median time to diagnosis of 52.5days. Most patients with ICI-P had cases of high severity, and eight patients (27%) died with ongoing ICI-P treatment. Development of ICI-P was independently associated with the presence of baseline fibrosis on chest CT scan (adjusted OR [aOR], 6.61; 95%CI, 2.48-17.7), a composite measure of obstructive lung disease (aOR, 2.79; 95%CI, 1.07-7.29), and treatment with pembrolizumab (aOR, 2.57; 95%CI, 1.08-6.11). In this cohort, ICI-P was more common and severe than previously reported and carried an unexpectedly high mortality rate. Risk for ICI-P was shown to be independently associated with several chronic pulmonary diseases, which may account for the higher incidence of ICI-P in patients with lung cancer.

Cabozantinib versus other TKIs after CPI treatment in the real-world management of patients with metastatic renal cell carcinoma (mRCC).

293 Background: Checkpoint inhibitors (CPIs) are a treatment option for patients with metastatic renal cell carcinoma (mRCC), but there is limited clinical data on the efficacy of targeted therapies following CPI treatment. Cabozantinib is a tyrosine kinase inhibitor (TKI) that targets multiple receptor kinases implicated in tumorigenesis. In the US, cabozantinib is approved for use in patients with advanced RCC including after CPI treatment. Methods: This retrospective observational cohort study (NCT04353765) evaluated outcomes associated with cabozantinib or other TKIs (axitinib, lenvatinib, pazopanib, sorafenib, sunitinib) in patients with mRCC following CPI treatment. Eligible patients initiated TKI therapy between May 1, 2016 and Sep 31, 2019 and had received a CPI as their last systemic treatment prior to TKI therapy. Patients were identified from the US Oncology Network iKnowMed electronic health record database through structured queries and a targeted chart review. The following real-world outcomes were assessed: 6-month response rate (RR6months; primary); overall response rate (ORR); overall survival (OS); time to treatment discontinuation (TTD); rates of dose reductions, and discontinuation due to adverse events (AEs). The p value for RR6months was used to test for non-inferiority. Results: Eligible patients ( n = 247) had a mean (SD) age of 65.9 (10.5) years and 74.1% were male; 75.7% ( n = 187) received cabozantinib and 24.3% ( n = 60) received other TKIs. All patients had intermediate or poor MSKCC score; more poor-risk patients received cabozantinib than other TKIs (28.9% vs 20%). Outcomes data are shown in the Table. Compared with other TKIs, cabozantinib was associated with a significantly higher RR6months and ORR, and TTD was twice as long with cabozantinib. Discontinuation due to AEs was more frequent with other TKIs than with cabozantinib, although this was not statistically significant; 21.7% of discontinuations occurred during the first 3 months of treatment. AEs leading to discontinuation were consistent with the known safety profile of the products. Conclusions: In this mRCC population receiving routine care in the US, cabozantinib was used more frequently than other TKIs after CPI treatment. Cabozantinib was an effective and well tolerated option post-CPI, with a high response rate in the real-world setting.abozantinib was associated with a significantly higher response rate and a lower discontinuation rate due to AEs; TTD was double that of other TKIs. [Table: see text]

Combinatorial atomistic-to-AI prediction and experimental validation of heating effects in 350 F supercapacitor modules

Accurately predicting thermal behavior is critically important in the real-world thermal management of supercapacitor modules with ultrahigh power and discharging current. In this work, an artificial intelligence approach based on the improved multiscale coupled electro-thermal model is employed for the first time to accurately predict the thermal behavior of a 350 F supercapacitor module under air-cooling conditions. Different from previous work that used commercial cells, the 350 F supercapacitors are fabricated from our proprietary pilot-scale production line. This approach provides a platform to precisely measure the structural parameters, electrical and thermal properties of electrodes and electrolytes (e.g., the temperature/current dependent equivalent series resistance and axial/radial thermal characteristics), which can improve the model for characterizing the irreversible heat generation and thermal transport processes. In particular, coupled with molecular dynamics simulations, the molecular origin of entropy is revealed via probing the atomic-level information (e.g., 1D/2D electric double-layer structure, electrical field/potential distributions, areal capacitance, and diffusion kinetics) to accurately predict the reversible heat generation. As a consequence, the deviation between our improved model and experimental results is substantially reduced to below 5%. A deep neural network based on the long short-term memory (LSTM) approach is trained to build a temperature database for practical supercapacitor modules under different operating conditions (including charging/discharging currents, cooling airflow rates, and cycle duration). This work demonstrates the potential of LSTM in predicting the thermal behavior, which can be broadly used for industry-relevant thermal management applications.

