SAS Enterprise Guide Research Articles

FC51: A Big BIT: Utilizing Behavioral Intervention Team Approaches to Improve the Care of Older Adults on Med-Surg Units

Background: Older adults may exhibit behavioral disturbance while medically hospitalized. Restlessness, removing medical devices, or wandering may lead to sentinel events including falls, elopements, or violence. The traditional consultation-liaison model addresses challenging or high-risk behaviors but is often reactive and may lead to missed opportunities. The interdisciplinary Behavioral Intervention Team (BIT) was implemented on the campus of Prisma Health Baptist Hospital in Columbia, SC to address and anticipate the need for behavioral health support on medical units.Methods: A pilot BIT program was implemented in September 2019. Two psychiatric nurses were embedded on med-surg units as a part of medical and psychiatric interdisciplinary teams. After obtaining approval from the Prisma Health Institutional Review Board, a retrospective review was conducted to evaluate the correlation between BIT interventions and patient safety events. Two time periods were examined: six months with early-BIT efforts and six months with expanded-BIT efforts. Medical records and safety reports were reviewed, and statistical analysis was conducted in SAS Enterprise Guide 8.3. Statistical significance was based on associated p- values (p < 0.05).Results: Of admitted patients during the study period (N = 1413), almost half were age 65+. Pre- existing psychiatric diagnoses were present in 58% of cases with mood, anxiety, and neurocognitive disorders being most common. A majority of patients were on psychotropic medications during both study periods; however, there was a significant decrease in the use of psychotropic medications with expanded-BIT efforts (71.2% vs 61.3%, p < 0.001). In comparing early-BIT efforts to expanded-BIT efforts, significant reductions in workplace aggression (6.7% vs 2.3%, p < 0.001), use of restraints (5.8% vs 3.4%, p = 0.034) and need for security (4.2% vs 0.8%, p < 0.001) were observed. Geriatric subgroup analysis demonstrated a significant decrease in the need for security only (4.6% vs 0.6%, p < 0.001).Conclusions: Engaging BIT significantly reduced aggression, restraint use, and security interventions. As psychiatric comorbidities continue to impact overall treatment plans, care teams will need to prevent high-risk behaviors and events. Implementing an interdisciplinary BIT is feasible and effective in reducing negative outcomes.

A retrospective look: Industry partnership and transparency in phase III randomized clinical trials of breast cancer targeted therapies across two decades.

580 Background: To unveil industry involvement with respect to sponsorship, authorship, and demographic shifts in the trends of randomized clinical trials for breast cancer targeted therapies over the past two decades. Methods: All randomized phase III clinical trials focusing on targeted therapies for breast cancer were systematically identified from clinicaltrials.gov and reviewed using peer-reviewed publications. Trials that focused solely on chemotherapy and hormonal therapy were excluded. SAS Enterprise Guide v7.1 was used to analyze trial characteristics, authorship, and demographic details with Chi-square and Fisher’s exact tests. Results: From 2005-2023, 998 breast cancer treatment clinical trials were identified; 110 trials were included in the final analysis. Overall, 8.2% were limited to the U.S. and Canada while 67.3% were carried out internationally. 34.5% were led by cooperative (Co-op) groups vs 65.5% by pharmaceutical industries. 19.1% of trials were published in the New England Journal of Medicine (NEJM); all NEJM published trials reported positive results and 76.2% of were industry led. In contrast, of the 4.5% of trials featured in The Lancet, only 60% showed positive findings and 60% had major industry sponsorship. The most common industry partnerships were with Roche (27.3%), Novartis (12.7%), and Pfizer (7.3%) while the most common leading Co-op group was the National Cancer Institute (7.3%). To evaluate trends, trials were split into 3 time periods based on publication dates: 2005-2011, 2012-2017, and 2018-2023. The number of trial publications increased from 13 to 43 to 54. Of the 70% of trials that reported race/ethnicity data, the proportion of White patients decreased (84.5%, 78.8%, 79.3%; p<0.001) and the proportion of Asian patients increased (8.9%, 18.4%, 16.7%; p<0.001). However, enrollment of Black (6.6%, 2.8%, 4.0%; p<0.001) and Hispanic (7.0%, 2.8%, 5.0%; p<0.001) patients remained low. There were no statistically significant changes in international participation (46.2%, 69.8%, 70.4%; p=0.22), the proportion of exclusively industry-led (46.2%, 74.4%, 63.0%; p=0.15) or Co-op group-designed trials (61.5%, 35.7%, 26.4%; p=0.10). Industry-involved data collection increased from 23.1% to 64.2% to 73.6% (p=0.01) while industry sponsored data analysis (38.5%, 61.9%, 66.0%; p=0.49) and manuscript drafting (38.5%, 66.7%, 71.7%; p=0.09) did not significantly change. Conclusions: Over time, there was a notable rise in the number of phase III clinical trials for breast cancer targeted therapies. More than 70% of these trials now engage in international collaboration. Despite this progress, there remains an underrepresentation of Black and Hispanic participants in trial enrollment. Today, nearly 70% of trials have major industry sponsorship in study design, data analysis, and manuscript preparation.

