Years In Patients Research Articles

Medial and Lateral Meniscus Allograft Transplantation Showed No Difference With Respect to Graft Survivorship and Clinical Outcomes: A Comparative Analysis With a Minimum 2-Year Follow-Up

To compare the differences with respect to clinical and graft survivorship and patient-reported outcomes (PROs) between lateral (LMAT) and medial (MMAT) meniscus allograft transplantation. Patients having a primary MAT between 1998 and 2016 were enrolled. The inclusion criteria were (1) patients who had a minimum 2-year follow-up and (2) patients who had magnetic resonance imaging (MRI) >2 years after surgery. Knees with localized grade 4 articular cartilage lesions >3 cm2 at the time of MAT were excluded. Clinical failure was defined as follows: modified Lysholm score <65, meniscectomy >50% of the graft, meniscectomy to the meniscocapsular junction zone, conversion to revision MAT, or realignment osteotomy or arthroplasty. Graft failure was defined as follows: tears involving >50% of the graft or unhealed peripheral rim observed on MRI. Kaplan-Meier survival analysis with log-rank test was used to compare survivorship between LMAT and MMAT. Patient-reported outcomes were compared based on the Hospital for Special Surgery, modified Lysholm, and International Knee Documentation Committee subjective scores collected preoperatively and at the final follow-up. A total of 299 knees (249 LMAT, 50 MMAT, mean age 33.0 ± 9.8 years) were included. Twenty clinical [2 MMAT (4.0%), 18 LMAT (7.2%)] and 24 graft [2 MMAT (4.0%), 22 LMAT (8.8%)] failures were identified. The mean clinical follow-up period was 63.1 ± 43.1 months (range 2 to 248), and MRI follow-up period was 62.6 ± 43.8 months (range 2 to 248). No significant differences in clinical and graft survivorship were found between the LMAT and MMAT groups (P= .481, P= .271, respectively). PROs preoperatively and at last follow-up also showed no significant difference between the groups. No significant differences in clinical survivorship, graft survivorship, and PROs were found between the LMAT and MMAT groups. Level III, retrospective comparative study.

PND75 BASELINE DISEASE-MODIFYING THERAPY USE IN THE MULTIPLE SCLEROSIS CONTINUOUS QUALITY IMPROVEMENT RESEARCH COLLABORATIVE (MS-CQI)

This study describes characteristics and disease modifying therapy (DMT) use among patients in year 1 of Multiple Sclerosis Continuous Quality Improvement (MS-CQI) - the first multicenter improvement research collaborative for Multiple Sclerosis (MS).

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

BackgroundAppropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes. However, the implementation and management of comprehensive lung nodule programs is challenging.MethodsThis single-center, retrospective report describes the development and outcomes of a comprehensive lung nodule program at a community practice in Tennessee. Computed tomography (CT) scans potentially revealing incidental lung nodules were identified by a computerized search. Incidental or screening-identified lung nodules that were enlarging or not seen in prior scans were entered into a nodule database and guideline-based review determined whether to conduct a diagnostic intervention or radiologic follow-up. Referral rates, diagnosis methods, stage distribution, treatment modalities, and days to treatment are reported.ResultsThe number of patients with lung nodules referred to the program increased over 2 years, from 665 patients in Year 1 to 745 patients in Year 2. Most nodules were incidental (62–65%). Nodules identified with symptoms (15.2% in Year 1) or through screening (12.6% in Year 1) were less common. In Year 1, 27% (182/665) of nodules required a diagnostic intervention and 18% (121/665) were malignant. Most diagnostic interventions were image-guided bronchoscopy (88%) or percutaneous biopsy (9%). The proportion of Stage I-II cancer diagnoses increased from 23% prior to program implementation to 36% in Year 1 and 38% in Year 2. In screening cases, 71% of patients completed follow-up scans within 18 months. Only 2% of Year 1 patients under watchful waiting required a diagnostic intervention, of which 1% received a cancer diagnosis.ConclusionsThe current study reports outcomes over the first 2 years of a lung cancer screening and incidental nodule program. The results show that the program was successful, given the appropriate level of data management and oversight. Comprehensive lung nodule programs have the potential to benefit the patient, physician, and hospital system.

Value of long non-coding RNA Rpph1 in esophageal cancer and its effect on cancer cell sensitivity to radiotherapy.