Prevalence and real-world management of vedolizumab-associated enthesitis in successfully treated IBD patients.

Some studies have reported the development of moderate and severe de novo SpA-associated disease under vedolizumab (VDZ) treatment for IBD. Herein, we report a case series who developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases. In a single Italian IBD Unit in which 90 cases were on VDZ therapy, we identified 11 cases who developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, and outcomes (including therapy switches) was described. A total of 11 cases, including 8 prior anti-TNF failures, with new-onset entheseal pathology were identified: multifocal (n = 4), unifocal (n = 6), and enthesitis/synovitis/dactylitis (n = 1). The mean duration of symptoms was 46 weeks (range 6-119), the mean CRP was 5.1 mg/dl, and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and US showed severe enthesitis, including power Doppler change in 7 patients. All patients were initially treated with NSAIDs, and 5 patients underwent local steroid injections. At 12 months, 5/7 cases continued VDZ and 2 were switched to ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of power Doppler signal. In addition, 4/7 severe patients developed marked post-inflammatory entheseal calcifications. A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy.

A case study on revisiting meeting and event competency standards and student perspective

Utilizing an experiential learning project, reflection surveys, and post-program questionnaires, this descriptive case study approach explores a real-world event management course as a professional skill builder for students. Course outcomes were compared to the Meeting and Business Events Competency Standards (MBECS) Curriculum Guide to determine if the experiential learning opportunity addressed the industry standards. Student reflections were coded for categorical and themed relationships and post-program questionnaires were reviewed for student perspectives. Through this research, it was found that students had opportunities to participate in activities which fell into 30 of the 33 categories of the MBECS. Through further analysis, 3 major themes emerged from the student reflections, and the post-program questionnaires indicated that the skills developed in the course were being used within the workforce. Fundraising was also highlighted throughout the research as a valuable component needed within event programs. Recommendations for future course and curriculum success are also offered.

Real-world management of hyperphosphataemia withsucroferric oxyhydroxide: the VELREAL multicentre study.

BackgroundThe efficacy and safety of sucroferric oxyhydroxide (SO) have been reported in clinical trials. However, real-life data are scarce. This study presents data on the use, efficacy and safety of SO in real clinical practice.MethodsWe performed a retrospective multicentre study, without any influence on the prescription decisions, that included 220 patients from 11 Spanish centres. Demographic, treatment, analytical and nutritional parameters and adherence, side effects and dropout rates were collected during 6 months.ResultsSO was initiated due to inadequate control of serum phosphate (P) in 70% of participants and in 24.5% to reduce the number of tablets. Monotherapy with SO increased from 44% to 74.1%, with a reduction in the average daily number of sachets/tablets from six to two. Serum P decreased by 20% (4.6 ± 1.2 versus 5.8 ± 1.3 mg/dL; P < 0.001), with a significant reduction in intact parathyroid hormone levels (P < 0.01). The percentage of patients with adequate serum P control at threshold levels of 5 and 4.5 mg/dL increased by 45.4% and 35.9%, respectively. Serum ferritin was not modified, while the transferrin saturation index increased significantly (P = 0.04). Serum albumin and normalized protein catabolic rate, when normalized by serum P, increased, averaging 37% and 39%, respectively (P < 0.001). Adherent patients increased from 28.2% to 52.7%. Adverse effects were reported by 14.1% of participants, with abandonment of treatment in 9.5%.ConclusionsThe use of SO in real-life results in better control of serum P, a reduction in the number of tablets and an improvement in therapeutic adherence. In addition, it may be beneficial with regards to secondary hyperparathyroidism and nutritional status.

Real-world management of chronic myeloid leukemia in South Korea: the TARGET survey.