Characteristics of Comorbid Physical Disease in Patients With Severe Mental Illness in South Korea: A Nationwide Population-Based Study (2014-2019).

The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea. This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests. The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease. This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.

The Business Environment in Slovakia from the Point of View of the Death of Enterprises

Creating favorable conditions in the business sphere is one of the main priorities of the European Union, while each member country implements the objectives of the EU strategy in its national strategic documents. The goal of this paper is modeling respectively quantifying the effect of the death of business entities in Slovakia in 2019 and 2020 from selected factors using logistic regression. We decided to find out which of the selected factors (legal form of the enterprise; size group according to the average registered number of employees; region; economic activity performed by the enterprise) most influenced the death of enterprises in the period before and during the pandemic, which will allow us to determine the most and the least threatened categories of enterprises. The analysis was based on the business demography database, while the processing itself was carried out using the statistical tool SAS Enterprise Guide 7.1. The results of the analysis during the COVID-19 pandemic showed a significant impact of the factor legal form of the enterprise - mainly in the group of enterprises owned by natural persons, then a statistically significant impact of the factor size group of enterprise with an average registered number of employees 0-1 and finally a significant impact of the factor economic activity of the enterprise, mainly in the field of services. The smallest but statistically significant effect was manifested in the region factor, while the region in the east of Slovakia can be considered the most threatened from the point of view of the demise of enterprises. An interesting fact is that the influence of individual categories of factors on the closure of a enterprises in the case of micro-enterprises with one employee is very similar to the situation throughout Slovakia.

Willingness to Keep or to Give Up the Social Media for a Certain Monetary Compensation

Millions of people around the world use social media every day for various reasons, whether it is sharing information, self-presentation, filling free time, or communicating with friends. The use of social networks brings with it advantages, but also risks associated with information overload, loss of privacy, as well as fraud or criminal acts. Mostly young people are connected to social networks almost constantly and find it more difficult to give up using social networks compared to older age groups. The aim of the present paper is to find out the willingness of social network users to give up social network such as Facebook and Instagram for certain monetary compensation. The necessary data were collected based on a questionnaire survey within 4 months. A total of 2 095 responses were collected. The static methods Chi-Square test of independence, logistic regression and the statistical program SAS Enterprise Guide were used to evaluate the results of the questionnaire survey. Analysis of Maximum Likelihood Estimates was tested for five predictors: Age, Gender, Income, Activity on the social network, Number of subscribers on the social network, especially for the social network Facebook and Instagram. Based on the results of the questionnaire survey, it can be concluded that Facebook users (in all age groups and regardless of gender) demand a higher average monthly financial compensation for giving up the social network compared to Instagram users. The same conclusion follows when categorizing respondents into age categories. Regarding gender, women demand lower monetary compensation than men in relation to both social networks. There was a significant difference in the Activity predictor, where active users asked for a higher amount of money for the Instagram social network and, conversely, inactive users asked for a higher average monthly payment for the Facebook social network.
 
