Support Unit Research Articles

Impact of Palivizumab in Preventing Severe Acute Lower Respiratory Infection in Moderate-to-Late Preterm Infants: A Nationwide Cohort Study.

Respiratory syncytial virus (RSV) prophylaxis using palivizumab effectively reduces RSV-associated morbidity in preterm infants. In Korea, national insurance coverage for palivizumab was implemented in October 2016 for moderate-to-late preterm (MLPT) infants born during the RSV season (October-March) who have older siblings. However, no large-scale studies have investigated the changes in the incidence and risk of severe acute lower respiratory infections (ALRIs) after insurance coverage implementation for MLPT infants. This large-scale retrospective cohort study used data from the Korean National Health Insurance Service between October 2013 and December 2019. MLPT infants (32 0/7-35 6/7 weeks of gestation) with older siblings were stratified into pre-insurance period (PIP; October 2013-September 2016) and insurance period (IP; October 2016-March 2019) groups based on the date of birth with respect to initial insurance palivizumab implementation. Severe ALRI outcomes (hospitalization, respiratory support, and intensive care unit admission) were evaluated up to 1 year of age using multivariable logistic regression models. Of the 11,722 MLPT infants included in the study, 6,716 and 5,006 infants were included in the IP and PIP groups, respectively. The incidences of ALRI-hospitalization and ALRI-respiratory support were significantly lower in the IP group than that in PIP group (24.0% vs. 26.0% and 3.1% vs. 4.0%, respectively). Additionally, ALRI-respiratory support risk was significantly lower in the IP group (adjusted odds ratio 0.771, 95% confidence interval 0.626-0.949, P = 0.014) than that in the PIP group. Among infants born during the RSV season, the risk of ALRI-hospitalization and ALRI-respiratory support were significantly lower in the IP group than that in the PIP group. However, no significant differences were observed between the IP and PIP groups for infants born during the non-RSV season. The risks of severe ALRI outcomes decreased in Korea following the 2016 insurance implementation of palivizumab prophylaxis for MLPT infants born during the RSV season with older siblings.

Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study.

The Spanish Emergency Medical Services, according to the model we know today, were formed during the 80s and 90s of the 20th century. The Health Emergency Service (EMS), 061 La Rioja, began to assist the population of La Rioja in November 1999. An essential part of the mission of the SES is the provision of care and the transfer of critical patients using advanced life support unit (ALSU) techniques. In daily practice, out-of-hospital emergency services are faced with situations in which they must deal with the care of serious or critically ill patients, in which the possibility of being able to channel peripheral vascular access as part of ALSU quickly may be difficult or impossible. In these cases, cannulation of intraosseous (IO) vascular access may be the key to early and adequate care. This study aimed to determine the incidence and epidemiology use of IO vascular access in SES 061 La Rioja during the year 2022. We performed observational retrospective cross-sectional studies conducted in 2022. It included a population of 4.364 possible patients as a total of interventions in the community of La Rioja in that year. A total of 0.66% of patients showed a clinical situation that required the establishment of IO vascular access to enable out-of-hospital stabilization; this objective was achieved in 41.3%. A total of 26.1% of patients who presented with cardiorespiratory arrest (CA) were stabilized, while 100% presented with shock and severe trauma. IO vascular access provides a suitable route for out-of-hospital stabilization of critically ill patients when peripheral vascular access is difficult or impossible.

МЕТОДИКА РОЗРАХУНКУ ОБМІННОГО ФОНДУ МАЙНА ЗВ’ЯЗКУ ЧАСТИН НАЦІОНАЛЬНОЇ ГВАРДІЇ УКРАЇНИ

In the conditions of modern highly maneuverable combat operations and the presence of the enemy's powerful means of defeat, the restoration of the combat capability of communications equipment in the shortest possible time and its maintenance at a certain level depend on the clear organization and timely performance of technical support tasks regarding the staffing of military units and units of the NGU with communications property connection (MZ), maintaining it in constant readiness for use as intended, quick restoration and implementation. These tasks can be partially solved due to the creation of a special exchange fund, intended for the prompt replenishment of communications assets that have turned out to be inoperable or were lost as a result of hostilities. The main task of technical support of communications (TSC) is to carry out a set of measures to equip military units and subdivisions of the National Guard of Ukraine (NGU) with communications equipment, maintain it in constant readiness for intended use, and quickly restore and put it into operation. The purpose of the study is to develop a methodology for calculating the exchange fund of communication property (EFCP) of the NGU units. The article proposes a solution to the problem of determining the optimal structure of the exchange fund of the NGU units, and reveals the methods of calculating the amount of communication property (CP) for different strategies of using the exchange fund. Based on the results of the study carried out in the article, the main directions for improving the system of M&E in the NGU are identified. The method described in the article can be recommended for use by the personnel of the communication technical support units of the NGU when forming an exchange fund for communication property and developing relevant instructions for the material support of the troops.