BACKGROUNDEsophageal cancer is a common digestive tract tumor that is generally treated with radiotherapy. Poor responses to radiotherapy in most patients generally result in local radiotherapy failure, so it is essential to find new radiosensitizers that can enhance the response of cancer cells to radiotherapy and improve the survival of esophageal cancer patients with radiation resistance. The long non-coding RNA (lncRNA) Rpph1 is highly expressed in human gastric cancer tissues, and represses breast cancer cell proliferation and tumorigenesis. However, the expression of lncRNA Rpph1 in esophageal cancer and its relationship with radio-sensitivity has not been studied.AIMTo explore the value of lncRNA Rpph1 in esophageal cancer and its effect on cancer cell sensitivity to radiotherapy.METHODSEighty-three patients with esophageal cancer admitted to Qilu Hospital of Shandong University and 90 healthy participants who received physical examinations were collected as research participants. The expression of Rpph1 was determined by qRT-PCR. siRNA-NC and siRNA-Rpph1 were transfected into esophageal cancer cell lines, and cells without transfection were designated as the blank control group. Cell survival was tested by colony formation assays, and the levels of proteins related to apoptosis and epithelial-mesenchymal transitions were determined by Western blot assays. Cell proliferation was assessed by MTT assays, cell apoptosis by flow cytometry, and cell migration by wound-healing assays. Changes in cell cycle distribution were monitored.RESULTSRpph1 was highly expressed in esophageal carcinoma, making it a promising marker for the diagnosis of esophageal cancer. Rpph1 could also be used to distinguish different short-term responses, T stages, N stages, and clinical stages of esophageal cancer patients. The results of 3-year overall survival favored patients with lower Rpph1 expression over patients with higher Rpph1 expression (P < 0.05). In vitro and in vivo experiments showed that silencing Rpph1 expression led to higher sensitivity of esophageal cancer cells to radiotherapy, stronger apoptosis in esophageal cancer cells induced by radiotherapy, higher expression of Bax and caspase-3, and lower expression of Bcl-2 (Bax, caspase-3, and Bcl-2 are apoptosis-related proteins). Additionally, silencing Rpph1 attenuated radiation-induced G2/M phase arrest, and significantly inhibited the expression of proteins involved in cell proliferation, migration, and epithelial-mesenchymal transition regulation in esophageal cancer cells.CONCLUSIONRpph1 is highly expressed in esophageal cancer. Silencing Rpph1 expression can promote cell apoptosis, inhibit cell proliferation and migration, and increase radio-sensitivity.

Impact of COVID‐19 on clinical practice

These are strange times. As I write this, we are yet to reach the peak of the first wave of the coronavirus outbreak in the UK. For academics like me, it has been reasonably easy to adjust to home working, sitting in the damp and cold office in our cellar, getting to grips with a multitude of different video-conferencing tools. Teaching is being redesigned to suit online delivery after the Easter break, but most non-COVID-19 related clinical research has paused. Away from work, I'm getting my daily exercise with the family – a weird affair, as we cheerfully cross the road to avoid passing too close to a person walking the other way. Finding eggs and flour in the supermarket is impossible, but at least there is toilet roll now. Of course, the impact on clinical practice is something I am certain I will never witness again in my lifetime. My poor hospital colleagues are experiencing the terrifying brunt of the pandemic, and routine practice has ceased. In contrast, my own clinical work as a GP has dwindled and comprises primarily phone calls, as people avoid their GP surgery at all costs. We've been trying to persuade patients for years that antibiotics won't fix viral infections, but people are all too aware that there is currently nothing their GP can prescribe that will treat SARS-CoV-2. But there are nonetheless some really important issues that have arisen from the perspective of medicines use in primary care. There are shortages of inhalers as patients stockpile just in case they get sick, and pharmacies are requesting that repeat prescriptions are not reissued too early, again to maintain supplies. I suspect the standards of drug monitoring and medication review have dropped considerably, and one must ask whether prescribing in the absence of standard face-to-face clinical assessment could be leading to harm. People are asking about the safety of ibuprofen – the evidence suggests that it may prolong other respiratory illnesses, although whether that translates to COVID-19 is as yet unknown. So paracetamol is a preferred option, despite the considerable lack on many shop shelves. Questions have also been asked about the safety of ACE inhibitor use, the third most commonly prescribed drug class in primary care. Because SARS-CoV-2 enters its target cells using angiotensin-converting enzyme 2 (ACE2), and expression of this enzyme is increased in patients taking ACE inhibitors and angiotensin II-receptor blockers, concerns have been raised that these drugs may increase severe infection rates, although theoretical benefits in terms of reducing serious lung complications have also been suggested. Again, the jury is out, but the MHRA advice is to continue these for now until further information is available. Repurposing of certain drugs, such as hydroxychloroquine and HIV antivirals, are being explored in clinical trials; some of these have been added to a growing list of products for which parallel exports have been banned to ensure the UK retains sufficient supplies (disturbingly, this list also includes various anaesthetic agents for those people requiring ventilation). I am certain that the impact of the pandemic on prescribing (and indeed life more generally) will be felt for years to come. Whether it makes us more appreciative of the huge benefits pharmaceuticals bring to us, or improves how effectively we use medicines, remains to be seen. For now, we must get though the coming difficult months, and simply acknowledge the wonderful work that all those amazing prescribers and other people working in the health service are doing. Thank you all and stay safe.

Association between dietary patterns and disease recurrence in Thai colorectal cancer patients.