 Received: 25 July 2023 / Accepted: 20 November 2023 / Published: 5 January 2024

Atypical antipsychotic use does not impact weight gain for individuals with extreme anorexia nervosa: a retrospective case–control study

BackgroundThere are no U.S. Food and Drug Administration (FDA)-approved medications for the treatment of anorexia nervosa (AN). Various medication classes have been evaluated for benefits in this population, including antipsychotics. Studies focused on use of antipsychotics for assistance with weight restoration in AN produced conflicting results. While current evidence does not suggest that antipsychotic medications can be generally recommended for persons with AN, some individuals might benefit from an antipsychotic medication for anxiety, mood, and the cognitive distortions that accompany the illness. It is well-established that atypical antipsychotics can cause weight gain when taken by other psychiatric populations. This published data can understandably limit the willingness of persons with AN to trial these medications. Given the conflicting results of studies examining antipsychotic-related weight gain in AN, it is currently hypothesized that individuals with extreme anorexia nervosa, restricting type, do not experience the weight gain seen in other psychiatric populations utilizing atypical antipsychotics.MethodsTwo hundred seventy-six individuals with extreme AN were enrolled in this retrospective, case–control study between April 1, 2016 and June 30, 2022 utilizing study-specific inclusion and exclusion criteria. Clinical and demographic data, including use of atypical antipsychotics and weights, were retrospectively obtained from chart review. Variables were assessed for normality using univariate statistics. Continuous variables were described using means (M) and standard deviations (SD) or medians and interquartile ranges (IQR) based on normality. Differences in weight gain between cohorts was ascertained via independent samples t-test. P values of < 0.05 were considered statistically significant, and all analyses were completed using SAS Enterprise Guide software version 7.1 (SAS Institute, Cary, NC) and R version 4.3.1 (R Core Team, 2023).ResultsUse of antipsychotics in this population of individuals with extreme AN did not impact the rate of weight gain (M: 1.7 kg/week, SD: 0.9 and 0.8, for cases and controls respectively).ConclusionsWeight gain is often cited by individuals with AN as a feared side effect of antipsychotic medications. In this study, there was no difference in weight trends for individuals taking atypical antipsychotic medications during the refeeding process compared with individuals who were not.

Clinical Characteristics and Anticoagulation Use in Antiphospholipid Syndrome: A Single-Center Retrospective Analysis