BackgroundThe global TARGET survey examined real-world management of chronic myeloid leukemia (CML) compared with international guideline recommendations. This report focused on the responses of physicians from South Korea compared with those of physicians from the rest of the world (ROW).MethodsThe self-administered, online survey, comprising 23 questions and clinical case scenarios, was completed between April and August 2017. It was designed to gather information on practicing physicians and local practices for CML diagnosis, disease monitoring, treatment, and adverse event (AE) management.ResultsWhile there were similarities in the mutation analysis and treatment efficacy between Korea and the ROW, there were also differences in CML management. Initial diagnostic testing was more comprehensive in Korea than in the ROW, and there was significantly better access to standardized polymerase chain reaction testing. Assessment of BCR-ABL levels during the first 12 months of treatment was excellent in Korea, and there was greater frontline use of second-generation BCR-ABL tyrosine kinase inhibitors. Korean physicians were significantly less likely to switch therapy for hematologic AEs. Treatment-free remission was not an important goal of therapy among Korean or ROW physicians.ConclusionThis study identified some differences in the current CML management between Korea and the ROW; CML management in Korean patients was generally in line with the current guidelines.

Patterns of comorbidity and psychopharmacology in adults with intellectual disability and attention deficit hyperactivity disorder: an UK national cross-sectional audit

ABSTRACT Background: Attention-deficit hyperactivity disorder (ADHD) is higher in people with intellectual disability (ID) compared to the general population. Available limited evidence suggests this population has increased psychological problems, diagnostic overshadowing and psychotropic prescribing. This audit Identifies and analyzes real-world characteristics, diagnostic practices, treatment, and management of ADHD in adults with ID. Research Design and Methods: Pooled retrospective case note data for people with ID and ADHD, collected from 30 organizations across the UK, were analyzed. Patients were classified into mild and moderate-profound ID groups. Associated mental health and neurodevelopmental co-morbidity, Demographics, concomitant psychotropics, and mental and behavioral concerns were collected. Group differences were reported using logistic regression models. Results: Of 445 participants, 73% had co-occurring autism spectrum disorder (ASD) and 65% were prescribed ADHD medications. Those on ADHD medication were less likely to be prescribed antipsychotics (p < 0.001) and antidepressants (p < 0.001). Multiple significant differences were found in ADHD medication response between ID groups and those with/without co-morbid ASD but not associated with challenging behavior reduction. Conclusions: High levels of neurodevelopmental and psychiatric comorbidity were found. ID severity and the presence of ASD appear to influence the use of certain psychotropic medications. Appropriate use of ADHD medication appears to reduce psychotropic polypharmacy.

The Age-Related Efficacy of Dimethyl Fumarate and Natalizumab in the Real-World Management of Multiple Sclerosis

We investigated the comparative age-related efficacy of dimethyl fumarate (DMF) and natalizumab (NTZ) in clinical practice on multiple sclerosis (MS). Research in this area is lacking in the previous literature. In a three-year retrospective and clinical–paraclinical study, we compared 173 DMF patients and 94 NTZ patients with a similar average age (40 years) and disease duration (DD) (10 years). Expanded Disability Status Scale (EDSS) scores were higher in the NTZ group than in the DMF group at 3.5 vs. 2.5, respectively (p = 0.001). However, in both groups, age values correlated with DD (r = 0.42; p < 0.001), EDSS (r = 0.52; p < 0.001) and age at onset (r = 0.18; p < 0.001). Furthermore, age-adjusted Kaplan–Meier curves showed that NTZ-treated subjects maintained a 1.0–3.0 EDSS status score (p = 0.003) more frequently and a 3.5–7.0 score (p = 0.022) significantly less frequently compared with DMF-treated subjects. The EDSS percentage mean difference between NTZ and DMF groups was 81.6%, decreasing inversely with age (r = −0.34; p < 0.001). Finally, high EDSS score values were reached at the age of 39–40 years, regardless of their experimental group. We demonstrated age as a major contributor in disability and response to therapy in current management of MS. Thus, age should be considered in the risk/benefit evaluation in decision making for the disease modifying treatments in MS.

