The Clinical Characteristics, Perioperative Management, and Treatment Outcomes of Spinal Tuberculosis Associated With Diabetes Mellitus

Background. To report a preliminary experience of surgical treatment for patients with spinal tuberculosis (STB) associated with diabetes mellitus (DM) and discuss the strategic factors that should be considered.Methods. A retrospective study of DMSTB patients who underwent surgical treatment between January 2012 and April 2018 in our center was carried out. For each patient: demographic information, perioperative management, laboratory examination, radiographic assessments, and clinical outcomes were reviewed.Results. A total of 17 patients were included (11 males and 6 females), with a mean age of 57.53±9.25 years and a follow-up of 28±3.00 mos. Hypertension, Osteoporosis, and Hypoproteinemia were the most common complication. All patients passed the perioperative period smoothly, the 3 months follow-up showed the CRP and ESR have a significant decline, and the final follow-up shows both CRP and ESR back to normal, and there were a significant improvement of serum albumin levels. The Bone fusion time is 9.88±2.65 mos.Conclusions. Perioperative management of DMSTB patients is a complicated issue with numerous factors to be considered. Spinal surgery can achieve satisfactory outcomes in these patients if the glycemic level remains well controlled, nutritional supplementation is adequate, and antituberculosis treatment is sufficient.

Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service. Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.

Adoption patterns of an electronic patient-reported outcomes tool in oncology.

e19127 Background: Patient-reported outcomes (PROs) are critical for the delivery of patient-centric care. Previous research has shown that the use of PROs can impact clinical outcomes in Oncology. Despite these benefits, PROs have not been widely implemented as part of standard of care. Significant barriers exist for its adoption including lack of integration between PRO tools and electronic health record systems (EHRs). We developed MSK Engage, a home-grown PRO tool integrated with the EHR and embedded within MSK's patient portal (MyMSK). It was launched in late 2015 and it is currently used enterprise-wide for both standard of care and research purposes. The purpose of this study was to describe the usage patterns of PROs in a real-world setting. Methods: We conducted a retrospective analysis of patients that have been assigned at least one MSK Engage survey instrument between 2015 and 2019. Patient demographic information was extracted from the EHR system. Usage patterns including the number of survey instruments assigned and completed were extracted from MSK Engage. Survey completion rates were stratified by patient demographic information and number of assigned surveys. We performed univariate and multivariate analyses to identify factors associated with survey completion rates. Results: During the study period, 57 survey instruments were implemented, with the majority being used for standard of care (41 for standard of care only, 9 for research protocols, 6 for standard of care and research, and one for a quality improvement initiative). In total, 246,638 patients were assigned 557,559 surveys. Of those, 146,505 patients completed a total of 265,174 surveys, with a median completion time of 3 minutes. Among the patients that were assigned a survey, 73.7% were women. Women in our sample were older than men, with median age 52 and 47 years old, respectively. Men were more likely to complete the assigned surveys with 61.2% completion rate among men and 43.3% among women (p < 0.001). On multivariate analysis, men were less likely to miss surveys than women (odds ratio [OR], 0.49; 95% CI, 0.48-0.49). We also identified a significant correlation between the survey completion rate and number of assigned surveys, demonstrating that assigning a large number of surveys for each patient can lead to a reduced survey response. Conclusions: Providers have quickly adopted MSK Engage demonstrating that it is feasible to incorporate PROs as part of standard of care. Patients are willing to answer PROs; however, it is important to mindful when assigning surveys to avoid negative effects of survey burden.