Background: Warfarin remains the anticoagulant of choice for patients with antiphospholipid syndrome (APLS). However, conflicting data exists regarding the role of direct oral anticoagulants (DOACs) as reasonable alternatives to warfarin, which has a less desirable side effect profile. In clinical practice, some patients start taking DOACs or aspirin before an official APLS diagnosis is confirmed and these patients may choose to continue a DOAC after an informed discussion with their hematologist. To gain a better understanding of anticoagulant use in APLS at our center, we conducted a retrospective study to assess the clinical characteristics of patients diagnosed with APLS. Methods: All patients with an ICD-10 code indicating APLS from January of 2020 to April of 2023 were included. Patient characteristics, relevant laboratory testing (lupus anticoagulant, beta-2 glycoprotein IgG/IgM, and anti-cardiolipin IgG/IgM), and treatment history were extracted from the electronic medical record. Patients were deemed to have single positivity if any one of the following were present: detectable lupus anticoagulant, elevated (defined as &amp;gt;40 GPL) beta-2 glycoprotein (B2GP) IgG or IgM, or elevated cardiolipin IgG or IgM both on initial and confirmatory testing (performed approximately 12 weeks later). Similarly, double positivity was defined as the presence of two of these biomarkers and triple positive was defined as the presence of three of these biomarkers. Initial laboratory testing results are included in Table 1. Statistical analysis was conducted using the SAS software (SAS Enterprise Guide 7.1) and the R Core Team (R 4.2.2). Continuous variables such as BMI and age were evaluated using the Wilcoxon rank-sum test, while categorical variables were assessed using Fisher's Exact Test and Chi-squared test. Results: Seventy-two patients were included in our analysis. Mean age and BMI were 56.3 ± 16.8 years and 32.3 ± 11.2, respectively. The majority of patients were female (69.4%) and white (83.8%). Approximately half of all patients had single positivity (64.4%) and more than half had detectable lupus anticoagulant (58.7%). Cardiolipin IgM was the most frequently (36.1%) elevated biomarker. Patient characteristics between the DOAC/aspirin and warfarin/enoxaparin cohorts were not significantly different; however, significantly more patients with single positivity received DOAC/Aspirin rather than warfarin/enoxaparin (77.8% vs.43.5%, p = 0.012). There was no statistically significant difference between the frequency of arterial complications in patients who took DOAC/Aspirin (4 events in 39 patients) versus those who took warfarin/enoxaparin (1 event in 33 patients), p = 0.366. The majority of arterial complications (4 of 5 events) occurred in patients with double and triple positivity. In addition, a logistical regression was performed regarding different characteristic effects on positivity level (single, double or triple laboratory positive), which found the presence of lupus anticoagulant had a significant association with higher likelihood of double/triple positivity (p = 0.048). Conclusion: This study provides potential reassurance for clinicians regarding the use of DOACs during the investigative phase of APLS and supports the continuation of DOAC therapy in patients, particularly those with single positivity, after careful evaluation and shared decision-making with patients. However, caution should be kept when considering DOAC use in patients with lupus anticoagulant, double, or triple positivity, due to concerning arterial events. Further large multi-center randomized clinical trials are necessary in the future to clarify the role of DOACs in APLS.

The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study

BackgroundPrevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship.MethodsThis retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA).ResultsThe ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency.ConclusionsIncome and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

LZM008, a proposed tocilizumab biosimilar: Pharmacokinetics, safety, and immunogenicity profiles compared with ACTEMRA® in Chinese healthy male subjects.

Background: This study aimed to investigate the pharmacokinetics, safety, and immunogenicity of recombinant humanized anti-human IL-6R monoclonal antibody injection, LZM008, and evaluate the pharmacokinetic similarity between LZM008 and tocilizumab (ACTEMRA®) in Chinese healthy male subjects. Research design and methods: In this randomized, double-blinded, paralleled, two-center Phase I clinical trial, 96 subjects were randomized with a 1:1 ratio to receive 4mg/kg intravenous dose of LZM008 or ACTEMRA® and evaluated for 28days. The pharmacokinetic bioequivalence was assessed by the maximum serum concentration (Cmax), the area under the serum concentration-time curve (AUC) from time 0 to the last detectable drug concentration (AUC0-t), and AUC0-∞. The statistical analysis was conducted using SAS Enterprise Guide statistical software. Safety was assessed by physical examinations, vital signs, laboratory tests, and electrocardiograms. Anti-drug antibodies (ADAs) were measured by a bridged electrochemiluminescence immunoassay. Results: LZM008 (N = 49) and ACTEMRA® (N = 47) groups showed similar pharmacokinetic properties. After a single intravenous infusion of 4mg/kg LZM008, the Cmax and AUC0-∞ values of LZM008 reached 87.99μg/mL and 11,526.70h*μg/mL, respectively, with Tmax 1.98h, and the half-life (t1/2) was 83.45h. The 90% confidence intervals of ratios for Cmax, AUC0-t, and AUC0-∞ were within the range of 80.00%-125.00%. After infusion, one (2.0%) subject in the LZM008 group and three (6.4%) subjects in the ACTEMRA® group showed positive ADA test results. The incidence of treatment emergent adverse events (TEAEs) was comparable in LZM008 and ACTEMRA® groups (98.0% versus 100%), with the decrease in blood fibrinogen and neutrophil counts being the most common TEAEs. Conclusion: The pharmacokinetic characteristics and immunogenicity exhibited by LZM008 were similar to those of the reference product, ACTEMRA®. The safety profiles of LZM008 were similar in the two groups with mild-moderate adverse effects. Trial Registration: The trial is registered at www.chinadrugtrials.org.cn (CTR20190889).