A hybrid rolling grey framework for short time series modelling

Time series modelling is gaining spectacular popularity in the prediction process of decision making, with applications including real-world management and engineering. However, for short time series, prediction has to face unavoidable limitation for modelling extremely complex systems. It has to apply inadequate and incomplete data from short time to predict unknown observations. With such limited data source, existing techniques, such as statistical modelling or machine learning methods, fail to predict short time series effectively. To address this problem, this paper provides a global framework for short time series modelling predictions, integrating the rolling mechanism, grey model, and meta-heuristic optimization algorithms. In addition, dragonfly algorithm and whale optimization algorithm are investigated and deployed to optimize the framework by enhancing its predicting accuracy with less computational costs. To verify the performance of the proposed framework, three industrial cases are introduced as simulation experiments in this paper. Experimental results confirm that the framework solves corresponding short time series modelling predictions with greater accuracy and speed than the standard GM(1,1) models. The source codes of this framework are available at: https://github.com/zhesencui/HybridRollingGreyFramework.git .

A Value-at-Risk Modeling Techniques to Computing Equity Trading Risk Exposure in Emerging Stock Markets

The attempt of this article is to fill a gap in the equity trading risk management literature and particularly from the perspective of emerging and illiquid financial markets, such as in the context of the Moroccan stock market. This paper provides real-world risk management techniques and strategies that can be applied to equity trading/investment portfolios in emerging markets. In this work, we divulge a proactive approach for the measurement/management of risk exposure for financial trading portfolios that contain illiquid equity securities.

Math Programming based Reinforcement Learningfor Multi-Echelon Inventory Management

Reinforcement Learning has lead to considerable break-throughs in diverse areas such as robotics, games and many others. But the application to RL in complex real-world decision making problems remains limited. Many problems in Operations Management (inventory and revenue management, for example) are characterized by large action spaces and stochastic system dynamics. These characteristics make the problem considerably harder to solve for existing RL methods that rely on enumeration techniques to solve per step action problems. To resolve these issues, we develop Programmable Actor Reinforcement Learning (PARL), a policy iteration method that uses techniques from integer programming and sample average approximation. Analytically, we show that the for a given critic, the learned policy in each iteration converges to the optimal policy as the underlying samples of the uncertainty go to infinity. Practically, we show that a properly selected discretization of the underlying uncertain distribution can yield near optimal actor policy even with very few samples from the underlying uncertainty. We then apply our algorithm to real-world inventory management problems with complex supply chain structures and show that PARL outperforms state-of-the-art RL and inventory optimization methods in these settings. We find that PARL outperforms commonly used base stock heuristic by 51.3% and RL based methods by up to 9.58% on average across different supply chain environments.

Decrease in radiation therapy rates in patients with stage I seminoma: a population-based study.

BackgroundRadiotherapy has long been considered the standard adjuvant treatment after radical orchidectomy for stage I seminoma. However, active surveillance and carboplatin chemotherapy have recently become alternative strategies. Despite this, the transition in management regimens is not yet fully recognized. Thus, this study aimed to analyze the 40-year trend in radiotherapy for patients with stage I seminoma in the United States.MethodsWe identified 21,976 men in the Surveillance, Epidemiology, and End Results (SEER) database who were registered in 18 centers and who had a diagnosis of localized testis seminoma between 1975 and 2015. Patients of unknown age or whose tumors were not malignant were excluded. We investigated the rate of radiotherapy, chemotherapy and surveillance by year of diagnosis, clarified the characteristics related to the decline in radiotherapy rate, and analyzed patient survival by year of diagnosis.ResultsFrom 1975 to 2015, 52.9% (11,622/21,976) patients with stage I seminoma received external radiotherapy. The rate of radiotherapy, however, gradually decreased to 46.7% (189/405) in 2008, 18.6% (70/376) in 2012, and 5.3% (19/359) in 2015. Patients aged under 34 years and married patients were more likely to avoid radiotherapy in the 21st century. Compared with the 1975–1999 time period, patient overall survival (OS) decreased significantly in 2000–2007. However, OS during 2008–2015 was not statistically different than that during the 1975–1999 time period.ConclusionsThe role of radiotherapy in patients with stage I seminoma has fundamentally changed in the past 40 years and is no longer an essential treatment in the real-world management of this patient group.

