PP89 The Investigation And Development Of A National Formulary Monitoring System Across Wales

IntroductionThe New Treatment Fund (NTF), launched in January 2017, aims to support the faster introduction of new medicines recommended by the National Institute for Health and Care Excellence (NICE) and the All Wales Medicines Strategy Group (AWMSG). The NTF requires seven health boards and one trust to make recommended medicines available within 60 days of any positive recommendation decision. The project goal was to develop a system for demonstrating how monitoring the NTF improves medicines access for the people of Wales.MethodsThe process was derived via a series of task and finish group meetings with relevant stakeholders. The monitoring criteria were agreed through a collaborative expert approach using a nominal group technique. This determined a minimal dataset of formulary status, which included time to formulary addition. Pre-NTF medicines data (n = 59) were available for a six-month period.ResultsBy the three-year milestone of the NTF, the average time taken for newly recommended medicines (n = 219) to become available to patients across Wales had decreased by eighty-five percent from 90 to 13 days (p < 0.01).ConclusionsAn innovative and robust system has been created for accurately monitoring the formulary addition of medicines within the NTF, supporting the rapid and comprehensive uptake of medicines deemed clinically and cost effective by NICE and the AWMSG.

An Individualized Red Blood Cell Transfusion Strategy Using Pediatric Perioperative-Transfusion-Trigger Score Reduced Perioperative Blood Exposure for Children: A Randomized Controlled Clinical Trial

Background The optimal red blood cell transfusion strategy in children remains unclear. We developed an individualized pediatric red blood cell transfusion strategy, and postulated that red blood cell transfusion guided by this strategy in children would reduce blood exposure without compromising patients’ safety. Methods In this randomized controlled clinical trial, 99 children undergoing non-cardiac surgeries who had blood loss of more than 20% total blood volume were randomly assigned to an individualized-strategy group using Pediatric Perioperative-Transfusion-Trigger Score, or a control group. The amount of transfused red blood cells was counted, and patients were followed up for postoperative complications by day-30. This trial was registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR-IRP-16007909, Date:07/02/2016). Results 26 children (53.1%) in individualized-strategy group received transfusion perioperatively, as compared with 37 children (74%) in the control group (p<0.05). During surgery, children in individualized-strategy group were exposed to fewer transfusions than in the control group (0.87±1.03 vs. 1.33±1.20 red-blood-cell units per patient, p<0.05). The incidence of severe complications in individualized-strategy group had the lower trend compare to the control group (8.2% vs. 18%, p=0.160). No significant differences were found in the other outcomes. Conclusion This study proved that transfusion guided by the individualized strategy reduced perioperative blood exposure in children, without increasing the incidence of severe complications. This conclusion needs to be further confirmed by implementing multicenter, large-sample clinical trials. Trial registration The study was registered at http://www.chictr.org.cn/showprojen.aspx?proj=13361 (Registration number: ChiCTR-IRP-16007909, Date:07/02/2016).

Financial control and business strategy in start-up companies: An empirical analysis

This article focuses on the relationship between financial control (FC) techniques and business strategies (BSs). The context of the study is start-up companies in Italy, and the main motivation to consider this context is the very limited extant literature. The authors performed a survey to collect quantitative data from start-up companies, and they also complemented the survey with a series of interviews to collect qualitative data. Results show that the use of different FC techniques does not depend on BSs. As a strategic risk factor, the authors also show that reputation risk differs significantly between the two strategy-based groups, differentiation strategy group and focus strategy group. The interviews conducted with expert entrepreneurs aimed at determining the importance of specific FC techniques and the benefits of adopting them in start-up companies. Overall, the article provides new evidence for the debate about the role of FC techniques in the BSs of the firm.