Beside established anti-cancer treatment, dietary modification is one of the most promising approaches for reducing the probability of colorectal cancer (CRC) recurrence. Many Western studies showed a relationship between shortened survival and increased amounts of Western diet (meat and processed meat). Given that Thai food is dissimilar to Western diet, we aimed to explore the association between dietary patterns and disease recurrence among Thai CRC patients.Early-stage CRC patients who were disease-free at the end of a 2-year period or patients with disease recurrence within 2 years were enrolled. Patients were administered a food frequency questionnaire to evaluate their dietary lifestyle. Quantitative comparison within individual food groups among patients who were disease-free and among those with recurrence was performed. Proportion of patients with recurrence and disease-free survival was compared between patients who had consumed the lowest and highest tertile of each dietary pattern.A total of 225 CRC patients were enrolled (151 disease-free and 74 recurrence). There were no significant differences in demographic or tumor parameters between patients with or without disease recurrence. From the questionnaire, 45 food items were assigned to 1 of 12 food groups according to similarity in nutritional profile. Patients who consumed high amounts of pickled fish or chili-paste had significantly lower recurrence rates compared to patients who had never eaten those foods (P < .01). From the factor analysis, meat/wheat, vegetarian, and fast-food/processed fruit patterns were identified as the major dietary patterns. There was no significant association between intakes of individual dietary patterns and CRC recurrence.Among CRC patients with Thai dietary lifestyles there was no association between meat/wheat, fast-food/processed fruit, or vegetarian dietary patterns and CRC recurrence. Greater consumption of some unique Thai foods, such as chili-paste or pickled fish, may relate to better outcomes for CRC patients.

Impact of preoperative portal vein thrombosis on the outcome of living donor liver transplantation

Abstract Background Portal vein thrombosis (PVT) is a common complication in terminal-stage liver disease. Its incidence in liver transplantation (LT) ranges from 2.1% to 26%. In the past, PVT was considered an absolute contraindication for LT, especially due to the technical difficulty involved. Nonetheless, since the mid-1980s, with the introduction of new surgical techniques, PVT is no longer considered an absolute contraindication in a larger percentage of patients. Aim of the Work to show the effect of preoperative portal vein thrombosis with its different extension degree on both patient and graft survival post living donor liver transplantation. Patients and Methods This retrospective cohort study was conducted on all the patients who performed living donor liver transplantation during the period from January 2010 till June 2017 at Ain Shams centre for organ transplantation (ASCOT). Our study included 240 cases who performed right lobe LDLT in that time interval and fulfilled the required data and time interval follow up. Those 240 cases were classified into 2 groups: group A Patients without preoprative PVT (200); group B Patients with pre-operative PVT. (40). Results 1-year patients survival rates of patients with and without PVT were 75% vs. 85%. t 2-year patients survival rates of patients with and without PVT 75% vs. 84%. 1-year graft survival rates of patients with and without PVT were 75% vs. 84%; that 2-year graft survival rates of patients with and without PVT: 65% vs. 77%. Conclusion P.V.T not only makes the surgery more difficult and complex but it also affects the outcome of LT. However Further studies should be done taking in consideration different degree of extension of the thrombus as it has crucial effect on the outcome of the liver transplantation.

The teaching of removable partial dentures in dental schools in Oceania

ObjectivesTo examine the current arrangements and trends in the teaching of removable partial dentures (RPDs) in dental schools in Oceania. MethodsA validated and trialled 30-item electronic survey was sent via e-mail to 12 dental schools in Oceania that offered undergraduate dentistry. The survey explored various aspects of the teaching of RPDs in preclinical and clinical courses including: educational content and process, staff members involved, facilities and techniques utilized, clinical requirements, coursework evaluation and perceived challenges to RPD teaching. ResultsThe response rate of the survey was 75 % (n = 9). All respondent schools taught a preclinical course in RPD design and production, with the majority (67 %) starting the clinical provision of RPD patients in Year 3. The mean duration of the course was 63 h for hands-on activities and 23 h for didactic teaching. The courses were mainly taught by senior lecturers. On average, students made four units of acrylic RPD and two cobalt-chromium RPDs during the course. All respondent schools taught prescription writing for RPD. The majority of schools (n = 8) stated that they had an adequate patient pool for students to treat. Lack of adequately trained staff for teaching and pressure on teaching time from other sources were the most commonly reported challenges. ConclusionThe structure and content of RPD courses in dental schools of Oceania provide an adequate level of competence on the subject, and is broadly similar to other parts of the world. Plans should be in place to maintain and improve the quality of educational programmes to keep pace with growing student numbers and the rapidly evolving profession. Clinical significanceWith increasing numbers of patients presenting to general dental practitioners requiring complex RPDs, it is paramount that undergraduate training programs produce graduates with the competencies necessary to care for such patients to a high standard.

Trends in Utilization of Image Guidance for Hip Joint Injections.

This study aims to evaluate trends in utilization of image guidance for intraarticular hip injections and to compare the cost efficiency of ultrasound-, fluoroscopic-, and landmark-guided injections in the management of hip osteoarthritis (OA) and femoroacetabular impingement (FAI). Retrospective descriptive epidemiology study. The information was collected from Humana private payer insurance claims database encompassing all practice settings. A total of 302 855 patients for years 2007 to 2015. Primary diagnosis of hip OA or FAI. Injection type [corticosteroid (CS) or hyaluronic acid (HA)], imaging modality (landmark, ultrasound, or fluoroscopic guidance), and costs. Landmark-guided CS and HA injections for the management of hip OA decreased, whereas fluoroscopic and ultrasound guidance increased. Similar trends were demonstrated in the management of FAI using CS. In the management of FAI using HA, landmark- and ultrasound-guided injections decreased and fluoroscopic-guided injections increased. Cost analysis revealed lower reimbursement of landmark and ultrasound guidance compared with fluoroscopic guidance. During the study period, there was an increase in the use of image guidance and decline in landmark guidance for the treatment of OA and FAI using CS and HA. Fluoroscopic guidance demonstrated increased reimbursement compared with landmark and fluoroscopic guidance. There is an opportunity to mitigate cost and reduce radiation exposure by using ultrasound-guided injections rather than fluoroscopic guidance.