ОБГРУНТУВАННЯ ПОКАЗНИКА ЕФЕКТИВНОСТІ РОБОТИ ЗАГОНУ ЗАБЕЗПЕЧЕННЯ РУХУ КОЛОН ПІД ЧАС МАРШУ

The article shows the necessity of improving the system of task performance by the detachment of ensuring the movement of columns during the march. The successful performance of combat tasks by units and units of the Armed Forces of the Armed Forces of Ukraine is not possible without comprehensive support, in particular, without such an important type of operational (combat) support as engineering, which is organized for the purpose of timely and covert deployment of troops (forces), conducting maneuvers by them, creating the necessary conditions for the successful performance of assigned tasks, increasing the level of protection of troops (forces) and objects from the enemy's means of destruction, assigning losses to the enemy and complicating his actions. The engineering support of combat operations of units is inextricably linked with the implementation of a certain management procedure, the development of options for working out the received tasks and the purposeful use of engineering units. One of the important tasks of combat engineering support is the preparation and maintenance of troop (force) movement routes. Preparation and maintenance of troop movement routes (forces) is carried out in all types of combat operations, on the march and in the deployment of troops in place. The existing indicators for evaluating the level of efficiency of the use of machines do not allow for a generalized assessment of the level of effectiveness of tasks performed by the detachment ensuring the movement of columns during the march. Therefore, there was a need to obtain a dependency for evaluating the effectiveness of tasks performed by the unit to ensure the movement of columns during the march. In order to determine the efficiency of the convoy movement support unit, it is proposed to use the coefficient of performance of tasks by the column movement support unit during the march. Dependencies for evaluating the effectiveness of tasks performed by the squad to ensure the movement of columns during the march allow you to determine the influence of various factors on the efficiency indicator and outline ways to meet the specified requirements for modern models of engineering machines. A practical calculation was carried out.

Implementation of procedures by the Mobile Emergency Care Service (SAMU 192) in Brazil: performance, benchmarking, and challenges

The scope of this article is to describe and analyze the production of approved procedures carried out by regulation centers and mobile resources of SAMU 192 between 2015 and 2019, according to frequency, population-based indicators, and daily productivity, to establish a performance indicator. It consisted of an observational and descriptive census study, with production data drawn from the Outpatient Information System, and population data from the Brazilian Institute of Geography and Statistics and information from the Ministry of Health. The 116.8 million procedures analyzed resulted from a 28.5% increase in the period, while the population covered and mobile resources grew by 9.7% and 14.4%, respectively. Every 1,000 inhabitants covered generated 109.8 calls, resulting in 24.0 mobile resource dispatches per year. Basic support units performed 3.3 consultations, and 0.5 transfers daily, while advanced support performed 2.7 consultations and 0.9 transfers. The production of procedures exceeded the increase in the population covered, with variations between states, high incidence in populated areas, a strong presence of basic support and an increase in transfers, although national productivity was seen to be lower than international productivity.