A q-rung orthopair fuzzy non-cooperative game method for competitive strategy group decision-making problems based on a hybrid dynamic experts’ weight determining model

How to select the optimal strategy to compete with rivals is one of the hottest issues in the multi-attribute decision-making (MADM) field. However, most of MADM methods not only neglect the characteristics of competitors’ behaviors but also just obtain a simple strategy ranking result cannot reflect the feasibility of each strategy. To overcome these drawbacks, a two-person non-cooperative matrix game method based on a hybrid dynamic expert weight determination model is proposed for coping with intricate competitive strategy group decision-making problems within q-rung orthopair fuzzy environment. At the beginning, a novel dynamic expert weight calculation model, considering objective individual and subjective evaluation information simultaneously, is devised by integrating the superiorities of a credibility analysis scale and a Hausdorff distance measure for q-rung orthopair fuzzy sets (q-ROFSs). The expert weights obtained by the above model can vary with subjective evaluation information provided by experts, which are closer to the actual practices. Subsequently, a two-person non-cooperative fuzzy matrix game is formulated to determine the optimal mixed strategies for competitors, which can present the specific feasibility and divergence degree of each competitive strategy and be less impacted by the number of strategies. Finally, an illustrative example, several comparative analyses and sensitivity analyses are conducted to validate the reasonability and effectiveness of the proposed approach. The experimental results demonstrate that the proposed approach as a CSGDM method with high efficiency, low computation complexity and little calculation burden.

Contrast‐Induced Nephropathy in Patients Undergoing Staged Versus Concomitant Transcatheter Aortic Valve Implantation and Coronary Procedures

Background The impact of staged versus concomitant coronary procedures on renal function in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains unclear. Methods and Results Three‐hundred thirty‐nine patients undergoing coronary procedures and TAVI as a staged strategy (160, 47.2%) or concomitant strategy (179, 52.8%) were retrospectively analyzed. Contrast‐induced acute kidney injury (CI‐AKI) occurred in 49 patients in the staged strategy group (30.6%) and in 18 patients (10.1%) in the concomitant strategy group ( P <0.001). Among the staged strategy group, 25 (15.6%) patients developed CI‐AKI after coronary angiography or percutaneous coronary intervention, 17 (10.6%) after TAVI, and 7 (4.3%) after both the procedures. Staged strategy was associated with a higher risk of CI‐AKI (odds ratio, 3.948; P <0.001) after adjustment for multiple confounders and regardless of the baseline renal function ( P for interaction=0.4) when compared with the concomitant strategy. At a median follow‐up of 24.0 months (3.0–35.3), CI‐AKI was not associated with sustained renal injury ( P =0.794), irrespective of the adopted strategy. The concomitant strategy did not impact the overall early safety at 30 days follow‐up after TAVI compared to the staged strategy ( P =0.609). Conclusions Performing coronary procedures with a staged strategy before TAVI was associated with a higher risk of CI‐AKI compared with a concomitant strategy. Moreover, a concomitant strategy did not increase the risk of procedure‐related complications.

Schweres Asthma: Vergleich einer Typ-2-Biomarkerstrategie mit einem Symptom-basierten Algorithmus zur Steuerung der Kortisondosis