ColPortal, an integrative multiomic platform for analysing epigenetic interactions in colorectal cancer

Colorectal cancer (CRC) is the third leading cause of cancer mortality worldwide. Different pathological pathways and molecular drivers have been described and some of the associated markers are used to select effective anti-neoplastic therapy. More recent evidence points to a causal role of microbiota and altered microRNA expression in CRC carcinogenesis, but their relationship with pathological drivers or molecular phenotypes is not clearly established. Joint analysis of clinical and omics data can help clarify such relations. We present ColPortal, a platform that integrates transcriptomic, microtranscriptomic, methylomic and microbiota data of patients with colorectal cancer. ColPortal also includes detailed information of histological features and digital histological slides from the study cases, since histology is a morphological manifestation of a complex molecular change. The current cohort consists of Caucasian patients from Europe. For each patient, demographic information, location, histology, tumor staging, tissue prognostic factors, molecular biomarker status and clinical outcomes are integrated with omics data. ColPortal allows one to perform multiomics analyses for groups of patients selected by their clinical data.

Feline chronic gingivostomatitis is more prevalent in shared households and its risk correlates with the number of cohabiting cats

ObjectivesThe aim of this study was to determine whether feline chronic gingivostomatitis (FCGS) is more prevalent in shared vs single-cat households, whether the number of cohabiting cats or outdoor access represent risk factors for FCGS and whether the number of cohabiting cats is a useful prognostic indicator for standard surgical treatment.MethodsCats diagnosed with FCGS (study group) in the past 5 years at a referral institution were identified. The number of cohabiting cats, outdoor access, number of other cohabiting cats diagnosed with FCGS, ⩾6 month surgical outcome, when applicable, and historical signs of upper respiratory disease among any of the cohabiting cats, as well as patient demographic information, were recorded. Data were collected from medical records and by means of a telephone interview with the owners. The same information was collected from a group of cats of similar demographic characteristics diagnosed with periodontal disease but free of FCGS (control group).ResultsSeventy-six cats were included, of which 36 (47%) had FCGS and 40 (53%) served as controls. Bivariate analysis showed that cats with FCGS were significantly more likely to come from shared households, and had significantly more total cats per household compared with controls. Multivariate analysis also showed that cats in shared households had a significantly increased odds of FCGS compared with those from single-cat households. Historical signs of upper respiratory disease and outdoor access among cats within the same household were not associated with FCGS. The number of cohabiting cats was not associated with surgical outcome.Conclusions and relevanceCats with FCGS are more likely to live in shared households. The risk of FCGS correlates with the number of cohabiting cats. The epidemiological features of FCGS may support an infectious etiology. The number of cohabiting cats within a household is not a useful prognostic indicator for standard surgical treatment of FCGS.

Baseline Characteristics of 412 Hodgkin's Lymphoma Patients Diagnosed between July 2015 and May 2018: A Report from China Lymphoma Patient Registry (CLAP)