СОВЕРШЕНСТВОВАНИЕ ТЕХНОЛОГИИ ДИАГНОСТИРОВАНИЯ ОПОРНЫХ УЗЛОВ ТРАНСМИССИИ АВТОМОБИЛЯ КАМАЗ-55111

The paper presents trends in the development of automatic diagnostics systems for mechanical transmission units. (Research purpose) The research purpose is substantiating the technology of automatic identifying the pre-failure condition of transmission units. (Materials and methods) The supporting components of the KamAZ-55111 transmission with rolling bearings 50412 and 53610 were chosen as the research material. The analysis of existing methods of labor intensity, methods for calculating machine parts, reference information on bearings, finite element analysis of temperature fields and regression analysis were used. (Results and discussion) The characteristics of the indicators of the transmission support units (rolling bearings) were described, methods of their diagnosis were considered. The forces acting on the bearings on the secondary and intermediate shafts of the KamAZ-55111 car were calculated. The design, technological and operational parameters were used to calculate the temperature in the friction zone. In order to improve the diagnostic technology, temperature fields were simulated using the APM FEM CAD Compass 3D application. A device for automatic temperature measurement in the friction zone and a sensor for temperature measurement have been developed. (Conclusions) The reliability of the transmission support units of agricultural machinery is affected by the working conditions. It was established that the most effective method of diagnosing the complexity of the transmission is the method of thermodiagnostics. Analysis of the temperature in the friction zone of bearings 50412 and 53610 from first to fourth gear showed a decrease in temperature. The study of temperature field maps made it possible to establish the relationship between the temperatures in the friction zone and in the control zone of bearings 50412 and 53610. A recorder for automatic monitoring of the technical condition of the nodes has been developed and tested.

Causes of Child Marriage and its Effects on Maternal Health of Teenage Mothers in Chereponi District, Ghana

The purpose of the study was to investigate child marriage and its effects on maternal health of teenage mothers in the Chereponi District in the North East Region of Ghana. The study used a quantitative approach underpinned by descriptive survey design. A sample size of 150 was selected using purposive sampling technique. Child marriage questionnaire, psychological general well-being and a demographic questionnaire were used to collect data. Data was analysed using frequency, percentage, mean and standard deviation using SPSS version 25.0. Findings revealed that child marriage is caused by poverty and economic demands, the protection of girls’ sexuality as a means of strengthening family relations, socio-cultural and religious factors, and preventing premarital sex. The study also found that child marriage has profound impact on the maternal health of teenage mothers. Again, girls should be oriented to take their studies seriously and report any early signs of child marriage to Domestic Violence and Victims Support Unit and Social welfare for prompt action. The study recommended that there should stringed measures where perpetrators of child marriage will be sanctioned by law. The study further recommended that girls should be given enough psychoeducation on the effects of child marriage. Finally, it was again recommended that counsellors and psychologists should provide counselling to girls to be self-assertive and provide economic empowerment strategies to make girls less dependent and vulnerable.

Conflict Prevention in Sub-Regional Institutions: The Case Study of IGAD in Ethiopia from 2015-2020

Conflict prevention is the primary objective of the Inter-Governmental Authority on Development (IGAD). Despite efforts made by the institution, it has, however, not succeeded in preventing conflict in Ethiopia. IGAD, like other sub-regional institutions in Africa, has established an early warning early response mechanism and a Mediation Support Unit that is aimed at preventing conflicts. The study examines the legal and institutional framework of IGAD for conflict prevention. A qualitative case study research design was employed in this study. Purposive and snowball sampling were used to select eighteen informants for the study, and data was collected using semi-structured in-depth interviews, document reviews, and literature reviews. Five themes have been identified for data analysis. The findings show that the legal and institutional framework of IGAD is relevant for preventing conflict, however, it has identified several limitations within and beyond the scope of the legal and institutional framework.

Optimising Same Day Emergency Care (SDEC) Delivery Within a Leading Tertiary Cancer Centre in Southeast Wales

