Recommended Time Interval Research Articles

Development of an automated process for monitoring of amiodarone treatment

Abstract Background Amiodarone treatment requires repeated laboratory evaluations of thyroid and liver function due to risk of side effects during long-term administration. Robotic process automation (RPA) represents the use of software robots to automate repetitive and routine tasks typically performed by humans. Purpose We aimed to develop an RPA using a diagnostic classification algorithm and clinical support system for follow-up of amiodarone treatment. Methods Based on international guidelines and clinical specialist advisory we constructed an RPA which was studied in a test environment in parallel with routine amiodarone treatment. Expert advice was integrated through a series of collaborative workshops, ensuring alignment of the algorithm with current best practices in thyroid and liver disease management. The RPA provided recommendations on the time interval to next laboratory testing and suggestions for patient management to the physician, who was serving as a human-in-the-loop responsible for clinical decisions. Results After iterative improvements the RPA was evaluated against physician orders (n=390 paired orders) without technical failures. The recommended time interval to next follow-up was (mean ± SD) 4.5 ± 2.4 vs. 3.1 ± 1.4 months for RPA vs. physician (p<0.0001). While normal laboratory findings resulted in recommended follow-up in 6 months by the RPA (72.2%) this was only ordered in 9.9% by the physician (Figure). Physicians’ orders clustered between 3-4 months (58.5%). All patients diagnosed with new side effects (n=12) were detected and communicated correctly by the RPA, whereas only 8 were correctly detected and responded to by the physician (Table). Conclusions An automated process constitutes a reliable alternative to the current fully manual management of amiodarone follow-up. It may reduce manual labour, frequency of laboratory testing and detect side effects with increased precision, thereby reducing costs and enhancing patient value. While the RPA shows promise, further research is needed to explore its adaptability to other treatment scenarios.

Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district.

Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.

Prevalence of vaccine-derived hepatitis B surface antibodies in children and adolescents in Germany: results from a population-based survey, 2014–2017

IntroductionChildhood vaccination against hepatitis B has been recommended in Germany since 1995. WHO defines a primary vaccination series as successful if the initial hepatitis B surface antibody (anti-HBs) level is ≥ 10 IU/L directly after vaccination. Anti-HBs levels vary depending on the number of doses, type of vaccine, and time interval between the last two doses. In 2021, Germany began to recommend three instead of four doses of polyvalent hepatitis-B-containing vaccines. Our aim was to estimate the proportion of vaccinated children in Germany with anti-HBs levels < 10 IU/L, 10–99 IU/L, and ≥ 100 IU/L by number and type of vaccine, and assess if number of doses and compliance with recommended time interval between the last two doses are associated with an anti-HBs level ≥ 10 IU/L when considering type of vaccine and time since last dose.MethodsWe used data from a national cross-sectional study (2014–2017) of children (3–17 years). We excluded participants with unknown vaccination dates, unreadable or incomplete vaccination cards, and hepatitis B virus (HBV)-positive participants. We defined a recommended schedule as a vaccination series with at least six months between the two last doses and having three doses or more. We calculated weighted anti-HBs sero-prevalence for three anti-HBs levels: < 10 IU/L, 10–99 IU/L and ≥ 100 IU/L. We fitted two logistic regression models to examine the relationship between number of doses and recommended schedule on anti-HBs levels (≥ 10 IU/L and ≥ 100 IU/L) considering time since last dose and type of vaccine (Infanrix, Hexavac, Monovalent).ResultsWe included 2,489 participants. The weighted proportion of vaccinated children per anti-HBs level was < 10 IU/L: 36.3% [95%CI 34.0–38.7%], 10–99 IU/L: 35.7% [33.2–38.2%] and ≥ 100 IU/L: 28.0% [25.9–30.2%]. We did not find an association between a recommended schedule of three versus four doses and anti-HBs ≥ 10 IU/L or ≥ 100 IU/L.ConclusionsAnti-HBs levels in later childhood were about equal, whether children received three or four doses. This implies that the change in the recommendations does not affect the anti–HBs level among children in Germany. Future studies are needed on the association of anti-HBs levels and adequate sustained protection against HBV.