Budget Impact of Enzalutamide for Nonmetastatic Castration-Resistant Prostate Cancer.

Prostate cancer is the most common cancer and second-leading cause of cancer death among men in the United States. Prostate cancer poses a large economic burden, which increases with progression from localized to metastatic disease. Newly approved treatments for non-metastatic castration-resistant prostate cancer (nmCRPC) delay disease progression and reduce the risk of metastatic disease. Quantifying the potential budget impact of these new treatments is of interest to health care decision makers. To estimate the budget impact of enzalutamide for the treatment of patients with nmCRPC in the United States over a 3-year time horizon. An Excel-based model was developed to estimate the budget impact to a U.S. health plan of enzalutamide, a second-generation antiandrogen, as an add-on to androgen deprivation therapy (ADT) for the treatment of high-risk nmCRPC patients (prostate-specific antigen doubling time of ≤ 10 months). Comparators include apalutamide + ADT, bicalutamide + ADT, and ADT only. The analysis includes treatment costs for nmCRPC and for treatment after progression to metastatic castration-resistant prostate cancer (mCRPC). The treated population size was estimated from epidemiological data and literature. Dosing, duration of therapy, and adverse event rates were based on package inserts and pivotal studies. RED BOOK, Centers for Medicare & Medicaid Services fee schedules, and literature were used to obtain costs of drugs, adverse events, and health care visits. Market shares were estimated for each comparator before and after enzalutamide adoption. A 1-way sensitivity analysis was performed to quantify the impact of parameter uncertainty. In a hypothetical 1-million-member plan with 3% annual growth, it was estimated that there would be approximately 19 eligible incident nmCRPC patients in year 1, increasing to 20 eligible incident patients in year 3. With an assumed market share of approximately 6% for enzalutamide in year 1, the budget impact would be $106,074 ($0.009 per member per month [PMPM]). With a 26% enzalutamide share in year 3, the budget impact would be $632,729 ($0.048 PMPM). Cumulative budget impact to the health plan over 3 years is estimated to be $1,082,095 ($0.028 PMPM). The increased cost of the treatment regimen is partly offset by reduced postprogression costs. Treatment of nmCRPC patients with enzalutamide has a modest budget impact that is partly offset by delaying progression to mCRPC. This research was sponsored by Astellas Pharma and Pfizer, the codevelopers of enzalutamide. All authors contributed to the development of the manuscript and maintained control over the final content. Schultz is employed by Astellas Pharma and owns stock in Gilead Sciences and Shire. O'Day and Sugarman are employees of Xcenda, which received consultancy fees from Astellas Pharma. Ramaswamy is employed by Pfizer. A synopsis of the current study was presented in poster format at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019, in San Diego, CA, on March 25-28, 2019.

Survival in men diagnosed with prostate cancer in Poland in the years 2000 - 2014 compared to European Countries based on Concord-3.

Wealthy countries have observed in recent decades a fast-growing number of prostate patients, who require treatment and long-term cancer care. This trend seems to be connected with some demographic changes such as aging societies, better access to diagnostic methods with high sensitivity as well as large-scale secondary prevention (prostate cancer screening at early stage before clinical manifestation). Secondary prevention is becoming more accessible and widely applied. The expected effect of prevention is to improve overall survival while the mortality trend is decreasing. The prevention success requires highly effective healthcare system that must manage additional burden which is a consequence of the need to provide optimal treatment and healthcare in a big group of cancer patients diagnosed in effective prevention programms. According to the National Cancer Registry (NCR) the number of incidence from year 1980 - 1731 cases rose in year 2013 to 12 162 cases. Apart from incidence and mortality rates, the 5-year survival is a significant factor for the assessment of a population healthcare and healthcare system efficiency. The prognosis related to prostate incidence is 22 344 men in year 2025 in comparison to 12 162 in year 2013 - that would be a double rise in incidence. CONCORD-2 results (years 1995-2009) showed, among the others, that cancer curability for some cancers, including prostate cancer improved. In year 2018 the results of CONCORD-3 were published (years 2000-2014) showing a rising trend in improvement in prostate cancer curability in Poland. The objective was to analyse the 5-year survival in prostate cancer patients in Poland, and in each of 16 voivodships, with the focus on changes in years 2000 - 2014 in comparison to European trends. The analysis was based on the 5-year net survival (estimated in CONCORD-3) in prostate cancer patients diagnosed in Poland (NCR national data) and in all Polish voivodships. The 5-year survival of prostate cancer patients and its changes in years 2000 - 2014 compared between 16 voivodships, Poland in total and 28 European countries. In Poland in years 2010 - 2014 the 5-year survival in prostate cancer patients was 78.1%, and compared to years 2000 - 2004 rose by 9.3 percentage points. Despite a systematic improvement in survival the differences between individual voivodships in Poland remained. In 6 voivodships the survival was higher than average for Poland and ranged from 80 to 82%. The lowest survival was in Opolskie voivodship - 72.3%. On a European scale, the curability of prostate cancer at that time was over 90% (9 countries), while Poland was among 5 countries whose total survival rate was less than 80% (from 72.3% - Opolskie voivodship to 83.6% -- Pomeranian voivodship). The 5-year survival in prostate cancer patients in years 2010 - 2014 in Poland was significantly lower in comparison to Western Europe countries, and favourable trends on a regional level in Poland were too slow to overcome high differentiation in Europe. It is expected that changing the structure and organisation of cancer care in Poland into a modern National Oncology Network Comprehensive Cancer Care Network, together with the use of the experiences from European projects, including iPAAC and better financing will contribute to improvement in prostate cancer treatment in Poland.

