Significant Improvement In Median Time Research Articles

ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore

BackgroundTo test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital.MethodsThe ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months.ResultsVC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value < 0.001) of acute inpatient complications such as delirium, pneumonia, urinary tract infections, and pressure sores. VC program has shown significant reduction in median length of stay for acute hospital (13 to 9 days) as well as median combined length of stay for acute and sub-acute rehabilitation hospital (46 to 39 days), thus reducing the total duration of hospitalization and saving total hospital bed days. Operative and inpatient mortality, together with readmission rates, remained low and comparable to international Geriatric Fracture Centers (GFCs).ConclusionThe implementation of VC methodology has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

Effectiveness of a multicenter training programme to teach point-of-care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes

BackgroundThe primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD-scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes.MethodsFive podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1-day), supervised scanning (5-weeks), independent scanning (3-weeks) and a final evaluation of performance (1-day).Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD-scan assessment) were assessed for every supervised scan and again for the final evaluation of performance.ResultsA total of 90 PAD-scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9–25.5) vs 9.3 min (IQR 7.3–10.5);p = 0.028) and DUOSATS scores (17.5 (IQR 16.8–21) vs 25 (IQR 24–25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3–5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist.ConclusionA structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD-scan

PTH-141 Gastrointestinal Malignancy – Same Day CT Scanning Post Endoscopy Saves Time Resulting in Earlier MDT Decisions

Introduction Staging CT scanning is essential in guiding the management of patients with newly diagnosed gastrointestinal malignancy when discussed in multi-disciplinary team (MDT) meetings. Long waiting times for staging CT causes delays in MDT decision making for patients and initiating treatment. Kettering General Hospital (KGH) implemented a pathway in December 2014 in which patients with newly detected malignancy on endoscopy can have staging CT scan post endoscopy (same day). We are auditing the effectiveness of this pathway in terms of time saved. Methods Data was analysed between January 1st 2014 to December 31st 2015 from endoscopy, radiology and cancer MDT reporting systems to compare time from day of endoscopy to day of CT and to date of MDT discussion pre and post implementation of the pathway. Patients who underwent endoscopy in December 2014 were excluded, as the pathway was being implemented. Results There were 90 and 104 patients found to have new possible malignancy on endoscopy in 2014 and 2015 respectively. The median (and mean) days awaiting staging CT and MDT discussion prior to the pathway were 12.5 (11.4) days and 15.0 (16.0) days respectively. Since the implementation of the pathway, median (and mean) days for staging CT was 0 (1.6) days and MDT discussions were 6.0 (7.2) days (p = Conclusion This data shows significant improvement in median time to MDT discussion from endoscopy since the pathway was implemented (15 vs 6 days). The patient pathway implemented by our organisation has helped shortened decision time for MDT outcomes and is highly effective in improving patient care. Patients are diagnosed and staged quickly, requiring fewer visits to the hospital and starting their treatment earlier. We commend this pathway to other endoscopy / radiology departments around the country. Disclosure of Interest None Declared

Evaluation of tumour vaccine immunotherapy for the treatment of advanced non-small cell lung cancer: a systematic meta-analysis

ObjectivesOur meta-analysis performed a systematic evaluation on the therapeutic efficacy and safety of tumour vaccines for the treatment of advanced non-small cell lung cancer (NSCLC).DesignSystematic review and meta-analysis of randomised...

Icatibant for the Treatment of Hereditary Angioedema

To review the pharmacology, pharmacokinetics, clinical trials, and safety of icatibant, a recently approved bradykinin B(2) receptor antagonist for treatment of acute attacks of hereditary angioedema (HAE). Articles indexed in MEDLINE (1948-June 2012), International Pharmaceutical Abstracts (1970-May 2012), and Cumulative Index to Nursing and Allied Health Literature (1981-June 2012) were identified using the search terms icatibant, bradykinin B(2) receptor antagonist, and hereditary angioedema. Additional references were identified from the reference lists of the articles identified. English-language articles were reviewed. Icatibant was evaluated in 3 Phase 3 clinical trials and found to be a safe and effective option for treatment of acute HAE. Icatibant was compared to placebo in 2 clinical trials (FAST-1 and FAST-3) and to tranexamic acid in the FAST-2 trial. Patients receiving icatibant in FAST-1 did not experience a significant improvement in median time to clinically significant relief of the index symptom (p = 0.14), whereas patients receiving icatibant in FAST-3 experienced a significant improvement in median time to at least 50% reduction in symptom severity (p < 0.001). When icatibant was compared to tranexamic acid in FAST-2, the median time to clinically significant relief of the index symptom was shorter for patients receiving icatibant (p < 0.001). The most common adverse events associated with the administration of icatibant were injection-site reactions, which were mild to moderate and transient. These data suggest that icatibant is a safe and effective treatment for acute attacks of HAE. Although direct comparisons of recently approved alternatives for treatment of acute attacks are lacking, there are administration advantages of icatibant over other agents. Additionally, the cost of icatibant is comparable to that of the C1 esterase inhibitor Berinert and less expensive than ecallantide. Available efficacy data support that icatibant should be considered a safe and effective treatment for acute attacks of HAE. Additionally, limited treatment options for this rare condition, ease of administration, and comparable cost profile support its consideration for formulary inclusion.