Pediatric High Blood Pressure Follow-Up Guideline Adherence in a Massachusetts Health Care System

ObjectivesTo describe adherence to the American Academy of Pediatrics’ (AAP) 2017 clinical practice guidelines for follow-up after high blood pressure (BP) screening by pediatric and family medicine providers in a Massachusetts health care system and to assess differences in receipt of follow-up according to child- and clinic-level factors. MethodsElectronic health record data were analyzed for children aged 3 to 17years who had an outpatient primary care visit during 2018 with a high BP screening (according to AAP guidelines). We classified AAP guideline adherent follow-up as BP follow-up within 6months after an elevated finding (+2-week buffer) and within 2weeks after a hypertensive finding (+2-week buffer). Differences in receipt of guideline adherent follow-up by child- and clinic-level factors were assessed via multilevel mixed effects logistic regression models. ResultsThe median age of the 4563 included children was 12years and 43% were female. Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval; 27.4% for those whose index BP was elevated and 5.4% for those whose index BP was hypertensive. Modeling revealed older children and those belonging to clinics with more providers, smaller patient panels, and smaller proportion of Medicaid patients were more likely to receive adherent follow-up. ConclusionsFew children received guideline adherent BP follow-up and most differences in adherence were related to clinic resources. System-level interventions are needed to improve BP follow-up.

Psoriasis/Psoriatic Arthritis Patients' Long-term Treatment Patterns and Adherence to Systemic Treatments Monitoring Recommendations.

Limited information exists regarding treatment of patients with psoriasis/psoriatic arthritis in primary care. The aim of this study is to assess treatment patterns, adherence, persistence, and compliance in newly diagnosed patients with psoriasis/psoriatic arthritis from 2012 to 2018 in Stockholm, Sweden. In addition, laboratory monitoring before initiation of treatment and at recommended intervals was quantified for patients prescribed methotrexate or biologics. A total of 51,639 individuals were included, with 39% initiating treatment with topical corticosteroids and < 5% receiving systemic treatment within 6 months post-diagnosis. During a median (interquartile range) follow-up of 7 (4-8) years, 18% of patients received systemic treatments at some point. Overall, 5-year persistence rates were 32%, 45% and 19% for methotrexate, biologics, and other systemic treatments, respectively. Pre-initiation laboratory tests, as recommended by guidelines, were performed in approximately 70% and 62% of methotrexate and biologics users, respectively. Follow-up monitoring at recommended time intervals occurred in 14-20% and 31-33% of patients prescribed methotrexate and biologics, respectively. These findings highlight gaps in the pharmacological care of patients with psoriasis/psoriatic arthritis, including suboptimal adherence/persistence and inadequate laboratory monitoring.

Fair-split distribution of multi-dose vaccines with prioritized age groups and dynamic demand: The case study of COVID-19

The emergence of the SARS-CoV-2 virus and new viral variations with higher transmission and mortality rates have highlighted the urgency to accelerate vaccination to mitigate the morbidity and mortality of the COVID-19 pandemic. For this purpose, this paper formulates a new multi-vaccine, multi-depot location-inventory-routing problem for vaccine distribution. The proposed model addresses a wide variety of vaccination concerns: prioritizing age groups, fair distribution, multi-dose injection, dynamic demand, etc. To solve large-size instances of the model, we employ a Benders decomposition algorithm with a number of acceleration techniques. To monitor the dynamic demand of vaccines, we propose a new adjusted susceptible-infectious-recovered (SIR) epidemiological model, where infected individuals are tested and quarantined. The solution to the optimal control problem dynamically allocates the vaccine demand to reach the endemic equilibrium point. Finally, to illustrate the applicability and performance of the proposed model and solution approach, the paper reports extensive numerical experiments on a real case study of the vaccination campaign in France. The computational results show that the proposed Benders decomposition algorithm is 12 times faster, and its solutions are, on average, 16% better in terms of quality than the Gurobi solver under a limited CPU time. In terms of vaccination strategies, our results suggest that delaying the recommended time interval between doses of injection by a factor of 1.5 reduces the unmet demand up to 50%. Furthermore, we observed that the mortality is a convex function of fairness and an appropriate level of fairness should be adapted through the vaccination.

Decision to Delivery Interval, Perinatal Outcome and Factors Following Emergency Cesarean Section in Southern Ethiopia.