Temozolomide plus whole brain radiotherapy for the treatment of non-small-cell lung cancer patients with brain metastases: A protocol of an updated systematic review and meta-analysis.

Introduction:Whole brain radiotherapy (WBRT) has been the mainstay treatment of brain metastases (BM) in non-small cell lung cancer (NSCLC) patients for years. Temozolomide (TMZ) could penetrate the blood–brain barrier and some studies showed that TMZ plus MBRT may improve clinical effectiveness. This meta-analysis is aim to evaluate the clinical effectiveness and safety of TMZ plus MBRT in the NSCLC patients with BM.Methods and analysis:We systematically searched databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database) without language restrictions from inception until July 26, 2019. Randomized controlled trials (RCTs) which compared TMZ plus WBRT with single WBRT in the advanced NSCLC patients with BM were included. The outcomes analysis reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), quality of life (QOL), and adverse effects. Two reviewers will independently extract data from the selected studies and assess the quality of studies. Statistical analyses will be performed using Review manager 5.3 software. Random-effects or fixed models were used to estimate pooled hazard ratio and relative risk.Results:This systemic review and meta-analysis will evaluate the effects of TMZ plus MBRT in the NSCLC patients with BM in RCTs.Conclusion:Our study will provide evidence to judge if TMZ plus MBRT are effective treatment for NSCLC patients with BM.

Outils numériques en psychiatrie et art-thérapie, quels points de rencontre possibles ?

Digital has gradually infiltrated all areas of our daily lives. Health and mental health have not escaped the arrival of new technologies and has seen many new devices of care, using connected objects, applications, or artificial intelligence. However, addressing the digital issue is a delicate subject as it is clear that this field is wide and constantly evolving. However, the new possibilities offered by digital are an incredible opportunity to modernize the therapeutic setting. Moreover, the arrival of the new generation which have grown with these digital technologies requires to consider the responses to be made to the changes induced by digital technology. One of the domains which has been used by psychiatric to care their patient for years was the art therapy. This field is interested in expression and creation as a possible source of recovery. And the question of digital technology in art therapy is all the more important than numeric has already been integrated in art through the concept of numeric art. Despite this observation it could be difficult to envisage therapeutic setting modification to incorporate digital field in art-therapy as it is also important to take account of pathological aspects. To address this issue, we propose to develop in this article the current knowledge about digital application in mental health. In this part we develop three paragraphs about the applications in psychiatry, the serious games and the virtual reality, and the devices online such as massive open online courses and social networks. We then propose to present the current status of numeric art with a presentation of the history of numeric art and some examples of this construct. And then we propose to discuss of the possible mutation in art therapy in touch with digitals mutations. This discussion implies to address the question of the therapeutic setting in art therapy and the general question of changes induces by digital in our thinking and habits. This discussion also proposes to develop concrete possibilities to set up these technologies in art therapy.