AJ-3 - HER2-Neu in Breast Cancer: History and Future Directions

ABSTRACT Shortly after discovery of epidermal growth factor receptor (EGFR) as an inducer of increased cell growth [1], Weinberg et al. characterized Neu oncogene in rat neuro/glioblastomas [2,3] and later its human homolog was called Human Epidermal growth factor Receptor 2 (HER2) [4]. Then amplification was shown in human breast carcinoma cell lines [5] (Figure 1). Slamon et al. identified that 30% of patients with primary breast cancers harbored HER2 amplification which negatively correlated with survival [6]. In early 1990s, a humanized monoclonal antibody against domain IV of HER2 (trastuzumab, Herceptin®) was developed and it was found to be safe and active in HER+ breast cancer patients. Soon the Chemotherapy and Antibody Response Evaluation (CARE) trial of trastuzumab in combination with chemotherapy was launched for metastatic breast cancer (MBC). This randomized study showed significant improvement in median time to progression (TTP) in combination with trastuzumab and chemotherapy arm compared with chemotherapy alone arm (4.6–7.4 months) [7]. Based on the results of this randomized phase III trial and a single-arm single agent trastuzumab study [8], trastuzumab was approved in HER + MBC in combination with paclitaxel in first and as single agent in second-line setting, respectively. The clear additional benefit of trastuzumab to chemotherapy was also shown in neo-adjuvant [9], and adjuvant settings [10,11]. Laptinib, a dual tyrosine kinase inhibitor (inh) against EGFR and HER2, is the second agent that has been approved by FDA for HER+ patients with MBC in combination with capecitabine [12,13] or letrozole [14]. The additional benefit of laptinib to trastuzumab in heavily pretreated HER2+ MBC improved PFS from 8.1 to 12 months [15]. Homo- and heterodimerization of HER receptors are essential for the signaling and HER2-HER3 heterodimer is the most potent pair in downstream signaling [16]. Pertuzumab is a humanized monoclonal antibody against domain II of HER2 that inhibits HER2 dimerization and the activation of the signaling pathway [16]. CLEOPATRA was a randomized phase III study that launched to test the efficacy of adding pertuzumab to trastuzumab plus chemotherapy (docetaxel) in first-line setting and the results clearly showed the significant improved median progression-free survival (PFS) (18.5 versus 12.4 months) in HER2+ MBC patients [17]. Despite this progress in the treatment of HER2+ breast cancer, the median PFS in CLEOPATRA study was reported to be 18.5 months, which means that half of the patients in

Timing Is Everything: Preclinical Evidence Supporting Simultaneous Rather Than Sequential Chemohormonal Therapy for Prostate Cancer

Androgen ablation is the mainstay of systemic therapy for prostate cancer, with cytotoxic therapies reserved for hormone-refractory disease. It is not clear, however, that this is the most appropriate sequence of interventions for this disease. This study addresses the ideal timing of systemic treatments in the Shionogi and LNCaP xenograft models. We explored the hypothesis that stress-induced gene expression changes after chemotherapy can induce a hormone-independent phenotype. Three groups of mice bearing either Shionogi or LNCaP xenografts were treated with (a) initial castration and delayed paclitaxel, (b) initial paclitaxel and delayed castration, or (c) simultaneous castration plus paclitaxel. End points were time to tumor progression and time to sacrifice. Microarray and reverse transcription-PCR analyses were carried out to assess changes in gene expression induced by paclitaxel. Mice receiving simultaneous therapy showed a significant improvement in median time to progression (TTP: Shionogi, 65 versus 38 days, P = 0.004; LNCaP, 105 versus 70 days, P = 0.032) and time to sacrifice (Shionogi, 83 versus 66 days, P < 0.014) versus best sequential therapy. A marked lack of response to castration was observed after initial paclitaxel therapy. Gene expression and reverse transcription-PCR studies confirmed that several genes known to play a role in androgen independence were up-regulated in response to paclitaxel exposure. In laboratory models of prostate cancer, simultaneous androgen deprivation plus paclitaxel is more effective than sequential treatments. These findings provide preclinical proof-of-principle for ongoing clinical trials addressing the role and timing of systemic therapies in prostate cancer.