Comparison of stakeholder's perceptions of mandatory CCTV installation in long-term care facilities: A descriptive study

Purpose: This study aimed to investigate the status of closed-circuit television (CCTV) installation and operation in long-term care facilities and to compare the differences in stakeholders' perceptions of CCTV mandatory installation.Methods: The participants included 743 heads of facilities, 802 care workers, and 864 family caregivers. The questionnaire included CCTV installation and operation status and perceptions on CCTV installation in long-term care facilities. For the data analysis, descriptive statistics and chi-squared tests were performed through SAS Enterprise Guide 7.1.Results: For the mandatory installation of CCTV in long-term care facilities, 96.5% of family caregivers, 83.2% of care workers, and 65.0% of heads of facilities agreed (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=273.71, &lt;i&gt;p&lt;/i&gt;&lt;.001). There was no difference in opinion among the stakeholders that a living room and program room should have CCTV installed. All stakeholders agreed that the items to punish CCTV information leakage should be included in the guidelines for installation and operation of CCTV in long-term care facilities. In addition, more than 90% agreed on the preparation of confidentiality obligation for viewing CCTV in all groups. However, there were differences in opinions among stakeholders on composing the guidelines in accordance with the Child Care Act and restricting CCTV installation to the outside of bedrooms.Conclusion: This study confirms that there was a difference in stakeholders’ perceptions of mandatory CCTV installation in long-term care facilities. To increase the effectiveness of mandatory CCTV installation in long-term care facilities, it is necessary to strengthen education on human rights and safety for older adults and improve care workers’ working environment.

Relationship between depression and lifestyle factors in Chinese adults using multi-level generalized estimation equation model.

Relationship between depression and lifestyle factors in Chinese adults using multi-level generalized estimation equation model.

Uptake of community pharmacist prescribing over a three-year period

ObjectivesPharmacists in Nova Scotia have had legislated authority to prescribe since 2011. This study aimed to describe the prescribing activities of pharmacists and the characteristics of patients who used pharmacist prescribing services. MethodsUsing provincial health administrative databases we identified all community pharmacists who prescribed during the study period (October 2016 to March 2020) and correspondingly patients who had medications prescribed by a pharmacist during this period. Differences in, and predictors of the quantity of pharmacist prescribing over three fiscal years (April 2017 to March 2020) were described. Pharmacist prescribing activity was compared across the fiscal years of the study period with One-way Analysis of Variance. Negative binomial regression examined patient factors associated with use of pharmacist prescribing services. Analysis was carried out using SAS ENTERPRISE GUIDE v.8.2 (SAS Institute Cary, NC, USA). Key findingsA total of 1182 pharmacist prescribers were identified, who on average prescribed 24.6, 26.3, and 32.5 (p < 0.001) times per month in fiscal years 2018, 2019, 2020, respectively. The patient cohort contained 372,203 Nova Scotians over the 3-year period. For approved common and minor ailment prescribing in Nova Scotia, gastroesophageal reflux disease, vaccines (non-travel), contraceptive management, herpes zoster treatment, and allergic rhinitis had the highest number of prescriptions over the study period. Patient factors most strongly related to receiving more prescribing services by a pharmacist included receiving income assistance without copay (Incidence rate ratio (IRR) = 1.70), having >2 comorbidities (IRR = 1.51), male sex (IRR = 1.03), and greater age (IRR = 1.01). Those from an urban area (IRR = 0.92) or having a higher income (IRR = 0.95) received fewer pharmacist prescribing services (all p < 0.0001). ConclusionsPharmacist prescribing increased over the 3-year period. Patients who were older and those with multiple comorbidities used pharmacist prescribing services most often. Prescribing activities represent an increasingly utilized role for pharmacists in primary care.