Refining Blood Products Utilization: Every One (unit) Matters

INTRODUCTION Appropriate restriction of blood transfusion is important to reduce harm to patients and cost to society. Current research shows that every RBC transfused unit increases 30-day mortality (odd ratio = 1.32), composite morbidity (odd ratio =1.23), pneumonia (odd ratio = 1.24) and sepsis/shock (odd ratio = 1.29) of 95% Confidence Interval. Literature shows that it is feasible to significantly reduce healthcare costs and potential transfusion-related harm by minimizing blood transfusion orders. This will help improve transfusion quality, minimize administrative cost, and maximize patient safety. We examined the extent of adherence to the American Association of Blood Banks (AABB) transfusion guidelines by reviewing blood transfusions orders that were fulfilled throughout the year of 2018, and the potential effect of quality improvement intervention. OBJECTIVES The objective of this research is to restrict blood transfusion products through the implementation of an automated process that accords with current guidelines. The process entails modifying the current interface at the VA Palm Beach and effectively create an embedded clinical decision-making system that includes appropriate logistics to guide the appropriateness of blood transfusion orders. The interface promises interactive pop-up dialogue that engages users with a set of rules to assess transfusion indication and guide its appropriateness. The proposed intervention provides safer evidence-based transfusion, reduced risk of non-infectious adverse events and infectious agents, and decreased demand on limited blood supplies. METHODS This is a retrospective analysis of transfused patients in year 2018 .The data was retrieved from an electronic medical record database, which included patient gender, age, comorbidities, mean baseline hemoglobin, pre- and post- transfusion hemoglobin, hemodynamics status, complications, active bleeding, history of cardiac disease, ordering division, and number of units transfused. Patients were randomly selected from January to August 2018 (n=204). Roughly 302 PRBC units were transfused, averaging 1.4 units per person. Insignificant life-threatening complications were reported. The Average pre-transfusion hemoglobin was 7.6, and post-transfusion hemoglobin was 9.3. 54% received 2 units, whereas 46% received 1 unit. INTERVENTIONS We propose a two-tier auditing system, based on a low and high priority, which reflects the timeline to address non-compliant transfusion orders. Low priority orders are evaluated during the periodic meeting of the transfusion committee, and high priority orders are addressed within a few hours of the transfusion order. All transfusion orders of Hg &gt; 7-8 g/dL are flagged with low priority, whereas those with Hg&gt; 8g/dl and/or with orders exceeding one unit are flagged with high priority. The intervention includes: Identify the key Stakeholders and seek appropriate approvals, modify the existing interface to comply with AABB transfusion guidelines, establish a cultural change of blood management, "Every One (unit) Matters", educate our staff, physicians, residents, and students, through didactic channels on guidelines, and present case reports on patient safety. RESULTS The system was embedded with a logging mechanism to record non-compliant order requests, collect pre and post intervention data, audit transfusion records, restrict transfusions to 1 unit per order. Each unit is treated as a unique clinical decision, and each patient is evaluated for symptoms upon every transfusion. The interface also includes a logistics serving as a clinical decision tool and as an advisory delineating transfusion indication. Each transfusion order placed that doesn't meet requirements is reviewed retrospectively and is considered a fall out and flagged for chart review. Cases are escalated to the medical review committee, based on auditing priority, and the ordering physician is contacted accordingly. CONCLUSION Each unit blood transfused is associated with incrementally increased risk for adverse outcomes. Improvement of the overall transfusion rate is a key component to the success of this project. Our future directions are to engage and earn the confidence of all divisions, as well as change the existing culture in order to promote evidence-based medicine and safer practices in a cost-effective manner. Disclosures No relevant conflicts of interest to declare.

Home Treatment of Bortezomib: A Preliminary Exploration of a New Treatment Mode in China

Background:Bortezomib had been used as a standard treatment in plasma cell disorders patients for years. It has been proved that subcutaneous bortezomib was locally well tolerated, had non-inferiority effect andless peripheral neuropathy compared with intravenous administration. Few studies about home treatment of bortezomib had been reported to be feasible and of benefit to patients. But in these studies, bortezomib was adminstrated by special nurse visiting home regularly.In consideration of the shortage of medical resources in China and aiming to make it easier to receive bortezomib treatment for patients, we made a preliminary exploration of home treatment of bortezomib by patients or relatives themselves in China for the first time. Methods:234 patients provided written informed consent were enrolled in our study between March 2018 and April 2019.A clinical nurse specialist provided hands-on guidance on home-injection for patients in outpatient department. The following information including geographical and clinical data, adverse events in treatment, feedback from patients about cost and time saved than hospital injection, and difficulty degree and satisfaction with home treatment using a rating scale between 0 and 10 were collected. The higher the score, the easier the injection and more satisfied with the mode of home treatment. Results:The median age at diagnosis was 56 (27-83) years old. 75 (32.1%) patients were diagnosed with primary light chain amyloidosis, 70 (30.0%) POEMS syndrome, 62 (26.5%) multiple myeloma, 15 (6.4%) multi-center Castleman disease, 4 (1.7%) light chain deposition disease, 4 (1.7%) Waldenstrom's macroglobulinemia, 2 (0.9%) cryoglobulinemia, 1 (0.4%) mycosis fungoides and 1 (0.4%) monoclonal gammopathy-associated scleromyxedema.Patients lived within a 3,010 kilometer radius of the city of Beijing, 46 (19.7%) patients lived in Beijing and 67 (28.6%) patients lived more than 1,000 kilometers from our hospital (Figure 1. Geographical distribution of 234 patients. The dots represent number of patients in different provinces. The blue dot represents 46 patients lived in Beijing, the city our hospital located in). As so far, patients received a median number of 20 (4-36) injections and a total of 5068 injections of bortezomib. The most common injection-site reaction was redness (24.8%) and pigmentation (20.9%). In 5068 injections, 2 (0.04%) local hematomas at injection site, 7 (0.14%) injection dose errors and 5 (0.10%) needlestick injuries occurred, respectively. Medicine bottle was broken during drug dissolution for only once (0.02%). The median cost and time saved was RMB 200 (100-6000) and 4.5 (0.5-100) hours per injection per person for home treatment. The total saving of money was RMB 3927,804, and the total time saved was 15,617.5 hours. For the score of difficulty degree of injection and satisfaction with home treatment, 201 (85.9%) and 208 (88.9%) rated 8 and higher, respectively. Conclusion: Home treatment of bortezomib is feasible, and both cost-effective and time-saving in China, which should be promoted in other medical centers. Figure 1 Disclosures No relevant conflicts of interest to declare.