Real-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma

Introduction: Real-world management of patients with hepatocellular carcinoma (HCC) is crucially challenging in the current rapidly evolving clinical environment which includes the need for respecting patient preferences and autonomy. In this context, regional/national treatment guidelines nuanced to local demographics have increasing importance in guiding disease management. We report here real-world data on clinical outcomes in HCC from a validation of the Consensus Guidelines for HCC at the National Cancer Centre Singapore (NCCS). Method: We evaluated the NCCS guidelines using prospectively collected real-world data, comparing the efficacy of treatment received using overall survival (OS) and progression-free survival (PFS). Treatment outcomes were also independently evaluated against 2 external sets of guidelines, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC). Results: Overall treatment compliance to the NCCS guidelines was 79.2%. Superior median OS was observed in patients receiving treatment compliant with NCCS guidelines for early (nonestimable vs. 23.5 months p < 0.0001), locally advanced (28.1 vs. 22.2 months p = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months p = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months p = 0.6300), but PFS was similar. Better clinical outcomes were seen in BCLC C patients who received treatment compliant with NCCS guidelines than in patients with treatment only allowed by BCLC guidelines (median OS 14.2 vs. 7.4 months p = 0.0002; median PFS 6.1 vs. 4.0 months p = 0.0286). Clinical outcomes were, however, similar for patients across all HKLC stages receiving NCCS-recommended treatment regardless of whether their treatment was allowed by HKLC. Conclusion: The high overall compliance rate and satisfactory clinical outcomes of patients managed according to the NCCS guidelines confirm its validity. This validation using real-world data considers patient and treating clinician preferences, thus providing a realistic analysis of the usefulness of the NCCS guidelines when applied in the clinics.

Remote introductory pharmacy practice experiences focused on veterans prescribed chronic opioid therapy.

The Department of Veterans Affairs (VA) Northern California Health Care System (NCHCS) uses a dashboard to identify monitoring needs for veterans prescribed chronic opioid therapy (COT). Schools of pharmacy require introductory pharmacy practice experiences (IPPEs); however, resources for providing IPPEs at medical facilities are limited. This article describes collaboration by a primary care service and a school of pharmacy to provide services for patients prescribed COT through remote access to the VA electronic health record (EHR) system. Pharmacy students in a required population health IPPE provided clinical services for veterans remotely. Students were supervised by VA clinical pharmacists and granted remote EHR access privileges. Using personally owned laptops and VA cell phones, students performed prescription drug monitoring program (PDMP) activities, reviewed urine drug screening (UDS) results, called patients to assess pain, and documented progress notes. Students completed an assessment on the first and final days of the experience; a retrospective analysis was conducted to examine differences in student knowledge of and confidence in providing COT-focused services. The dashboard scorecard and student workload were tracked over a 1-year period. In that year, 143 students wrote 7,001 PDMP notes, reviewed 6,130 UDS results, and documented 202 pain assessments. Statistically significant improvements were reported in students' level of confidence in performing population health activities for patients prescribed COT, including interpreting PDMP and UDS results and talking with patients. The ongoing collaboration provides real-world population management experiences for future pharmacists and supports monitoring requirements for veterans prescribed COT. The program has helped NCHCS accomplish its teaching mission without dedicating clinic workspace or computers and gain an additional team to address quality measures and support population health activities.

PCN344 End of Life Secondary Care Resource Use and Costs in Mycosis Fungoides and Sézary Syndrome: An Analysis of Hospital Episode Statistics