Analysis of work intensity in Slovakia using testing and estimation of linear combinations of GLM parameters

Not only unemployment itself but also the reduced work intensity of a household has a major impact on the social exclusion of a person. The work intensity of households is currently being monitored in Europe mainly for purposes of identifying those people or households that are excluded from the labour market. The households’ work intensity directly affects the inclusion or exclusion from the labour market, which is one of the three social exclusion dimensions. Moreover, it also, as confirmed by several studies, fundamentally affects the other two dimensions of social exclusion, namely income poverty and material deprivation. The aim of the paper was to assess which factors in interaction with the economic activity status of a person significantly affect the household’s work intensity and, depending on these factors, to estimate the household’s work intensity. For this purpose, the general linear model and the associated analysis of marginal means and the contrast analysis were used. The analyses are based on a database EU-SILC 2020 for the Slovak Republic and performed in the SAS Enterprise Guide and by means of PROC GLM in the SAS programming language using CONTRAST and ESTIMATE statements. The article examines between which levels of significant factors there is a significant difference in terms of a household’s work intensity and in particular provides estimates of work intensity depending on the household type, educational attainment level and the age of a person. At the same time, in all three cases households are broken down by the economic activity status of the person. The presented analyses revealed categories of persons that are the most and the least threatened by labour market exclusion from the point of view of the considered factors.

Comparison of A1c Reduction, Weight Loss, and Changes in Insulin Requirements With Addition of GLP-1 Agonists vs SGLT-2 Inhibitors in Patients Using Multiple Daily Insulin Injections

Objective: To determine whether Glucagon-Like Peptide 1 (GLP-1) agonists or Sodium Glucose Transporter 2 (SGLT-2) inhibitors result in greater A1c reduction, weight loss, and reduction of insulin requirements in veterans using multiple daily doses of insulin. Methods: This retrospective, single-site, cohort study included patients of VA Eastern Kansas Health Care System with a diagnosis of Type II Diabetes utilizing multiple daily dose insulin and an SGLT-2 inhibitor or GLP-1 agonist. SAS Enterprise Guide was utilized to complete a multivariate analysis of variance to evaluate all outcomes. Key Findings: 150 patients met selection criteria. The GLP-1 group averaged a .65% reduction in A1c compared to a 1.05% reduction in the SGLT-2 group (P = .1397). The Basal insulin dose was reduced by 5.5 units in the GLP-1 group vs 2.45 units in the SGLT-2 group (P = .3132), and 7.12 units vs 8.14 units respectively for short-acting insulin (P = .8170). The resulting weight reduction was 4.1 Kg in the GLP-1 group compared to 3.6 Kg in the SGLT-2 group (P = .6993). Conclusion: The results suggest there is not a statistically significant difference in changes to A1c, insulin requirements, or weight after 1 year of treatment with an SGLT-2 vs GLP-1 in patients using multiple daily insulin injections.

Relationships between Alcohol Use, Musculoskeletal Pain, and Work-Related Burnout.

Background and Objectives: Burnout affects approximately half of all nurses, physicians, and other clinicians. Alcohol use may impair performance in work-related tasks, leading to decreased productivity and morale. The present study’s aim was to determine whether a causal relationship existed between alcohol use, work-related burnout (WB), and musculoskeletal pain. Materials and Methods: A total of 1633 members from a hospital affiliated with a medical university in Taichung, Taiwan, completed questionnaires in 2021, where 1615 questionnaires were declared valid. Questionnaires were used to obtain information on basic demographic variables, and the Nordic Musculoskeletal Questionnaire and Copenhagen Burnout Inventory were used. Statistical analyses were performed using SAS Enterprise Guide 6.1 software, and significance was set at p < 0.05. Results: Work experience, being married, parenthood, leisure activities with family and friends, and regular weekly exercise were negatively associated with WB. In addition, overtime work, irregular and regular shift work, the physician and nurse medical profession, chronic disease (heart disease, diabetes, etc.), neck and both shoulders pain (NBSP), both ankles pain (BAP), and alcohol use frequency (AUF) were positively associated with WB. NBSP could explain the residual effect of AUF on WB. AUF was determined to mediate the relationship between NBSP and WB. In addition, NBSP was found to mediate the relationship between AUF and WB. Conclusions: The individuals who used alcohol to cope with NBSP or those with NBSP who often consumed alcohol had worsened WB due to a vicious circle of musculoskeletal pain and alcohol use. Therefore, medical staff should not consider alcohol use as an option to reduce burnout.