The interval between the decision for an emergency cesarean section and the delivery of the fetus should be made within 30 minutes. In a setting like Ethiopia, the recommendation of 30 minutes is unrealistic. Decision to delivery interval should, therefore, be considered as vital in improving perinatal outcomes. This study aimed to assess the decision to delivery interval, its perinatal outcomes, and associated factors. A facility-based cross-sectional study was employed, and a consecutive sampling technique was used. Both the questionnaire and the data extraction sheet were used, and data analysis was done using a statistical package for social science version 25 software. Binary logistic regression was used to assess the factors associated with decision to delivery interval. P-value < 0.05 level of significance with a 95% Confidence interval was considered statistically significant. Decision-to-delivery interval below 30 minutes was observed in 21.3% of emergency cesarean sections. Category one (AOR=8.45, 95% CI, 4.66, 15.35), the presence of additional OR table (AOR=3.31, 95% CI, 1.42, 7.70), availability of materials and drugs (AOR=4.08, 95% CI, 1.3, 12.62) and night time (AOR=3.08, 95% CI, 1.04, 9.07) were factors significantly associated. The finding revealed that there was no statistically significant association between prolonged decisions to delivery interval with adverse perinatal outcomes. Decision-to-delivery intervals were not achieved within the recommended time interval. The prolonged decision to delivery interval and adverse perinatal outcomes had no significant association. Providers and facilities should be better equipped in advance and ready for a rapid emergency cesarean section.

Time from blood draw to multiple electrode aggregometry and association with platelet reactivity

Results from multiple electrode aggregometry (MEA) may vary according to pre-analytic factors. This study aimed to analyze the association of time from blood draw to MEA in patients undergoing percutaneous coronary intervention (PCI). In this observational single-center cohort study, platelet aggregation (aggregation units, U) was quantified by MEA (Multiplate Analyzer) after stimulation with adenosine diphosphate (ADP; final concentration [Fc] 6.4 μM), thrombin receptor activating peptide (TRAP; Fc 32 μM), or arachidonic acid (AA; Fc 0.5 mM) in patients treated with ASA and clopidogrel following PCI. High on-clopidogrel platelet reactivity (HPR) was defined as ADP-induced platelet aggregation ≥ 46 U. The manufacturer recommends performing the analysis within 30–180 min after blood draw. Patients were grouped according to the time from blood draw to MEA: 30–180 min, < 30 min, or > 180 min. Platelet function of 273 patients with coronary artery disease undergoing PCI with dual antiplatelet therapy was analyzed. The median age was 72 years (interquartile range, IQR 62–79) and 179 (66%) were male. Median ADP-, TRAP-, and AA-induced aggregation was 25 (IQR 18–36) U, 79 (IQR 63–96) U, and 12 (IQR 7–18) U, respectively. For those analyzed within 30–180 min from blood draw, no significant correlation of time from blood draw to MEA was observed 1) ADP (r = − 0.04, p = 0.51); 2) TRAP (r = − 0.06, p = 0.32); 3) AA (r = − 0.03, p = 0.67). In patients undergoing percutaneous coronary intervention and treated with dual antiplatelet therapy, the time from blood draw to multiple electrode aggregometry does not correlate with ADP- induced aggregation when the measurement occurred within the recommended time interval of 30–180 min after blood draw.

Colorectal cancer surveillance by colonoscopy in a prospective, population-based long-term Swiss screening study - outcomes, adherence, and costs.

Background The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time. Methods In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively. Results 1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30–9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1’934’521 per 1’000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals. Conclusion Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals.

Ionospheric Nighttime Enhancements at Low Latitudes Challenge Performance of the Global Ionospheric Maps

In this study, two ionospheric nighttime enhancement (INE) events at low latitudes are selected to investigate their spatial features through the observations from Global Navigation Satellite System (GNSS) receivers and ionosondes. For the first time, we present the detailed spatial pictures of premidnight and postmidnight INEs under geomagnetically quiet conditions. The two INE events have the maximum extents of about 11° × 34° and 17° × 25° (longitude × latitude), respectively. Dramatic latitudinal and longitudinal features are revealed in the two INEs. We perform a comparison between the products of Global Ionospheric Maps (GIMs) and total electron content (TEC) measurement from GNSS receivers. However, GIMs fail to capture the TEC distribution during INEs owing to their limited spatial and temporal resolution. Considering the extent of INEs from the observations, the spherical harmonic (SH) expansion adopted by the GIM models needs to upgrade the degree and order to 36. The pixel-based methods developed from two GIM models are required to reduce their grid size for higher spatial resolution. The recommended time interval is shorter than 30 min. Among seven GIMs, CODG and JPLG maps generally have the best performance in reproducing the latitudinal structure of the ionosphere.