Expansion and enhancement of Same Day Emergency Care at Velindre Cancer Centre during 2022 compromises of Ambulatory Care Unit, Assessment Unit, Patient Support Unit and Immunotherapy toxicities service.
 To provide better value-based healthcare we have introduced an Immunotherapy Toxicities service plus expanded the existing Ambulatory Care Unit and Patient Support Unit providing 12-hour weekday working including a weekend service. 
 The need for a dedicated Immunotherapy service was highlighted following NHS data which anticipated a growth of 240% in Immunotherapy treatments over the next 5 years with Immunotherapy treatments having already increased by 49% from 2018/19 to 2020/21. 
 Without investment this would have led to increasing admissions in South East Wales Health Boards by over 320 patients per annum. This increase would perpetuate the strain on the Ambulatory Unit within VCC and Local Health Boards emergency departments due to the need to admit the patients experiencing toxic side-effects with no viable alternative.
 The development of the Immunotherapy service has allowed for a clear alternative to emergency/unscheduled admission by ensuring robust pathways are in place, 24/7 resilience and support of toxicities, increased patient and staff education in managing toxicities and rapid treatment and management of patients. 
 The Ambulatory Care provision has expanded working hours as well as supporting a weekend service to ensure more timely interventions for patients on a same day basis, enhancing care and clinical outcomes plus removing additional demand on Local Health Boards by preventing admission. 
 Since 2019 the Patient Support Unit has seen a 51% reduction for inpatient admissions for head and neck cancer with the average monthly bed days for patients reduced by 45%. Through service expansion it has been predicted that admissions and length of stay are likely to reduce by a further 10-15%. This will further decrease the burden on external services such as acute hospitals with an ever growing demand on the services.
 The expansion has improved access to a skilled multidisciplinary team including specialist nurses, dieticians, speech and language therapists, physiotherapists and occupational therapists who will all work together to ensure all patients are cared for through robust interventions with timely follow ups.
 The model of delivery is innovative and forward thinking and endorsed by patients and staff alike. The joint MDT allows professionals to anticipate, ameliorate and treat complex and rapidly changing symptoms as an outpatient. 
 The services discussed are essential in reducing the burden on internal and external services whilst ensuring the patient has the best possible outcome. Through clear robust pathways and an upskilled workforce, the service will be sustainable for years to come whilst patients are dealt with in the best way possible in an Ambulatory manner.
 The outcome is a sustainably funded, evidence-based patient-centred service offered in a day case setting, that anticipates and manages complex toxicities and challenging symptoms that develop at different points during the treatment pathway. With these side effects managed on an ambulatory basis, it prevents patients requiring prolonged inpatient admission, a wider benefit for our partners in Local Health Boards.

Swedish social workers’ support to female survivors breaking free from male intimate partner violence

ABSTRACT This study sheds light on how Swedish social workers interpret and handle support needs of female survivors trying to break free from male intimate partner violence (IPV). This is investigated through fifteen group interviews with forty-nine social workers in thirteen different organizations (social service support units and shelters run by NGOs and for-profit companies). The material is analysed thematically. The first theme focuses on how social workers saw structural obstacles that hindered survivors from leaving their abusive men, but felt that their discretion (cf. Lipsky 2010) to change these were limited. Instead, they directed support towards emotional obstacles. The second theme illustrates differences and difficulties in offering survivors long-term, holistic support to break free from post-separation violence, and how support risk becoming a lottery where survivors might not always receive the support they need. The study indicates that social workers in NGO women’s shelters may try to deal with structural obstacles and offer ‘holistic’ support. Social workers in organizations with other perspectives and limited resources may instead delimit support – and (unintentionally) treat violence as an individual rather than social problem.

Optimization of Real-Time Operational Data Monitoring Through Installing The Device on the Unit

Coal is the largest natural resource in Indonesia and has a vital role in global energy in various industries. PT Putra Perkasa Abadi (PPA), a mining contractor in South Kalimantan, faces problems with manual reporting being late and prone to errors. This project aims to speed up the digitization of the reporting process by providing PPA Team devices in the Heavy Equipment (A2B) and Support units. This is in line with the commitment of the PPA Mining Work Safety, Environment and Quality (K3PLM) Policy. This implementation starts from observation and data collection by selecting SS6 devices and creating designs for each unit. Continue with device installation, analyze problems, and repair installation. Following, carry out trials and socialize the use of the device to operators. With the implementation of the PPA Team application on the SS6 Monitor, Operators at PPA can independently input data on operational activities, including check-in / check-out units. It will reduce paper in operational reporting by providing an SS6 Monitor device. In addition, cost calculations can be adjusted to actual data, and operators can monitor unit Hour Meter (HM) data and operational activities directly on the SS6 Monitor. This reduces the duration of data input time, but also reduces the intensity of crowding on communication radios, and minimizes data input errors. Therefore, optimizing operational monitoring at PPA by installing devices on units can increase efficiency, including HM input for cost calculations, efficient unit HM reporting, fast check-in / check-out processes, digital unit breakdown reporting for more efficient communication, rapid digital validation of P2H, and moving from paper forms to digital tools for more sustainable work practices.