A preliminary review of adoption of new HCPCS codes for NGS in CMS claims.

e13522 Background: Adequate reimbursement is considered a prerequisite for adoption of new diagnostic technologies that facilitate patient access to better treatments. Detailed longitudinal investigation of the adoption of new HCPCS codes and the factors influencing it are scarce, although the availability of large-scale claims databases should facilitate such studies. We examined claims for three CPT codes used for next generation sequencing (NGS): 81445, 81450 and 81455 in a large database of claims data from CMS and attempted to correlate presumptive drivers of test adoption such as coverage decisions and payments with test volume. Methods: CMS claims data were accessed using CMS’ Virtual Research Data Center (VRDC) under data use agreement 50486. Any claim with a CPT code of 81445, 81450 or 81455 was extracted from the data and analysed using SAS Enterprise Guide with results summarised in Microsoft Excel. Data relating to national/local coverage determinations were located by internet searches. Results: Test volumes for all 3 codes showed significant variability, including a large decrease around Q1-2 of 2020, likely due to the COVID-19 pandemic. Utilization of the 3 CPT codes varied by patient diagnosis. Details of the top 5 diagnoses for each CPT are given in the Table. The top 30 diagnoses for each CPT code accounted for 80.33%-88.45% of patients. Conclusions: Utilisation of NGS testing from 2016-2021 was highly variable, confounding attempts to match potential drivers to changes in monthly test volumes. A relatively small number of conditions accounted for &gt;80% test use. Increased use of 81445 and 81450 from 2019 onwards may be related to CMS LCD issued in March 2018, suggesting that it can take 8-9 months or more for a LCD to filter through to testing practice. Decreases in test volume around March 2020 coincide with decreased patient presentation and testing for cancer because of the COVID-19 pandemic indicating that factors beyond reimbursement can significantly affect test use. Changes in reimbursement or adoption of proprietary lab analysis (PLA) codes covering specific NGS tests may have caused the drop in test volumes in the latter half of 2021. This study demonstrates that determination of factors affecting adoption of a test technology can be problematic due to wide variation in claims over a relatively short space of time. However, determination of these factors is important as they ultimately affect patient access to testing and potentially to therapy. [Table: see text]

