PRESTIGE OF THE TEACHING PROFESSION AND THE LEVEL OF INTELLIGENCE DEVELOPMENT AMONG STUDENTS PEDAGOGICAL UNIVERSITIES

The main purpose of this study is an attempt to draw the attention of the scientific community to the problem of the prestige of the teaching profession against the background of the opinion that has developed in modern society about the low level of intelligence of applicants of pedagogical universities. This problem is relevant today for many European countries, including Poland, where the first stage of research was conducted. A wide range of studies conducted by scientists from Poland, Ukraine and Russia (a list of names is given in the text of the article) indicates the continuing interest of the scientific community in the problem of the prestige of the teaching profession. However, there are not enough publications linking the prestige of the profession and the intelligence of students studying in this direction in the scientific environment. Most publications on this topic do not have scientifically confirmed facts, but are based only on emotions and public perception of the problem. Therefore, we decided to conduct a number of studies in the universities of the three listed countries in order to confirm or decline the prevailing opinion about the low intellectual development of applicants of pedagogical universities. Our research (the first stage) was conducted on the basis of the Warsaw University of Natural Sciences among first-year students studying in the direction of "Pedagogy" using survey as a research method, in particular the Raven test. The article publishes only partial results of research conducted at this Polish higher educational institution, which, nevertheless, allow us to refute the thesis about the low level of intellectual development among students of pedagogical directions. These data are presented in comparison with the similar situation in Ukraine and Russia, which allows us to conclude that the prestige of the teaching profession as a pan-European trend is falling (in relation to the countries of the Eastern Europe). The research results also contradict the generally accepted opinion about the low level of intelligence among students of pedagogical educational institutions. Most of them have an average and high level (according to the Raven test), which, however, does not directly affect the prestige of the teaching profession. More than half of the respondents do not intend to work in their primary specialty, but consider pedagogical education prestigious for further career outside of school.

Barriers to Referral for Chimeric Antigen Receptor T Cell (CAR-T) Therapies Among U.S. Community Hematologists/Oncologists (cH/O)

Introduction: As of July 31, 2021, 5 CAR-T therapies have been approved in the U.S. to treat lymphomas (large B cell, follicular, and mantle cell), acute lymphoblastic leukemia, and multiple myeloma. These individualized, autologous cell therapies are expensive; involve complex manufacturing, transportation, and storage requirements; and have a unique set of serious adverse events associated with their use. Thus, the use of CAR-T therapies is limited mainly to tertiary care centers that have been licensed to administer these agents. Over half of all U.S. patients with cancer are treated in community-based oncology practices. Understanding the adoption of novel therapies by community hematologists/oncologists (cH/O) is critical to assessing their future utilization and impact on clinical outcomes in the real-world setting. We have assessed CAR-T adoption among cH/O in lymphoma (Gajra et al. Immunotherapy. PMID: 32552151) and with the expansion in number of agents and indications, we sought to assess the evolution of their use of, referrals for, and barriers to CAR-T therapy. Methods: Between January and April 2021, oncologists from across the U.S. were invited to complete a web-based survey about their CAR-T therapy utilization, referral patterns, barriers experienced, and overall impression of this class of therapy. Participant demographics and practice characteristics were also captured in the survey. Participants were not aware of the specific content of the survey as other areas in hematology/oncology were also addressed. Participants were compensated for their participation. Responses were aggregated and analyzed using descriptive statistics. Results: Of the 371 cH/O invited, 100% completed the survey; 63% identified their primary specialty as hematology oncology and 36% medical oncology. The median time in practice was 16 years with a median of 20 patients seen per day on clinic days. The top 3 hematologic malignancies treated by survey participants are CLL, AML, and B-cell NHL. Among the participants, 72% and 53% have referred patients for CAR-T therapy since the first approval and the preceding 6 months respectively; 16% of those who referred in preceding 6 months, reported that none of their referrals ultimately received the CAR-T product infusion. The top 2 barriers impacting timely referral for these participants include a slow approval process by payers (34%) and a slow intake process at the CAR-T center itself (23%). While patient deterioration is a significant challenge to 40% of the participants, other CAR-T center-related challenges perceived by the participants include the CAR-T product not being manufactured, lack of communication from the CAR-T center during the process, and lack of clear instructions to the referring oncologist about follow-up care. Common perceived barriers to prescribing/recommending CAR-T therapy include lack of long-term survival data (14%), therapy-related toxicity (30%), cumbersome logistics of administration (37%), and cost (39%). Among 309 participants queried about cost, 60% feel the price is acceptable for this breakthrough therapy. To facilitate their prescribing/recommendation of CAR-T therapies, the participants agreed that better support to community providers regarding post therapy management, easier referral process to CAR-T centers, timelier approval from payers, and more long-term clinical trial and real-world data are needed. As more CAR-T therapies gain approval and come to market, additional resources requested by the participants included more financial aid/support for patients (59%), more education for prescribing physicians (53%) and patients (29%), more decision support tools (38%), and better coordination and communication between community physicians and sites of care (37%). Conclusions: Most cH/O surveyed have referred patients for CAR-T therapies in hematologic malignancies but there is room for improvement in the referral and intake process as well as the treatment and post-infusion phase. Significant barriers of logistics and cost are potential deterrents to appropriate use. cH/O would welcome additional resources to aid the utilization of CAR-T. These results can inform stakeholders (manufacturers, payers, hospitals, and practices) regarding the need to improve processes and develop payment models to address cost in order to facilitate access of these agents to the appropriate patients. Figure 1 Figure 1. Disclosures Gajra: Cardinal Health: Current Employment, Current equity holder in publicly-traded company. Jeune-Smith: Cardinal Health: Current Employment. Feinberg: Cardinal Health: Current Employment.