<b>Background:</b> Asthma treatment guidelines recommend increasing corticosteroid dose to control symptoms and reduce exacerbations. This approach is potentially flawed because symptomatic asthma can occur without corticosteroid responsive type-2 (T2)-driven eosinophilic inflammation, and inappropriately high-dose corticosteroid treatment might have little therapeutic benefit with increased risk of side-effects. We compared a biomarker strategy to adjust corticosteroid dose using a composite score of T2 biomarkers (fractional exhaled nitric oxide [FENO], blood eosinophils, and serum periostin) with a standardised symptom-risk-based algorithm (control). <b>Methods:</b> We did a single-blind, parallel group, randomised controlled trial in adults (18–80 years of age) with severe asthma (at treatment steps 4 and 5 of the Global Initiative for Asthma) and FENO of less than 45 parts per billion at 12 specialist severe asthma centres across England, Scotland, and Northern Ireland. Patients were randomly assigned (4:1) to either the biomarker strategy group or the control group by an online electronic case-report form, in blocks of ten, stratified by asthma control and use of rescue systemic steroids in the previous year. Patients were masked to study group allocation throughout the entirety of the study. Patients attended clinic every 8 weeks, with treatment adjustment following automated treatment-group-specific algorithms: those in the biomarker strategy group received a default advisory to maintain treatment and those in the control group had their treatment adjusted according to the steps indicated by the trial algorithm. The primary outcome was the proportion of patients with corticosteroid dose reduction at week 48, in the intention-to-treat (ITT) population. Secondary outcomes were inhaled corticosteroid (ICS) dose at the end of the study; cumulative dose of ICS during the study; proportion of patients on maintenance oral corticosteroids (OCS) at study end; rate of protocol-defined severe exacerbations per patient year; time to first severe exacerbation; number of hospital admissions for asthma; changes in lung function, Asthma Control Questionnaire-7 score, Asthma Quality of Life Questionnaire score, and T2 biomarkers from baseline to week 48; and whether patients declined to progress to OCS. A secondary aim of our study was to establish the proportion of patients with severe asthma in whom T2 biomarkers remained low when corticosteroid therapy was decreased to a minimum ICS dose. This study is registered with ClinicalTrials.gov, NCT02717689 and has been completed. <b>Findings:</b> Patients were recruited from Jan 8, 2016, to July 12, 2018. Of 549 patients assessed, 301 patients were included in the ITT population and were randomly assigned to the biomarker strategy group (n = 240) or to the control group (n = 61). 28.4% of patients in the biomarker strategy group were on a lower corticosteroid dose at week 48 compared with 18.5% of patients in the control group (adjusted odds ratio [aOR] 1.71 [95% CI 0.80–3.63]; p = 0.17). In the per-protocol (PP) population (n = 121), a significantly greater proportion of patients were on a lower corticosteroid dose at week 48 in the biomarker strategy group (30.7% of patients) compared with the control group (5.0% of patients; aOR 11.48 [95% CI 1.35–97.83]; p = 0.026). Patient choice to not follow treatment advice was the principle reason for loss to PP analysis. There was no difference in secondary outcomes between study groups and no loss of asthma control among patients in the biomarker strategy group who reduced their corticosteroid dose. <b>Interpretation:</b> Biomarker-based corticosteroid adjustment did not result in a greater proportion of patients reducing corticosteroid dose versus control. Understanding the reasons for patients not following treatment advice in both treatment strategies is an important area for future research. The prevalence of T2 biomarker-low severe asthma was low. <b>Funding</b>: This study was funded, in part, by the Medical Research Council UK.

VERIFICATION OF THE PARETO PRINCIPLE FOR INCOME FROM SCIENTIFIC ACTIVITY OF HIGHER EDUCATION INSTITUTIONS OF UKRAINE

The purpose of the article is to verify the Pareto principle in terms of revenues to the special fund of higher education institutions of Ukraine based on the results of scientific and scientific-technical work on international cooperation projects, scientific and scientific-technical work under economic agreements and scientific services. With the help of ABC-analysis of indicators of income from scientific activity, domestic higher education institutions are divided into three groups: A – higher education institutions with a large amount of income from scientific activities; B – higher education institutions with an average level of commercialization of scientific activity; C – higher education institutions with little or no income from research. It was obtained that group A included 29 (19,595 %) higher education institutions of Ukraine, which in 2016–2018 provided paid scientific services in the amount of UAH 739,747 million (79,39 % of the total). Group B was formed by 34 (22,973 %) domestic higher education institutions, whose scientific activity in the analyzed period brought income in the amount of UAH 147,954 million (15,88 % of the total). Group C included 85 (57,432 %) Ukrainian higher education institutions, which earned UAH 44,082 million (4,73 % of the total) as a result of their scientific work. It was found that the Pareto principle 20/80 was reflected in the activities of higher education institutions in Ukraine. Strategies for commercialization of research results for domestic higher education institutions from each group are proposed: group A – leader’s strategy; group B – the applicant’s strategy; group C – strategy of the beginner.