Lessons learned: Characteristics of first-year COVID-19 hospital outbreaks

Background: At the start of the COVID-19 pandemic, the DC Department of Health (DC Health) mandated new case reporting for early outbreak detection: (1) weekly healthcare personnel (HCP) absenteeism line lists indicating staff absent for confirmed or suspected SARS-CoV-2, (2) daily line lists of all SARS-CoV-2–positive inpatients, and (3) hospital contact tracing. Between March 27, 2020, and December 31, 2020, DC Health detected 36 confirmed and 14 suspected hospital outbreaks, of which only 18% (8 confirmed and 1 suspect) were known to the affected hospital. DC Health learned which outbreaks warranted early or aggressive intervention by tracking outbreak characteristics across its jurisdiction. This allowed prioritization of during surges when it was difficult for DC Health and hospital staff to investigate every outbreak. Methods: Potential outbreaks in short-stay and inpatient rehabilitation hospitals were flagged after identifying SARS-CoV-2 hospital-onset (HO) inpatients or staff clusters on line lists. Variables of interest in line lists included specimen collection and hospital admission dates, units or departments, and patient contact. Facility contact tracing by infection preventionists further verified epidemiological links among cases. Outbreak details were systematically tracked in a locally developed REDCap database and were analyzed if they had an initial case, outbreak start date, or an investigation start date in 2020. Frequency procedures, SQL statements, and date calculations were computed using SAS Enterprise Guide version 8.3 software. Results: Confirmed outbreaks had an average of 6.92 (range, 0–32) HCP and 2.58 (range, 0–22) patient cases, with 69% being confirmed-HO cases and 31% probable HO. Moreover, 53% of confirmed outbreaks occurred in the following departments: cardiac, behavioral health, intensive care, and environmental services (EVS)/facilities. All of these departments had recurrent outbreaks. Behavioral health, medical and cardiac units had the highest number of patient cases. On average, confirmed outbreak investigations lasted 24.6 days, with outbreaks prolonged in the ICU (40.25 days) and the medical unit (37.67 days). Top triggers for investigations ultimately classified as confirmed outbreaks were (1) positive symptomatic HCP, (2) confirmed-HO cases, and (3) exposures from positive HCP. Conclusions: The dynamic nature of COVID-19 created challenges in detecting and responding to hospital outbreaks. Developing a low-resource outbreak tracking system helped identify outbreak types and triggers that warranted early or aggressive interventions. Understanding the characteristics of hospital outbreaks was critical for maximizing infection control resources during surges of infectious disease outbreaks, such as COVID-19. Hospitals or local health departments could adapt this system to meet their needs.Funding: NoneDisclosures: None

Vegetarian and Vegan Private Label Products as a Challenging Trend in Addressing the Customers Within Sustainable Food Consumption—A Case Study of Slovakia

The meat consumption at the current level is highly unsustainable. Because of the problems that meat production causes to the environment, it is considered as one of the main problems. Vegetarian and vegan private label products represent a new challenging trend in addressing the customers within sustainable food consumption at affordable prices. The submitted paper aimed to find out whether Slovak consumers know and subsequently buy products of the private brand targeted on vegans and vegetarians, in which product categories they do so, how they perceive them and what attracts and discourages them. The research was carried out in the period from September to December 2020, when a total of 2,011 respondents from all over Slovakia took part. As we have focused only on consumers who know the product line of private labels targeted on vegans and vegetarians (product line of vegan and vegetarian products), we have further analyzed and interpreted only the answers of 978 respondents. For the need to obtain the main aim of the research, we have formulated four theoretical assumptions and five hypotheses, whose veracity was verified with the use of selected statistical methods and techniques processed out at statistical programs XL Stat, SAS Enterprise Guide 7.1. and SAS 9.4. The key finding of our research is, that even if it could be assumed that the products of this specific private label will be bought only by respondents from the vegan or vegetarian category, the opposite is true—the private label is known and bought by the respondents from the category “I eat everything,” which means that it is necessary to think about this product line, to wider it and continue in the improvement of its quality as this is what the customers want.

Characteristics of the Audience Reached by the National Network of Sexually Transmitted Disease Clinical Prevention Training Centers and Correlation With Sexually Transmitted Infection Rates, 2015 to 2020.

The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC) trains clinical providers to diagnose and treat sexually transmitted infections (STIs) in the United States. The purpose of this study was to examine the demographics of clinical providers and to correlate the number of training episodes with STI rates at the county level. Registration data were collected between April 1, 2015, and March 31, 2020, in a custom Learning Management System from clinical providers taking NNPTC training. Using the 2018 STI surveillance data, counties were divided into quartiles based on reportable STI case rates and the number of county-level training events was compared per quartile. Univariate and multivariate analyses were conducted in IBM SPSS Statistics 23 (Armonk, NY) and SAS Enterprise Guide 7.1 (Cary, NC). From 2015 to 2020, the NNPTC trained 21,327 individuals, predominantly in the nursing professions and working in a public health environment. In multivariate analysis, the number of training events was significantly associated with higher STI rates at the county level (P < 0.0001) and the state where a prevention training center is located (P < 0001). The analysis suggests that NNPTC trainings are reaching the clinical providers working in geographic areas with higher STI rates.