Introduction Lymphoma is the most common hematologic tumor with about 88000 newly diagnosed cases in China in 2015 (Chen et.al, CA Cancer J Clin 2016). To better understand the epidemiology, treatment and prognosis of lymphoma in China, Beijing Cancer Hospital and other four hospitals jointly launched China Lymphoma Patient Registry (CLAP) study (NCT03313271) in early 2017. By the end of March 2018, a total of 3458 lymphoma patients, including 412 Hodgkin's Lymphoma (HL) cases and 3046 Non-Hodgkin's Lymphoma (NHL) cases, had been prospectively and retrospectively recruited. Here we report the baseline characteristics and initial treatment of HL patients diagnosed between July 2015 and March 2018. Method This is an observational bi-directional cohort study based on medical records of hospitalized lymphoma patients. Inclusion criteria of this study include: 1) newly diagnosed as HL after July 2015 in five participating hospitals; 2) age >=18 yrs old at time of disease diagnosed; 3) given informed consent if prospective follow-up is needed. This study has been approved by Institutional Review Board (IRB) of all study sites. Medical records of newly diagnosed adult HL patients in five participating hospitals were systematically reviewed. Study data, including patient demographic information, disease baseline characteristics, treatment options and prognosis were manually entered or directly transferred into a predesigned electronic database with the support of Medbanks Network Technology Co., Ltd. In this study, descriptive analysis was used to understand the distribution of patient demographic information (age, gender, medical history, etc.), disease baseline characteristics (symptom, score, stage, etc.) and initial treatment option (if ABVD) for HL population as a whole as well as by subtype stratification. Result A total of 412 HL patients were identified between July 2015 and March 2018. Among all HL patients, nodular sclerosis type of classic Hodgkin's lymphoma (NSCHL) was the most common subtype (53.6%) followed by mixed cell type of classic Hodgkin's lymphoma (MCCHL) (23.1%)(Figure1). All classic subtypes accounted for over 93% of all HL patients. Male is more common than female (60.4%vs39.6%), especially for nodular lymphocytes predominant type of HL (NLPHL). However, no statistical significant gender difference was observed across different subtypes. Age of NSCHL patients was relative younger than patients with other subtypes with a median age of 31. The general health status of most HL patients was relative good at first diagnosis, the percentage (excluding missing) of patient with recorded B symptoms and ECOG score >=2 were 42.4% and 2%, respectively. The distribution of clinical staging was 4.9%, 46.1%, 18.2% and 26.5% for I-IV respectively. Doxorubicin, Bleomycin, Vincristine, Dacarbazine (ABVD) contained regimen was the most common initial treatment regimen and was received by 72% of HL patients and no statistical significant difference was observed in term of ABVD use across HL subtypes (Table1). Hypertension was the most common comorbidity and 7% HL patients had reported concomitant hypertension followed by diabetes (4.4%), hepatitis B (1.9%) and tuberculosis (1.0%) (Figure2). Previous personal history of cancer and family history of cancer were reported by 1.7% and 9.2% of study subjects, respectively (Figure3). Conclusion Compared with Non-Hodgkin's Lymphoma, HL is less common, less aggressive and attracts less attention from researchers. In 2013, only about 700 HL newly diagnosed cases were reported, accounting for 5.4% of total lymphoma patients in the country (He, Chen, Chinese Cancer Registry Annual Report 2016). Although some multi-center studies had reported the pathology distribution of HL (Sun et.al, Am J Clin Pathol 2012; Cao et.al, Ann Diagn Pathol. 2018), very few of them have more detailed information on disease characteristics and treatment. As one of the biggest observational studies focus on HL in the country as well as in the region, this registry provides a unique opportunity and platform to understand the whole picture of HL diagnosis, treatment and prognosis in real world. Disclosures Song: Peking University Cancer Hospital (Beijing Cancer Hospital): Employment. Zhu:Beijing Cancer Hospital: Employment.

Burden of genital warts in Peru: an observational study

Genital warts (GW) are mucosal or skin lesions caused by sexual transmission of human papillomavirus (HPV). This study estimates the frequency of GW cases in physicians’ clinics and physicians’ usual practices of GW referral and diagnosis in Peru. Participants in this study were a convenience sample of 100 physicians in five specialties: primary care (17), gynecology (37), urology (10), dermatology (31), and infectious diseases (5). Physicians completed a survey and daily log of all patients aged 18–60 years seen over ten days in their offices located in Peru. The survey recorded GW referral patterns and the daily log recorded patient demographic information and GW diagnosis. Among 12,058 patients, the annual GW prevalence (95% confidence interval [CI]) was 2.28% (2.02–2.56) and cumulative incidence (95% CI) was 1.60% (1.38–1.84). Physicians reported that most GW patients were direct consult (73.5% of male and 67.9% of females) and physicians treated most GW patients themselves (73.4% of males and 76.7% of females). As reported, the most common reasons for referring were ‘serious cases requiring more specialized treatment’ (73.2% of male and 72.2% of female) and ‘lack of resources to treat’ (26.8% of male and 27.8% of female). We conclude that GW cases are commonly seen by physicians in Peru.