Predictors to quality of life improvements in patients with chronic coronary total occlusion depending on the selected treatment strategy

Highlights. The impact of clinical, angiographic and procedure-related factors on the quality of life of patients with chronic coronary total occlusions has been reported.Background. The impact of patient-related factors including clinical and angiographic data and procedure-related factors on the quality of life remains debating.Aim. To assess the impact of baseline and procedure-related factors on the quality of life in patients with chronic coronary total occlusion.Methods. 140 patients with chronic single-vessel disease randomly assigned either to the invasive-strategy group or the conservative-strategy group. Quality of life was measured in all patients using the Seattle Angina Questionnaire, European Quality of Life Survey, and Rose Dyspnea Scale after 3 and 12 months. To determine the predictors to the quality of life improvements in both groups, simple and multivariate regression analysis were performed. The baseline clinical, angiographic and procedure-related factors were included in the analysis.Results. The technical success of the procedure was the independent predictor to quality of life improvement in the invasive-strategy group (OR: 5.8, 95%, CI: 3,26-9.18, p = 0.001). The absence of diabetes mellitus (OR: 0.19, 95%, CI: 0.09-0.84, p = 0.04), CTO of other than left anterior descending artery (OR: 2.1, 95%, CI: 1.09-4.0, p = 0.03) and higher SAQ - 7 score at baseline (OR: 1.1, 95%, CI: 1.04-1.21, p = 0.02) independently predicted the improvements in the quality of life. The indicators of quality of life between the subgroups of subintimal and intraluminal recanalization did not differ significantly in the long-term period. The total SAQ-7 score in the subintimal recanalization subgroup was 85.5 ± 9.1 versus 89.3 ± 9.6 in the intraluminal recanalization subgroup (p = 0.21).Conclusion. The decision on the management of patients with chronic coronary total occlusions should be made individually, taking into account baseline clinical and instrumental data. The recanalization technique does not affect the quality of life. Its choice should be made individually in order to achieve technical success.

Current aspects of stable ischemic heart disease. ISСHEMIA study: breakthrough or constant optimism in approaches to treatment. Myocardial ischemia in non-obstructive coronary arteries (INOCA)

Approaches to stable coronary artery disease (CАD) treatment have been subject to debate for a long time. One of the first and fundamental studies in stable coronary artery disease patients treatment is the COURAGE study, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, CAD high prevalence with medical and social significance cause the need for future development of relationship between conservative and invasive approaches in the problem of this disease treatment. It was particularly the focus of recently completed multicentre ISCHEMIA trail. The aim of review is to analyze the available data on the management of stable coronary artery disease patients based on the ISCHEMIA study data. Results. In the largest multicenter randomized clinical trial ISCHEMIA, the primary outcome (cardiovascular death, myocardial infarction, cardiac arrest with effective resuscitation, hospitalization due to heart failure) rate was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The main secondary outcome rate also does not differ between groups significantly. Quality of life in the non-invasive group was higher only in those patients who had angina at baseline. Study subanalysis demonstrated that left coronary artery borderline stenosis accompanied by a poor prognosis, and an invasive strategy improves angina symptoms. Also, low density lipoprotein cholesterol target values achievement predictors were determined. In addition, women, participated in ISCHEMIA study had more frequent angina episodes, regardless less extensive coronary artery damage, and less severe ischemia manifestations than men. Among stable CAD accompanied moderate to severe ischemia and severe chronic kidney disease patients, no evidence initial invasive strategy, compared initial conservative strategy, in relation of death or non-fatal myocardial infarction risk reduction was found. Conclusion: ISCHEMIA trial data demonstrated necessity more carefully stable coronary artery disease patients selection for invasive treatment, taking into account angina pectoris severity and modern antianginal therapy possibilities.

Metacognitive Strategy and Science Problem-Solving Abilities in Elementary School Students

This research aimed to analyze the effect of metacognitive strategies on elementary school students' problem- solving abilities. This research used an experimental method with a quasi-experimental type of research by comparing two groups, namely the groups taught with metacognitive strategies and non-metacognitive strategies. The research subjects consisted of 100 fifth-grade students of elementary school. They were divided into 50 students in the metacognitive strategy group and 50 students in the non-metacognitive strategy group. The analytical technique was used to compare the two groups statistically. The research results showed differences in problem-solving that were taught by using metacognitive strategies and non-metacognitive strategies. Non-metacognitive strategies were better in problem-solving than metacognitive strategies. Problem-solving that had been done in learning was only focused on results. In conclusion, elementary school students needed assistance in the learning process to monitor their knowledge by providing feedback.