What causes prostate cancer: patient-perceived causes

Psychosocial distress caused by prostate cancer (PCa) can persist in patients for years after treatment. A possible factor in this context is the subjectively perceived cause of the disease, which can have a significant influence on the experience of distress, therapy adherence and preventive behaviour. The aim of this study was to record subjective reasons for PCa in long-term survivors and to investigate associated factors. PCa survivors from the national research project "Familial Prostate Cancer" were included in the study. As part of the annual postal follow-up questionnaire, PCa survivors were asked about subjectively perceived causes of their PCa. Responses were assigned to 18 possible categories. In addition, the association between the subjectively perceived causes of PCa and secondary tumours, a positive family history of tumour diseases and sociodemographic factors was investigated. Of the 9 047 PCa survivors surveyed, 4 054 (44.8 %) provided information on the subjectively perceived causes of their PCa and were included in this analysis. The mean time since diagnosis was 10.1 years with a mean age of 63.1 years at diagnosis. The most frequent responses were "don't know" (31.8 %), genetics (30.1 %) and stress (18.5 %). Age, the most important risk factor for PCa, was rarely mentioned (2.5 %). In addition to these responses, unusual non-evidence-based reasons were also reported. Men with a positive family history of PCa cited genetics as the cause of their disease about 4 times more frequently than sporadic cases. This proportion increased with the number of affected family members. PCa survivors aged ≤ 65 years at diagnosis indicated stress as the cause of their PCa approximately 2 times more often than men who were older than 65 years at PCa diagnosis. Most men surveyed reported non-evidence-based causes of their PCa. Preventive programs should address the evidence-based causes more distinctly and with a high visibility. Due to the significance of lay illness beliefs for the experience of distress and the adherence to treatment, the patient's subjective cause of disease should be surveyed and considered by the urologist in charge.

974 One, Three, and Five Years Post Transplant Outcomes in Diabetic Patients After Liver Transplant for NASH Cirrhosis: A Single Centre Study

INTRODUCTION: Beside immunosuppression, patients undergoing liver transplantation (LT) for non-alcoholic steatohepatitis (NASH) cirrhosis are at additional risk of complications due to a myriad of comorbidities that accompany the metabolic syndrome. We aimed to assess post-LT outcomes at one, three and five year intervals for patients with type-2 diabetes mellitus who underwent LT for NASH cirrhosis. METHODS: Using ICD-9 codes all type diabetics with the diagnosis of non-alcoholic fatty liver disease (NAFLD) were identified between January 2000 and Decemeber 2015. Of these, those who had biopsy-proven NAFLD and underwent LT for NASH cirrhosis were recognized and subsequently followed to assess outcomes at one-, three- and five-years. A P-value of &lt; 0.05 was considered significant. RESULTS: 60 out of 1300 patients underwent LT for NASH-cirrhosis. Mean age was 59.6 ± 7.6 years; mean BMI was 31.2 ± 6.3 kg/m2. Mean MELD score at listing was 17.9 ± 9.1 and on the day of LT was 20.1 ± 9.3. Median post-LT follow-up was 66.5 months (IQR 59.5). Follow-up was available for 57, 50 and 34 patients at 1, 3 and 5 years, respectively. Infection was the most common complication within the first year (35%). Cardiovascular (CV) events were most common overall, effecting 25.3% patients in year 1, 32 % in 3 years and 23.5 % in a 5-year period. Post-LT biliary complications were seen in 22.8%, 12.9% and 8%, respiratory complications in 4%, 2% and 0%; gastrointestinal complications in 1%, 2%, 1% and renal complications in 9%, 5%, and 1% within one, three and five years, respectively. 29.6% patients had an episode of rejection within one year of transplant, 7 % within 3 years and 3.3% in 5 years (P = 0.02). A worsening trend was seen in steatosis of the graft across the years 20%, 39.3%, 42.9 % for year 1, 3 and 5 ((P = 0.02). Rates of complications were not statistically different for patients who had normal versus those with elevated gylcated hemoglobin post LT, or for those who lost weight ( &gt;5 lbs), except at year 3 (P &lt; 0.05) (Figure 1). CONCLUSION: Patients undergoing LT for NASH-cirrhosis are at a high risk of developing post-LT infectious and cardiovascular complications. Risk of developing steatosis in the graft also increases every year. These patients need to continue dietary and lifestyle modifications to reduce the risk of future complications, even after LT.