Significant Differences Exist in Patient Demographics of Foot and Ankle Surgeries between High Quality Prospective Studies and National Databases

Category: Trauma Introduction/Purpose: Several high profile studies have compared surgical and non-operative treatments in specific types of major foot and ankle surgeries and serve as management guidelines for many Orthopaedic surgeons. However, the external validity of these studies has not been examined and should be confirmed in order to confidently apply the study conclusions to the national population and modify clinical practice. The purpose of the current study was to compare patient demographic information collected from major high quality, prospective studies in foot and ankle surgeries and from same surgical procedures recorded in a nationwide database of the United States patient population. Methods: Patient demographic information from surgical procedures for achilles tendon rupture, syndesmotic injury, calcaneal fracture, and lisfranc injury were pulled from American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2005 – 2014 by using CPT codes listed in Table I. The same information was collected from several randomized control or prospective cohort studies identified for each type of procedure (Table I). Patient age and body mass index (BMI) were compared by using two sample T-test, while Fisher’s exact test was used to compare patient sex. Study data on age and BMI that did not provide both mean and standard deviation were not included in analysis. Results: In the NSQIP database, 1,633 achilles tendon repair and 8,852 syndesmotic injury cases were identified, but few calcaneal fracture surgeries and no lisfranc injury cases were found. For surgical cases with syndesmotic injury repair, age, sex and BMI all differed significantly between NSQIP data and the aggregate values of published studies, with the NSQIP patients being older and have more females and larger BMI (Tables II-IV). By comparing individual study data with NSQIP, 1 of 3 studies showed the same trend in age, 2 of 3 in sex, and 1 of 1 in BMI. For cases with Achilles tendon rupture repair, both aggregate and individual comparisons with 2 studies showed statistical difference on age, with NSQIP patients being older (Table II). Conclusion: Although the results were somewhat mixed, statistical significance did exist in patient demographic characteristics between published clinical data and a national database in the same foot and ankle surgeries. Caution should be warranted when interpreting clinical studies and before generalizing it onto the national population.

Risk Factors for Elevated Intraocular Pressure on First Day Postoperative Review Following Pars Plana Vitrectomy

Purpose: To assess the relationship between day 1 postoperative intraocular pressure (IOP) and patient demographic information, indication for vitrectomy, lens status, tamponade medium (air, perfluoroethane, sulfur hexafluoride), and laser treatment. Methods: A prospective observational study of all patients undergoing pars plana vitrectomy (PPV) by a single surgeon within 1 case study. All patients had IOP recorded 1 day after surgery. None of the patients had postoperative antiglaucoma medications. All patients undergoing PPV were previously pseudophakic or underwent combined surgery. Results: Of a final cohort of 161 patients, 6% had raised IOP (defined as >30 mm Hg). A parsimonious regression model showed no strong correlation between raised IOP and type of gas tamponade ( P = .028 for C2F6, P = .067 for SF6, air was the reference category) and a moderate association with the number of laser burns ( P = .067). Conclusion: The use of gas tamponade, in particular C2F6, does not constitute justification for pre/postoperative antiglaucoma prophylactic treatment. In addition, we postulate that careful consideration should be given to the frequency of laser burns during PPV.

Impact of Phlebotomy Tourniquet Use on Blood Lactate Levels in Acutely Ill Patients

ObjectiveLactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet.MethodsA prospective cohort study was carried out on emergency department patients whose clinical presentation led a physician to order a lactate level. Written informed consent was obtained from patients or their proxies. Study lactates were obtained using a tourniquet during the draw sequence of other laboratory studies. Lactate levels for clinical use were drawn per hospital protocol with no tourniquet. The time of lactate measurements and patient demographic information were recorded. Lactate levels for each patient were compared with the Wilcoxon Rank-Sum Test.Results40 patients were consented and enrolled. The median clinical lactate level was 1.9 (interquartile range 1.5-2.6), and the median study lactate level was 1.9 (interquartile range 1.4-2.7). There was no difference between paired lactate values (p=0.95).ConclusionsTourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.