PROBLEMS OF IMPROVING OF DYNAMIC MODELS OF CYLINDRICAL ROLLER BEARINGS

Designing of construction of a bearing cage base on empirical data does not provide an opportunity to assess the impact of many structural and operational factors. Therefore, there is a need to develop analytical models of the functioning of roller bearings in order to determine the magnitude of the loads imposed on the separator by bearing parts. For this purpose, it is necessary to improve the models of the statics, kinematics and dynamics of bearing heads. This article examines high-capacity bearings with straight rollers of the normal accuracy grade, which, unlike bearings with taper rollers, allow higher operating speeds. The lack of a scientifically based model of the kinematics of straight roller bearings of the normal accuracy grade does not allow building an adequate model of their dynamics and therefore assessing the performance of their parts, which affects the reliability of machine support units. The analysis of the technical literature enables revealing that the vast majority of the articles on dynamics models are devoted to the speed group, which is used in the aviation and space industries. The dynamics of low-speed straight roller bearings under heavy operating conditions are the most extensively studied for the supporting units of the rolling stock of railway transport. We have determined the basic tasks for improving the dynamics models of low-speed straight roller bearings of normal accuracy grade, which are aimed at optimizing the kinematics models and studying the dynamics of the bearings in the areas loaded and unloaded by external forces, taking into account misalignment of the rings and deformation of the cage. The task of improving the dynamics models will include the development of 3D models of the interaction of the cage with the rollers in the radial load area, as well as the cage with the base ring, taking into account misalignment of the parts. New models of the bearing dynamics enable determining the forces of interaction of the parts under any operating mode to assess their performance and design optimal constructions of the cage. Key words: roller bearing, dynamics models, radial load area, cage, rollers

Using collective intelligence methods to improve government data infrastructures and promote the use of complex data: The example of the Northern Ireland Longitudinal Study

BackgroundThis paper discusses how collective intelligence (CI) methods can be implemented to improve government data infrastructures, not only to support understanding and primary use of complex national data but also to increase the dissemination and secondary impact of research based on these data. The case study uses the Northern Ireland Longitudinal Study (NILS), a member of the UK family of census/administrative data longitudinal studies (UKLS).MethodsA stakeholder-engaged CI approach was applied to inform the transformation of the NILS Research Support Unit (RSU) infrastructure to support researchers in their use of government data, including collaborative decision-making and better dissemination of research outputs.ResultsWe provide an overview of NILS RSU infrastructure design changes that have been implemented to date, focusing on a website redesign to meet user information requirements and the formation of better working partnerships between data users and providers within the Northern Ireland data landscape. We also discuss the key challenges faced by the design team during this project of transformation.ConclusionOur primary objective to improve government data infrastructure and to increase dissemination and the impact of research based on data was a complex and multifaceted challenge due to the number of stakeholders involved and their often conflicting perspectives. Results from this CI approach have been pivotal in highlighting how NILS RSU can work collaboratively with users to maximize the potential of this data, in terms of forming multidisciplinary networks to ensure the research is utilized in policy and in the literature and providing academic support and resources to attract new researchers.

A matching-adjusted indirect comparison of the efficacy of elranatamab versus physician’s choice of treatment in patients with triple-class exposed/refractory multiple myeloma

Introduction For patients with triple-class exposed/refractory multiple myeloma (TCE/R MM), prognosis is poor and effective treatment options are limited. Elranatamab is a novel B-cell maturation antigen (BCMA)- and CD3-directed bispecific antibody which was approved by the US Food and Drug Administration in August 2023 and demonstrated safety and efficacy in patients with TCE/R MM in the phase 2, single-arm MagnetisMM-3 trial (NCT04649359). To compare the effectiveness of elranatamab vs physician’s choice of treatment (PCT) in the absence of head-to-head comparative data, a matching-adjusted indirect comparison (MAIC) was conducted. Methods Individual patient data from MagnetisMM-3 (Cohort A [BCMA-naïve] N = 123, 14.7 months of follow-up) were reweighted to match published summary data from two real-world studies of PCT in patients with TCE/R MM (LocoMMotion and MAMMOTH) using a propensity score-type logistic regression. Unanchored MAIC analyses were conducted according to National Institute for Health and Care Excellence (NICE) Decision Support Unit (DSU) 18 guidance. Results Compared with PCT in LocoMMotion, elranatamab was associated with a significantly higher objective response rate (ORR rate difference: 37.52; 95% CI 26.20–48.83; odds ratio: 4.85; 95% CI 2.85–8.23) and complete or stringent complete response rate (≥CR rate difference: 42.29; 95% CI 31.84–52.74; odds ratio: 184.01; 95% CI 24.66–1372.86), longer progression-free survival (PFS HR 0.32; 95% CI 0.20–0.49), and overall survival (OS HR 0.62; 95% CI 0.40–0.94). Compared with PCT in MAMMOTH, elranatamab was associated with significantly higher ORR (rate difference: 28.14; 95% CI 16.77–39.52; odds ratio: 3.24; 95% CI 1.98–5.32) and ≥ CR (rate difference: 26.22; 95% CI 16.40–36.05; odds ratio: 5.48; 95% CI 2.88–10.44), as well as longer PFS (HR 0.25; 95% CI 0.17–0.37) and OS (HR 0.49; 95% CI 0.33–0.71). Sensitivity analysis results were consistent with the base case. Conclusion In the MAIC, elranatamab was consistently associated with improved rates and depth of response and significantly longer PFS and OS versus PCT in LocoMMotion and MAMMOTH.

