Real-world effectiveness of recombinant zoster vaccine in self-identified Chinese individuals aged ≥50 years in the United States

We evaluated the vaccine effectiveness (VE) of two doses of recombinant zoster vaccine (RZV) against herpes zoster (HZ) and postherpetic neuralgia (PHN) in Chinese adults at Kaiser Permanente Southern California (KPSC). Chinese KPSC members were identified based on self-reported ethnicity or self-reported preferred spoken/written language. Those aged ≥50 years who received two doses of RZV 4 weeks to ≤ 6 months apart were matched 1:4 to RZV unvaccinated Chinese members and followed through June 2022; second doses were accrued 6/1/2018-12/31/2020. We estimated incidence and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN). Adjusted VE (%) was calculated as (1-aHR)×100. 3978 RZV vaccinated Chinese members were matched to 15,912 RZV unvaccinated Chinese members. The incidence per 1000 person-years (95% CI) of HZ in the vaccinated group was 1.5 (0.9-2.5) and 10.9 (9.8-12.1) in the unvaccinated group; aHR (95% CI) was 0.12 (0.07-0.21). Adjusted VE (95% CI) was 87.6% (78.9-92.7) against HZ. We identified 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN supporting the real-world effectiveness of the vaccine in this population.

Geographic Trends in Pediatric Psychotropic Medication Dispensing Before and After the Start of the COVID-19 Pandemic

OBJECTIVE

This study examined trends and geographic variability in dispensing of prescription psychotropic medications to U.S. youths before and after the start of the COVID-19 pandemic.

METHODS

Using national data on prescription medication dispensing, the authors performed a cross-sectional study examining the monthly percent change in psychotropic medications dispensed (total N=95,639,975) to youths (ages 5-18 years) in 2020 versus 2019, across medication classes and geographic regions.

RESULTS

For many medications, more were dispensed in March 2020 than in March 2019 and fewer in April-May 2020 versus April-May 2019. Stimulants had the largest decline: -26.4% in May 2020 versus May 2019. The magnitude of the monthly percent change varied by region.

CONCLUSIONS

Fewer psychotropic medications were dispensed to U.S. youths after the start of the COVID-19 pandemic compared with 2019. Although some medication classes rebounded to prepandemic dispensing levels by September 2020, dispensing varied by class and region.

TP7.2.20 Systematic Review and meta-analysis of Interventions for Benign Large Non-Pedunculated Colonic Polyps (BLNPCP)

Aim

To examine the efficacy of treatment options for benign large non-pedunculated colonic polyps (BLNPCP).

Background

BLNPCP may harbour covert malignancy and opinions differ about the optimal treatment modality, be it endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESD), combined endoscopic laparoscopic surgery (CELS) or surgical resection (SR). Despite the widespread availability of endoscopic resection (ER) techniques, rates of surgery in the UK remain high.

Methods

This review is reported in line with PRISMA guidelines (PROSPERO registration: CRD42021148944). EMBASE, CENTRAL, and MEDLINE databases were searched from January 2000 to January 2020 to evaluate interventions for treating BLNPCP in adults. The primary outcome was recurrence, adverse events were secondary outcomes. Meta-analysis was performed using a random effects model expressed as a percentage with 95% confidence interval. Quality assessment was performed using ROBINS-I.

Results

Ten studies (2499 polyps in 2327patients) were included (five assessed EMR, four SR, two CELS, two ESD). All studies were at moderate risk of bias. SR, ESD and CELS had the lowest recurrence rates 0% CI:0-1, 1% CI:0-2 and 2% CI:0-12 respectively. EMR had the highest (15% CI:9-22). SR complication rate was 12% CI:7-19, ESD 12% CI:9-15, CELS and EMR 11% CI:0-45 and 7% CI:5-9 respectively. Rescue surgery for complication or finding of invasive cancer was 17% CI:5-35 for ESD, CELS 14% CI:3-30, EMR 11% CI:7-15, SR 4% CI:2-6.

Conclusion

These data provide information that should be taken into account when considering the choice of intervention. It will allow a more robust shared decision-making process to occur.

1225 How Are Acutely Symptomatic Hernias Repaired in The UK? Surgical Techniques from The MASH Study

Aim

Minimal evidence exists guiding the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. The aim of this study was to explore surgical techniques used in the repair of ASH.

Method

A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position, and whether bowel resection/stoma formation was required.

Results

Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% of patients underwent open repair, 93% under general anaesthetic. Mesh was used in 89% of inguinal hernia repair vs 29% umbilical hernia repair. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% of patients developed an SSI by 30 days, the majority which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery.

Conclusions

This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.

P48 Exploration of variation in Management of Acutely Symptomatic Hernia – results from the MASH practice survey

Introduction

There is minimal evidence to guide the emergency management of groin and abdominal wall hernia. The aim of this project is to understand current variations in clinical practice across the UK when managing common types of acutely symptomatic hernia.