An In-hospital Mortality Risk Model for Patients Undergoing Coronary Artery Bypass Grafting in China

To meet the demand of increasing surgical volume and changing of patient's risk profiles of coronary artery bypass grafting in China, we developed a new risk model that predicts in-hospital mortality. The analysis included patients who underwent coronary artery bypass grafting between January 2013 and December 2016 at 87 hospitals in the Chinese Cardiac Surgery Registry. Patients in years 2013 to 2015 were randomly divided into training (n= 31,297 [75%]) and test (n= 10,432 [25%]) samples; 2016 patients (n= 15047) comprised the validation sample. Demographic and clinical risk factors were identified. The Harrell C statistic was used to evaluate model discrimination, and the Hosmer-Lemeshow goodness-of-fit test was used to assess calibration. The 56,776 patients were a mean age of 61.8 (SD, 8.8) years, and 24.6% were women. Overall, in-hospital mortality was 2.1%. The final model included 21 risk factors represented by 16 unique variables. The model achieved good discrimination, with a C statistic of 0.79 (95% confidence interval [CI], 0.77-0.80) in the training sample, 0.79 (95% CI, 0.76-0.82) in the test sample, and 0.78 (95% CI, 0.76-0.81) in the validation sample. Model calibration was good according to the Hosmer-Lemeshow test (P > .05 in the 3 samples). Compared with the European System for Cardiac Operative Risk Evaluation 2011 revision (EuroSCORE II) and the Sino(Chinese) System for Coronary artery bypass grafting Operative Risk Evaluation (SinoSCORE), the model had better discrimination and calibration. We developed and evaluated a model with 16 risk factors that predicted in-hospital mortality risk after coronary artery bypass grafting in China. This updated model may help surgeons and hospitals better identify high-risk patient.

A Phase I/II, Prospective Multi-Center Study of the Safety and Preliminary Efficacy of Intravenous Allogeneic Mesenchymal Bone Marrow Cells in Chronic Ischemic Stroke

Abstract INTRODUCTION Stroke is a leading cause of disability, affecting patients for years. We examined safety and preliminary efficacy for a cellular therapy targeting patients with chronic disabling stroke, a population for whom limited treatment options currently exist. METHODS Entry criteria included ischemic stroke &gt; 6 mo prior, substantial disability (subject confined to wheelchair, had home-nursing care, or needed assistance with activities of daily living), and NIH Stroke Scale (NIHSS) score = 6 to 20. Enrollees received a single intravenous dose of allogeneic mesenchymal bone marrow cells. Phase 1 used a dose escalation design (3 tiers, n = 5 each). Phase 2 (n = 21) was an expanded safety cohort. The primary endpoint was safety over 1-yr. Secondary endpoints examined behavior, with a pre-specified focus at 6-mo. RESULTS In phase 1, each dose (0.5, 1.0, and 1.5 million cells/kg body weight) was found safe, so phase 2 subjects received 1.5 million cells/kg. At baseline, subjects (n = 36) averaged 4.2 ± 4.6 yr poststroke, age 61.1 ± 10.8 yr, NIHSS score 8.7 ± 3.0, and Barthel Index 65 ± 29. Two were lost to follow-up, one was withdrawn, and two died (unrelated to study treatment). There were 15 serious adverse events, none possibly or probably related to study treatment. Two adverse events were possibly related to study treatment, a UTI and IV site irritation. Treatment was safe based on serial exams, EKGs, laboratory tests, and pan-computed tomography scans. Change from baseline to 6-mo post-transfusion was significant for all 4 secondary endpoints: Barthel Index (6.8 ± 11.4 points, P = .002), NIHSS (−1.25 ± 1.7 points, P &lt; .001), MiniMental Status Exam (1.8 ± 2.8 points, P &lt; .001), and Geriatric Depression Scale (−1.6 ± 3.8 points, P = .015). At baseline 11.4% (4/35 subjects) had Barthel Index = 95 to 100 (favorable outcome); at 6-mo, 27.3% (9/33); by 12-mo, 35.5% (11/31). CONCLUSION Transfusion of mesenchymal bone marrow cells in patients with disabling chronic stroke was safe and significantly improved several behavioral measures. The initial results were potentially equivalent to or exceeded those of prior studies utilizing stereotactic implantation. These data support proceeding to a randomized, placebo-controlled study.

Relationship Between Depression and Healthy Lifestyle Behaviors of Patients With History of Transplant

BackgroundThe aim of this study was to investigate the relationship between depression and healthy lifestyle behaviors of patients with a history of transplant. MethodsThis was a descriptive study. The study was conducted on 110 patients who received organ transplant and attended a university hospital in Istanbul, Turkey. Data were collected using a patient information form, the Beck Depression Inventory, and the Healthy Lifestyle Behaviors Scale-II. ResultsThe mean age of the patients in years ± SD was 45.8 ± 12.35; 60.9% of them were men; and the mean body mass index (kg/m2) was 26.9 ± 4.84. There was a statistically significant difference between nutrition subscale and body mass index. A statistically significant difference was found between the total score of healthy lifestyle behaviors, nutrition, and interpersonal relationships subdimension with education status. There was a statistically significant difference between health responsibility, nutrition, and interpersonal relationships subdimension with marital status. There was a statistically significant difference between health responsibility subdimension and income status. A statistically significant difference was found between nutrition, spiritual growth, interpersonal relationships, stress management subdimension with living alone or living with someone. There was a statistically significant difference between depression scores and elapsed time after transplantation. There was a significant moderate negative correlation between depression and healthy lifestyle behaviors scores. ConclusionAccording to results of this study, healthy lifestyle behaviors of patients with a history of organ transplant were affected by factors such as body mass index, education status, income status, and marital status. Depression levels decreased as healthy lifestyle behaviors improved for the patients of organ of the transplant.