ВИЗНАЧЕННЯ ЗАЛЕЖНОСТІ ВТРАТ ОСОБОВОГО СКЛАДУ РЕМОНТНО-ВІДНОВЛЮВАЛЬНИХ ПІДРОЗДІЛІВ НА ЗБІРНОМУ ПУНКТІ ПОШКОДЖЕНИХ МАШИН

For the timely and high-quality restoration of weapons and military equipment that received combat or operational damage during the conduct of hostilities (operations), military command and control bodies carry out technical support planning measures during which one of the stages is to determine the capabilities of repair and restoration units (military units) . The experience of conducting combat operations during the anti-terrorist operation and the operation of the joint forces on the territory of the Donetsk and Luhansk regions indicates inaccuracies in the mathematical dependencies for determining the capabilities of repair and restoration units to carry out repair work during the planning of technical support. These mathematical dependencies do not take into account the losses of repairmen in the absence of a proper camouflage pattern for weapons and military equipment. The disguise of technical support units and subunits consists in the elimination or weakening of unmasking signs that reveal the purpose and nature of the tasks they perform. Therefore, the purpose of the article is to determine the dependence of the average daily losses of repair specialists on the organization of masking the assembly point of damaged vehicles. For more accurate calculations, the article takes into account the determination of the rational parameters of the horizontal mask, deformable pixel coverage of equipment, as well as the mathematical dependence of determining the production capabilities of repair and restoration units for the repair of damaged weapons and military equipment, taking into account the average daily sanitary, permanent and psychogenic losses of personnel. Keywords: horizontal camouflage net, pixelated coverage of equipment, repair and restoration units (parts), repair, specialists, losses

Post-conflict Rehabilitation: Understanding the Role of Civil-Military Cooperation in Supporting Child Protection Units (CPUs) in Newly Merged Districts (NMDs), Pakistan

Post-conflict Rehabilitation: Understanding the Role of Civil-Military Cooperation in Supporting Child Protection Units (CPUs) in Newly Merged Districts (NMDs), Pakistan

Māori end-of-life care in the intensive care unit: A qualitative exploration of nursing perspectives

BackgroundAlthough goals of care for intensive care patients are typically focussed on restoration of health, 8–15% of patients will die in the intensive care unit (ICU), or soon after transfer to a ward. Early recognition of the need for end-of-life care is vital to identify and support the wishes of the patient and needs of their family. In Aotearoa, New Zealand, Māori are over-represented in admissions to ICUs. Enabling nursing staff to provide culturally safe care to Māori patients and whānau (family, including extended family, kin) at the end of life is critical to upholding Te Tiriti o Waitangi requirements and providing equitable care. This qualitative study explores the experiences of both Māori and non-Māori intensive care nurses, in providing end-of-life care for Māori patients and their whānau. ObjectivesThe objective of this study was to characterise nursing experiences of end-of-life care for Māori in the ICU, identify barriers to and facilitators of confident, competent culturally responsive care, and highlight opportunities to improve preparation and support. MethodsQualitative semistructured interviews were undertaken with nine intensive care nurses (four Māori and five non-Māori) with experience ranging from novice to expert. Data collection and analysis was underpinned by reflexive thematic analysis strengthened by Kaupapa Māori Research values and tikanga best practice. FindingsParticipants described positive and negative experiences in caring for Māori at the end of life. Culturally responsive end-of-life care for Māori in intensive care appears dependent on the acknowledgement and inclusion of whānau as members of the multidisciplinary team. Participants identified a need for high-quality education, supportive unit end-of-life care guidelines and hospital policies, and cultural resources to confidently provide quality end-of-life care. ConclusionImproved understanding of Māori culture, critical awareness of systems of power and privilege, and the availability of cultural liaisons may increase the confidence and competence of ICU nurses providing care to Māori whānau.

Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study

ObjectiveSelective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health...

A Matching-Adjusted Indirect Comparison of the Efficacy of Elranatamab Versus Physician's Choice of Treatment in Patients with Triple-Class Exposed/Refractory Multiple Myeloma

BACKGROUND For patients with triple-class exposed/refractory multiple myeloma (TCE/R MM), prognosis is poor and limited effective treatment options are available. Elranatamab is a novel B-cell maturation antigen (BCMA)- and CD3-directed bispecific antibody that demonstrated safety and efficacy in patients with TCE/R MM in the phase 2, single-arm MagnetisMM-3 trial (NCT04649359). To compare the effectiveness of elranatamab vs physician's choice of treatment (PCT) in the absence of comparative data, an unanchored matching-adjusted indirect comparison (MAIC) was conducted. METHODS Individual patient data (IPD) from the 14.7-month follow-up of MagnetisMM-3 (Cohort A [BCMA-naïve] N=123) was matched to published summary data from two real-world studies of PCT: LocoMMotion ([NCT04035226]), an ongoing, prospective, non-interventional study of PCT in patients with TCE MM (N=248); and MAMMOTH, a multicenter, retrospective study investigating the history and outcomes of patients with TCE MM who received subsequent therapies (N=177). To adjust for differences in baseline characteristics, patients from MagnetisMM-3 were reweighted to match those in LocoMMotion reported in Mateos et al (2022) and MAMMOTH reported in Bal et al (2022). The base-case adjustment variables were selected based on univariate Cox regressions using the MagnetisMM-3 IPD, a systematic literature review of prognostic variables and effect modifiers in RRMM, a review of the prognostic variables identified in clinical studies for TCE/R MM, a review of the recent analogous indirect comparisons, and confirmation by clinical experts. Weights were determined using a propensity score-type logistic regression via the method of moments (Signorovitch et al. 2012) based on age, median time since diagnosis, International Staging System disease stage, high-risk cytogenetics, extramedullary disease, number of prior lines of therapy, Eastern Cooperative Oncology Group performance status, creatinine clearance, and penta-exposed and penta-refractory status (where available). In the analysis for the endpoint of overall survival (OS), sex was also included in the analysis. A sensitivity analysis was conducted in which missing values of the adjusted baseline characteristics for elranatamab were imputed by a random sample of the observations in MagnetisMM-3 to potentially increase the effective sample size (ESS). Unanchored MAIC analyses used the R Studio statistical code provided in the National Institute for Health and Care Excellence Decision Support Unit 18 by Phillippo et al (2016) . In the MAIC vs LocoMMotion & MAMMOTH, adjusted objective response rate (ORR), complete response rate or better (≥CR), progression-free survival (PFS), and OS at 15 months for elranatamab were compared with PCT. Results were reported as rate differences, which is the difference between the ORR or ≥CR rates of elranatamab and PCT, and odds ratios (ORs) for binary endpoints and hazard ratios (HRs) for time-to-event endpoints, with two-sided 95% confidence intervals (CIs). RESULTS In the MAIC for elranatamab vs PCT in LocoMMotion, the post-matching ESS was 68 for all endpoints in the base case. Compared with PCT in LocoMMotion, elranatamab was associated with a significantly higher ORR (rate difference: 37.52; 95% CI 26.20-48.83; OR: 4.85; 95% CI 2.85-8.23), higher ≥CR (rate difference: 42.29; 95% CI 31.84-52.74; OR: 184.01; 95% CI 24.66-1372.86), and longer PFS (HR 0.32; 95% CI 0.20-0.49) and OS (HR 0.62; 95% CI 0.40-0.94) (Table 1). In the MAIC vs PCT in MAMMOTH, the base-case post-matching ESSs were 100 for all endpoints. Compared with PCT in MAMMOTH, elranatamab was associated with a significantly higher ORR (rate difference: 28.14; 95% CI 16.77-39.52; OR: 3.24; 95% CI 1.98-5.32) and ≥CR (rate difference: 26.22; 95% CI 16.40-36.05; OR: 5.48; 95% CI 2.88-10.44). Elranatamab also had longer PFS (HR 0.25; 95% CI 0.17-0.37) and OS (HR 0.49; 95% CI 0.33-0.71) than PCT (Table 2). Sensitivity analysis results were consistent with the base case. CONCLUSIONS In this MAIC, elranatamab demonstrated significantly higher ORR, higher ≥CR rate, longer PFS, and longer OS compared with PCT in the real-world. These results suggest that elranatamab offers significantly improved outcomes versus standard treatments used in patients with TCE/R MM in clinical practice.