Methods

A survey of clinical practice was developed to explore the management of acutely symptomatic abdominal wall hernia (ASH) including groin (GH), umbilical (UH), and incisional hernia (IH). The survey captured respondent characteristics. It explored preferences in the management of each type of ASH, including factors related to treatment and repair strategy. Surgeons at ST3+ level with a UK practice were invited to participate through Twitter and collaborative networks.

Results

In total, 144 responses were received (response rate 26%). Of these, 62 (43.1%) were Consultant Surgeons, 105 (72.9%) did not have a specialist hernia practice, and 95 (66%) did not follow specific guidelines for emergency hernia repair. There was variation in investigations used e.g. CT required for IH (91%) but less for GH (34.7%) and UH (47.2%). Open repair was preferred in all settings. For GH with ischaemic bowel 76 (52.8%) would suture repair vs. 67 (46.5%) who would use a mesh (64.2% permanent synthetic) this is similar for IH, where 59 (41%) chose suture vs. 71 (49.3%) mesh, although 61.9% favoured biologic mesh for IH. Suture repair was preferred for UH with ischaemic bowel (69.4%).

Conclusion

The survey demonstrates variation in treatment of ASH. Areas which require further exploration include use of mesh and laparoscopy in the emergency setting.

Characteristics of Youths Treated With Psychotropic Polypharmacy in the United States, 1999 to 2015

This study investigates differences in the characteristics of US youths treated with psychotropic polypharmacy and in the psychotropic classes used in combination.

Availability of study protocols for randomized trials published in high-impact medical journals: A cross-sectional analysis

Background:

To improve reporting transparency and research integrity, some journals have begun publishing study protocols and statistical analysis plans alongside trial publications. We sought to assess the overall availability and characteristics of protocols and statistical analysis plans of randomized clinical trials published in the top five (by impact factor) general medicine journals.

Methods:

All randomized clinical trials published in Annals of Internal Medicine, BMJ, JAMA, Lancet, and NEJM in 2016 were identified. For each randomized clinical trial, we searched for protocols and statistical analysis plans on journal websites (including supplementary material) and in the article, for example, a referenced publication or link to trial or institutional website. Characteristics of randomized clinical trials were extracted from the publication and clinical trial registry. A detailed assessment of protocols and statistical analysis plans was conducted in a 20% random sample of randomized clinical trials.

Results:

Protocols were available for 299 (82%) trials, ranging from 50% in BMJ to >95% in NEJM and JAMA. Statistical analysis plans were available for 182 (50%) trials and varied from <10% for Annals of Internal Medicine, BMJ, and Lancet to 92% for NEJM. Of the 76 randomized clinical trials in the 20% random sample, 63 (83%) had a protocol but less than half (31; 44%) included an a priori (dated prior to patient enrollment) version of the protocol. Statistical analysis plans were available for 35 (46%) trials, and only 5 (7%) included an a priori version.

Conclusion:

Protocols and statistical analysis plans are publicly available for the majority of trials. However, the a priori versions of these documents are only available for a minority of trials. More attention must be paid to ensuring the public availability of a priori versions.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Patient consent to publication and data sharing in industry and NIH-funded clinical trials

BACKGROUND

Participants are recruited into clinical trials under the assumption that the research will contribute to medical knowledge. Therefore, non-publication trials-and, more recently, lack of data sharing-are widely considered to violate the trust of trial participants. Existing practices regarding patient consent to publication and data sharing have not been evaluated. Analyzing informed consent forms (ICFs), we studied what trial participants were told regarding investigators' intention to contribute to medical knowledge, publish trial results, and share de-identified trial data.

METHODS

We obtained 98 ICFs of industry-funded pre-marketing trials for all (17) antibiotics approved by the European Medicines Agency and 46 ICFs of publicly funded trials from the National Heart, Lung and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) data repository. Three authors independently reviewed ICFs to identify and extract what was stated or implied regarding: (1) publication of results; (2) sharing de-identified data; (3) data ownership; (4) confidentiality of identifiable data; and (5) whether the trial will produce knowledge that offers public benefit. Consensus was obtained from the two reviewers with the greatest overall agreement on all five measures. Disagreements were resolved through discussion among all authors.

RESULTS

Four (3%) trials indicated a commitment to publish trial results; 140 (97%) did not commit to publishing trial results; six (4%) indicated a commitment to share de-identified data with third party researchers. Commitments to share were more common in publicly funded trials than industry-funded trials (7% vs 3%). A total of 103 (72%) ICFs indicated the trials will or may produce knowledge that offers public benefits, while 131 (91%) ICFs left unstated who "owned" trial data; of those with statements, the sponsor always claimed ownership. Patient confidentiality was guaranteed in 137 (95%) trials.

CONCLUSIONS

Our results suggest that consent forms rarely disclose investigators' intentions regarding the sharing of de-identified data or publication of trial results.

Inaccuracies in measurement of dried milk powders

Infant feeds made up from dried milk are known to be hazardous if the mixture is too concentrated. Tests with five commercial brands of dried milk showed that nurses, midwives, and mothers often made up feeds incorrectly; in most cases the amount of powder used was excessive.Fewer mistakes would be made if scoops were standardized or, better, if the milk was made up in small, accurately weighed packets.