There are limited published data on the real-world management and outcomes of patients with Mycosis Fungoides (MF) and Sézary Syndrome (SS), particularly for end-stage disease. This study aimed to describe the end-of-life clinical pathway, healthcare resource utilisation (HCRU) and costs associated with MF and SS. Patients with ICD-10 diagnoses of MF (C84.0) or SS (C84.1) between 1-Oct-2010 and 31-March-2019 recorded in the National Health Service’s Hospital Episode Statistics (HES) database, who died in the same period, were included. Secondary care activity was described from diagnosis, including number of lines, types and duration of systemic (non-topical) treatments (of those available in HES). HCRU and costs per patient/week were evaluated for 6-monthly periods in the 24 months before death. During the study period, 554/1,737 (32%) patients with MF and 88/165 (53%) with SS died (MF: mean age at diagnosis=72 years, 65% male; SS: mean age=71 years, 48% male). Of patients who died, 46% with MF and 39% with SS had ≥1 treatment and 11% MF and 11% SS patients had ≥3 lines (≥70% received systemic anti-cancer treatments for each line). While the frequency of outpatient, Accident and Emergency and inpatient spells were relatively stable over time, the duration of inpatient stays increased towards end-of-life (mean duration of inpatient stays occurring 18-24 months prior to death=12 days [MF] and 16 days [SS]; mean duration in the 6 months prior to death=23 days [MF] and 24 days [SS]). Mean total cost of HCRU per patient/week ranged from £77 to £180 (MF) and £59 to £164 (SS) depending on the time period, with a 50-100% increase observed by the final 6 months of life. This study highlighted the significant burden of MF and SS prior to death, with many patients experiencing multiple systemic treatment switches and high resource use and costs.

PCN333 Analysis of Hospital Episode Statistics Data to Demonstrate the Secondary Care Treatment Pathway and Outcomes of Patients with Cutaneous T-Cell Lymphoma in England

This study aimed to describe the real-world demographics, management, clinical outcomes and healthcare resource use (HCRU) and costs of UK patients with Mycosis Fungoides (MF) and Sézary Syndrome (SS). Patients with ICD-10 diagnoses of MF (C84.0) or SS (C84.1) in the National Health Service’s Hospital Episode Statistics (HES) database between 1-Oct-2010 and 31-Mar-2019 were included, with secondary care activity tracked from diagnosis to study end date/death. Overall survival (OS) was calculated from date of diagnosis until death (or censored at study end date, if still alive). Next treatment-free survival (NTFS) was calculated from diagnosis until the date a new systemic (non-topical) treatment (of those available in HES) was started or added to existing treatment, or death. OS and NTFS were also calculated from the start of the next new systemic treatment. HCRU costs were estimated per patient/week. 1,737 patients with MF and 165 patients with SS (MF: mean age at diagnosis=65 years, 62% male; SS: mean age=66 years, 48% male) were included. 513 (30%) patients with MF and 58 (35%) with SS had ≥1 change in treatment and 554 (32%) MF and 88 (53%) SS patients died during the study period. Median OS for SS was 2.6 years (median not reached for MF) and median NTFS was 4.6 years (MF) and 1.0 years (SS). From start of the next new treatment, median OS was 1.5 years (MF) and 1.0 years (SS) and median NTFS was 0.3 years (MF) and 0.3 years (SS). Mean total HCRU costs varied between £53.07-£105.70 (MF) and £ 29.36-£135.93 (SS) per patient/week depending on the treatment line. HES data highlighted the significant real-world burden of MF and SS in England, demonstrating that many patients managed within the secondary care setting experience multiple treatment changes and poor survival outcomes, with high HCRU costs.

3D Geovisualization Interfaces as Flood Risk Management Platforms: Capability, Potential, and Implications for Practice

Recent advances in technology and workflows related to 3D geovisualization present numerous opportunities for development and evaluation of the usefulness of these tools for analysis and communication of environmental risks. This article explores how cartographic tools currently used for understanding and managing flood risks could be improved through the use of emerging 3D visualization approaches. The topological and dimensional realism enabled by these platforms has the potential both to improve the quality of representation and analysis and to reduce the knowledge barriers impeding understanding of flood risk by nonexpert audiences in risk communication. Furthermore, emerging mixed-reality interfaces offer multiple advantages over desktops for interaction with 3D content. The significant recent growth in both the interface and visualization domains represents an opportunity for researchers and practitioners to evaluate the contributions of these approaches to real-world planning and risk management. In this study, we overview the recent trends in the realm of flood risk visualization and the contributions mixed reality can have for the field. We then present a pragmatic workflow that enables integration of rigorous geospatial data related to flooding into a 3D visualization environment, to illustrate how various interface platforms can easily be integrated and evaluated.