A Matching-Adjusted Indirect Comparison of the Efficacy of Elranatamab Versus Physician's Choice of Treatment Among Patients with Triple-Class Exposed/Refractory Multiple Myeloma in Canada

BACKGROUND Given the poor prognosis and limited treatment options for patients with triple-class exposed/refractory multiple myeloma (TCE/R MM), there is a strong unmet need for novel interventions. Elranatamab, a B-cell maturation antigen (BCMA)- and CD3-directed bispecific antibody, recently demonstrated efficacy and safety in patients with TCE/R MM in the phase 2, single-arm MagnetisMM-3 trial (NCT04649359). The effectiveness of elranatamab was compared with physician's choice of treatment (PCT) in Canada through an unanchored matching-adjusted indirect comparison (MAIC), due to the absence of mature head-to-head comparative trial data. METHODS Individual patient data (IPD) from 14.7-month follow-up of MagnetisMM-3 (Cohort A [BCMA- naïve] N=123) was weighted to match published summary data from Canadian Myeloma Research Group (CMRG) database, which reported treatment patterns and outcomes on real-world patients with TCE/R MM in Canada (N = 199). Only BCMA-naïve patients from the MagnetisMM-3 trials were considered as BCMA therapies are not currently available as standard of care treatment options in Canada. To adjust for differences in baseline characteristics, patients from MagnetisMM-3 were reweighted to match those reported in the CRMG database. The adjustment variables were selected based on univariate Cox regressions using the MagnetisMM-3 IPD, a systematic literature review of prognostic variables and effect modifiers in relapsed or refractory MM, and a review of the recent analogous indirect comparisons, and confirmation by clinical experts. Weights were determined using a propensity score-type logistic regression via the method of moments (Signorovitch et al. 2012), based on age, median time since diagnosis, and number of prior lines of therapy. In the analysis for the endpoint of overall survival (OS), sex was also included in the analysis. A limitation of this MAIC is that key prognostic variables, such as International Staging System disease stage, cytogenetic risk, and extramedullary disease, were not adjusted for in the analysis as the definitions were not comparable between the data sources. Unanchored MAIC analyses used R code provided in the National Institute for Health and Care Excellence (NICE) Decision Support Unit (DSU) 18 by Phillippo et al (2016). The respective outcomes in the MAIC were OS and progression-free survival (PFS) based on the 15-month follow-up data for elranatamab. Results were reported as hazard ratios (HRs) for time-to-event endpoints, with 95% confidence intervals (CIs). RESULTS Median PFS and OS was not reached in the MagnetisMM-3 trial. Patients with TCE/RMM treated with PCT had a median PFS of 4.4 months (95% CI 3.6 - 5.3) and a median OS of 10.5 months (95% CI 8.5 - 13.8). Following weighting, the summary statistics of key baseline characteristics were matched between elranatamab and CMRG. The effective sample size was 82 post-matching for PFS and 81 post-matching for OS. Compared with the patients in the CMRG database, elranatamab was associated with better PFS (HR: 0.36; 95% CI 0.23 - 0.54) and better OS (HR: 0.48; 95% CI 0.32 - 0.73). CONCLUSIONS In this MAIC, among TCE/R MM patients elranatamab demonstrated a significantly longer OS and PFS compared with PCT in the real-world setting reported in the CMRG database.