REGIONAL ANALGESIA Programmed Intermittent Epidural Bolus for Labor Analgesia During First Stage of Labor: A Sequential Allocation Trial to Determine the Effective Interval Time Between Boluses of a Fixed Volume of 2.5 mL of Bupivacaine 0.25% Plus Fentanyl 8 µg/mL

(Can J Anaesth. 2021;68:653–660. doi: 10.1007/s12630-021-01922-6. Epub February 2, 2021) Programmed intermittent epidural bolus (PIEB) has been increasingly recommended and used during labor analgesia. This study aimed to determine the recommended time interval between boluses of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 µ/mL to provide effective analgesia in 90% of pregnant women (EI90) during the first stage of labor.

Assessment of vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia: A Mixed study

Age inappropriate vaccination of children increases the rate of mortality and morbidity. All studies conducted in some areas of Ethiopia were only quantitative in nature and focused on the main cities ignoring rural communities. The objective of this study is to assess vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia. A community-based cross-sectional study with quantitative and qualitative data collection methods was used, for which simple random sampling was used to select 602 mothers/caregivers who have vaccinated children aged 12 to 23 months in the district. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 23 for analysis. Bivariate analysis with a P-value of < 0.25 was used to select candidate variables for multivariate logistic regression. Adjusted odds ratio (AOR) with 95% CI and p-value < 0.05 were used to declare a significant association. Qualitative data responses were classified and then organized by content with thematic analysis. A total of 590 respondents responded to the interviews, making a response rate of 98%. In this study, 23.9% (95% CI: 20.4-27.7) of children aged 12-23 months had received all vaccines in the recommended time intervals. Urban residence (AOR: 3.15, 95% CI: 1.56-6.4), participation of pregnant women in conferences (AOR: 2.35, 95% CI: 1.2-4.57), institutional delivery (AOR: 2.5: 95% CI: 1.32-4.20), and sufficient knowledge of mothers (AOR: 3, 95% CI: 1.82-5.10) were significantly associated with the timeliness of childhood vaccination. Qualitative findings revealed that lack of knowledge and lack of information from mothers or caregivers, and inadequate communication with health workers hindered timely vaccination. The overall timeliness of the child's vaccination was low in this study. Residence, participation in a conference, place of delivery, and knowledge of the mothers were predictors of vaccination timeliness. Hence, promoting institutional delivery and increasing pregnant mothers awreness on vaccination timeliness through conference participation is compulsory.

Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination.

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Impact of Introducing Endovascular Treatment on Acute Phase of Subarachnoid Haemorrhage Outcome

Introduction: Ruptured intracranial aneurysm is an urgent diagnostic and therapeutic condition. Occlusion with coils is the first line treatment for ruptured aneurysms and also should be used to prevent re-rupture, potentially causing severe brain damage. Most aneurysms are subject to this type of treatment. The risk of intraoperative thromboembolic and haemorrhagic complications during treatment with coils is very low. Endovascular treatment with coils is therefore a safe and effective method that can prevent short and long-term haemorrhage. Short and long-term haemorrhage is achieved by early recanalization of cases with neuro-visualisation. Methods: In this article we present a retrospective analysis of the results of endovascular embolization of 137 patients, from 2017 to the present time, in three hospitals of Georgia country (Evex hospitals, New hospitals, New-vision University Hospital) with a diagnosis of acute subarachnoid haemorrhage. Results: In our study, overall postoperative mortality was reported to be 29.9% (41/137 patients). In 45 patients presenting with Hunt-Hess IV-V, the mortality rate was 51.1% (23/45). According to Raymond-Roy Scale, complete occlusion of aneurysm occurs in 66% of cases, residual occlusion of neck in 26%, and partial occlusion in 6%. Conclusion: Aneurysm rupture is an urgent clinical condition requiring rapid diagnosis and treatment. To prevent aneurysm re-rupture, operative intervention should be performed quickly. The recommended time interval is within 72 hours, and, if possible, within 24 hours after aneurysm rupture. Given the spasms typical of subarachnoid haemorraghe endovascular coiling of ruptured aneurysms is a first-line treatment that depends on the angioarchitecture and localization of the aneurysm. The main technique of endovascular treatment is occlusion by coils with or without remodeling balloon assistance. Generally, in acute periods, only aneurysms with coils are associated with relatively high rates of recanalization, so further observation and possible surgical treatment are recommended.

The Reliability of the Microsoft Kinect and Ambulatory Sensor-Based Motion Tracking Devices to Measure Shoulder Range-of-Motion: A Systematic Review and Meta-Analysis.

Advancements in motion sensing technology can potentially allow clinicians to make more accurate range-of-motion (ROM) measurements and informed decisions regarding patient management. The aim of this study was to systematically review and appraise the literature on the reliability of the Kinect, inertial sensors, smartphone applications and digital inclinometers/goniometers to measure shoulder ROM. Eleven databases were screened (MEDLINE, EMBASE, EMCARE, CINAHL, SPORTSDiscus, Compendex, IEEE Xplore, Web of Science, Proquest Science and Technology, Scopus, and PubMed). The methodological quality of the studies was assessed using the consensus-based standards for the selection of health Measurement Instruments (COSMIN) checklist. Reliability assessment used intra-class correlation coefficients (ICCs) and the criteria from Swinkels et al. (2005). Thirty-two studies were included. A total of 24 studies scored “adequate” and 2 scored “very good” for the reliability standards. Only one study scored “very good” and just over half of the studies (18/32) scored “adequate” for the measurement error standards. Good intra-rater reliability (ICC > 0.85) and inter-rater reliability (ICC > 0.80) was demonstrated with the Kinect, smartphone applications and digital inclinometers. Overall, the Kinect and ambulatory sensor-based human motion tracking devices demonstrate moderate–good levels of intra- and inter-rater reliability to measure shoulder ROM. Future reliability studies should focus on improving study design with larger sample sizes and recommended time intervals between repeated measurements.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Live Immunization Practices for Chronically Transfused Pediatric Patients

Introduction: Children with hemoglobinopathies often require chronic transfusion as a part of their care. The Canadian Immunization Guide, the National Advisory Committee on Immunizations, and the Centre for Disease Control recommend avoidance of live vaccination for a period following blood product transfusion. The literature indicates that human derived blood products contain significant amounts of antibodies to infectious agents that are prevalent in the general population, due to natural disease or vaccination of the donor, such as the measles virus and varicella zoster virus. The recommended time interval between packed red blood cell (PRBC) transfusion and live vaccination was extrapolated from a study which assessed vaccine responses after administration of Intravenous immune globulin. If practitioners adhere to guidelines, many chronically transfused pediatric patients would not be eligible to receive live vaccinations due to concerns of non-response to the vaccine. Thecomposition of blood products has changed over time and current immunization recommendations may not reflect the blood products being utilized today. Specifically, the amount of residual plasma in PRBCs has been reduced substantially, reducing passive antibody concentration and likely reducing interference in the immune response. To our knowledge, the immune response to live vaccines has not been formally studied in pediatric patients who undergo chronic transfusion with PRBCs. We aimed to determine the current live immunization practices of health care providers (HCPs) caring for chronically transfused pediatric patients.Hypothesis: Is there heterogeneity in the live immunization practices of North American Pediatric HCPs who care for chronically transfused children?Methods: The study was approved by the University of Alberta Research Ethics Board. A cross-sectional online survey was circulated to North American hematology HCPs. The survey was peer-reviewed by 7 practitioners prior to distribution for content and face validity with 3 versions before final approval and distribution. The survey was distributed via the Canadian Hemoglobinopathy Association (CanHaem,186 members) and the American Society of Pediatric Hematology/ Oncology (ASPHO, 1991 members) listservs. Responses were collated from June 2017-July 2017 in a REDcap database. Data was analyzed using descriptive statistics.Results: There were 60 respondents total. 60% of HCPs were from the U.S.A., and 70% cared for 1-19 patients meeting study criteria. The majority had 1-10 patients who travelled to measles endemic countries annually, and 33% of HCPs reported there had been a local outbreak of Measles, Mumps, Rubella or Varicella (MMRV) within the past year. Despite this, 50% were unaware of the MMRV immune-status of their patients. Eighty-seven percent of HCPs continued to administer live vaccinations as per the routine immunization schedule. Less than 10% had a protocol for the care of chronically transfused patients, and <25% complete pre-and-post vaccination serologies to assess immune-status in the transfused population. Respondents reported various follow-up strategies, including education of patients (40%), documentation of potential susceptibility to MMRV (15%), and education of the HCP's administering live vaccines (20%). Only 24/55 (44%) of respondents were aware of the recommendation to avoid live vaccinations in transfused patients, and 44% of respondents did not have a follow-up strategy for chronically transfused patients regarding immune-status.Conclusion: Live immunization practices for chronically transfused pediatric patients vary across North America. Many HCPs are unaware of the recommendations around avoidance of live immunizations post transfusion. Most respondents immunize their chronically transfused pediatric patients as per the routine schedule, but the immune-status post-vaccination is often unknown. Given changes to the processing of blood products over the last several decades, further research is needed in this area. Determination of pre-and-post-immunization serologies may help to establish the response of chronically transfused patients to live vaccinations, and allow for the development of evidence-based guidelines for live-immunization of this vulnerable patient population. DisclosuresBruce:Bristol-Meyers-Squibb - consultant 2016-2017: Consultancy; ovartis consult and ad board 2015-2016: Consultancy; Apopharma 2015: Consultancy.

Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test.

It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups. Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018. In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA. These results show some progress, driven by a modest increase in stool testing. However, colorectal cancer testing remains low in many population subgroups. These results can inform efforts to achieve population colorectal cancer screening goals.

Leitliniengerechte Diagnostik der Pankreatitis

There is currently no S3guideline that contains statements on the diagnosis and treatment of acute, chronic and autoimmune pancreatitis in asingle guideline. This article presents the most relevant recommendations relating to radiological imaging from the new "S3guideline for pancreatitis". The guideline was developed by the DGVS (German Society for Digestive and Metabolic Diseases). After an online-based Delphi survey, the statements were discussed by an interdisciplinary expert team at a3-day consensus conference and then agreed upon. The level of evidence scheme (version2) of the Oxford Centre for Evidence-based Medicine was used. The new German "S3guideline pancreatitis" comprises for the first time all entities of pancreatitis, acute, chronic and autoimmune pancreatitis and contains alarge number of innovations with regard to diagnostic imaging and therapy. In addition to the evidence-based recommendations for diagnosis and therapy, aGerman-language glossary of the revised Atlanta classification on acute pancreatitis was adopted by consensus of the interdisciplinary guideline expert team. Furthermore, protocol recommendations for the performance of computed tomography (CT) are provided for the first time. In this article we introduce the key recommendations and innovations in the field of diagnostic radiologic imaging for acute, chronic and autoimmune pancreatitis. In the future, every radiologist should have deep knowledge of the recommended time intervals for radiological imaging in acute pancreatitis and know the German terms for the description of acute pancreatitis; furthermore they should be able to classify the morphologies to the appropriate stages.

The use of an automated electronic registry for bladder cancer surveillance during the SARS-CoV-2 pandemic

Introduction: We aimed to develop and compare the utility of an automated registry of all patients undergoing surveillance for non-muscle invasive bladder cancer (NMIBC) during the severe acute respiratory virus coronavirus 2 (SARS-CoV-2) pandemic. Methods: We populated an electronic register of all patients undergoing bladder tumour surveillance (July–September 2019). The computerised ‘traffic-light’ system was implemented in September 2019 marking the beginning of phase 2. The register was audited at two- and six-months intervals during phase 2 (November 2019 and April 2020). Audit of the system In April 2020 allowed review of care given during the peak of the SARS-CoV-2 pandemic in Ireland. The primary outcome variable was the number of patients who had delayed surveillance cystoscopy in each group. Results: A total of 278 cases were reviewed, 96 in the first cohort and 91 at both intervals of second phase. During the first phase of the audit 17 patients (17.7%) had a missed cystoscopy. Phase 2 showed a sustained decrease in the number of patients with missed surveillance, with eight (8.8%) missing their procedure in both the November and April (SARS-CoV-2) cohorts (17 v. 8, X2 = 10.76, p = 0.0004). Overall, most patients had their procedure done within the recommended time interval (245, 88%). Conclusion: A centralised accessible computerised registry of patients with NMIBC undergoing surveillance is superior to traditional manual surveillance methods, especially during the period of SARS-CoV-2. Going forward we aim to have all patients undergo surveillance within schedule with a long-term goal of a centralised national registry. Level of evidence: Level 2c: “Outcomes Research”.