Outcomes of clinical decision support for outpatient management of Clostridioides difficile infection

Objective: To determine the impact of clinical decision support on guideline-concordant Clostridioides difficile infection (CDI) treatment. Design: Quasi-experimental study in >50 ambulatory clinics. Setting: Primary, specialty, and urgent-care clinics. Patients: Adult patients were eligible for inclusion if they were diagnosed with and treated for a first episode of symptomatic CDI at an ambulatory clinic between November 1, 2019, and November 30, 2020. Interventions: An outpatient best practice advisory (BPA) was implemented to notify prescribers that “vancomycin or fidaxomicin are preferred over metronidazole for C.difficile infection” when metronidazole was prescribed to a patient with CDI. Results: In total, 189 patients were included in the study: 92 before the BPA and 97 after the BPA. Their median age was 59 years; 31% were male; 75% were white; 30% had CDI-related comorbidities; 35% had healthcare exposure; 65% had antibiotic exposure; 44% had gastric acid suppression therapy within 90 days of CDI diagnosis. The BPA was accepted 23 of 26 times and was used to optimize the therapy of 16 patients in 6 months. Guideline-concordant therapy increased after implementation of the BPA (72% vs 91%; P = .001). Vancomycin prescribing increased and metronidazole prescribing decreased after the BPA. There was no difference in clinical response or unplanned encounter within 14 days after treatment initiation. Fewer patients after the BPA had CDI recurrence within 14–56 days of the initial episode (27% vs 7%; P < .001). Conclusions: Clinical decision support increased prescribing of guideline-concordant CDI therapy in the outpatient setting. A targeted BPA is an effective stewardship intervention and may be especially useful in settings with limited antimicrobial stewardship resources.

Laparoscopic cholecystectomy: do upper GI and lower GI surgeons have similar outcomes?

Background: Laparoscopic cholecystectomy is operation performed on a regular basis, regardless of surgeon’s primary specialty. Common complications include bile duct injury, bile leaks, bleeding, and bowel injury. In Tier 2 Hospitals, upper GI surgeons will manage patients with non-complex OG and HPB disease including laparoscopic cholecystectomy. The AUGSGBI proposed that laparoscopic cholecystectomy (LC) be performed by surgeons trained in upper GI surgery. NICE guidelines recommend similarly. Concentration of surgical expertise and volumes led to lesser conversions and complications. The aim was to compare the complication rates of consecutive patients undergoing laparoscopic cholecystectomy by upper and lower GI consultants in one hospital. Methods: This was a retrospective observational study. We collected 100 consecutive patients from a list of laparoscopic cholecystectomies performed by upper GI surgeons (UGI) and lower GI (LGI) surgeons. All complications were identified from electronic patient records. Complications were recorded according to the Clavien and Dindo system. Median length of stay (LOS) was recorded and compared between the two groups. Results: There was no difference in between groups with respect to sex, age, length of stay or ASA grade, nor a significant difference in complication rates between surgeons of upper and lower GI surgeons. Conclusions: In this study in a selected group, we did not find any difference in procedure related complications between operations conducted by upper GI and lower GI surgeon groups. However, there appeared to be a higher rate of port closure related complication at the umbilicus in operations performed by the lower GI team.

Adoption of Approved CAR-T Therapies Among US Community Hematologists/ Oncologists

Introduction: Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are chimeric antigen receptor T-cell (CAR-T) therapies approved in the United States (US) for the treatment of relapsed or refractory large B-cell lymphoma (R/R LBCL). Almost half of all patients with cancer are treated in community-based oncology practices in the US. Understanding the adoption of novel therapies by community hematologists/oncologists (cH/O) is critical to assessing their future utilization and impact on clinical outcomes. We sought to study the temporal trends of CAR-T utilization over a year among cH/O and their perceptions regarding the barriers to adoption of CAR-T therapies in R/R LBCL in a descriptive study using survey-based methodology. Methods: Live meetings held in February 2019 (cohort A) and Winter 2020 (November 2019-February 2020, cohort B) convened cH/O of diverse US regions and practice types to better understand perceptions around CAR-T, its utilization in R/R LBCL, and referral patterns. Participants were compensated for participation and submitted responses via web-based pre-meeting surveys and live audience response system. All responses are summarized using descriptive statistics. A subset analysis was performed for the cH/O who were surveyed in both cohort A and cohort B. Results: A total of 59 and 168 cH/O participated in this research study in cohorts A and B, respectively: 61% and 70% of participants identified their primary specialty as hematology/oncology; in a private community practice (50% and 56%), or community practice owned by a hospital or academic center (44% and 24%, p=.003). Both groups reported seeing an average of &gt;20 patients per day. The proportion of cH/O who indicated that they had referred at least one patient for CAR-T therapy for R/R LBCL in the preceding 6 months was 54% and 93% (p&lt;.00001) in cohorts A and B, respectively. The median number of patients referred for CAR-T therapy in the preceding 6 months in cohorts A and B was 1 and 2, respectively. Of those who had referred patients, 32% and 29% indicated that none of the patients referred had yet received the product infusion. Among the 30 physicians who participated at both time points, the percentage of those who had referred a patient for CAR-T in the preceding 6 months was 57% and 41% (p=.25), and the rates of non-receipt of product infusion for all referred patients among these 30 cH/O was 29% and 36% (p=.09) for the 2019 and 2020 timepoints, respectively. The major barriers to utilization of CAR-T therapy identified in cohorts A and B, respectively, included: the cost of the therapy (46% and 64%, p=.01), high toxicity (24% and 38%, p=.07) and lack of long-term survival data (19% and 24%, p=.66). The logistics of CAR-T process were identified by over half (52%) of cH/O as a barrier to utilization in cohort A. This issue of logistics was explored further in cohort B with barriers to intake of patients being attributable to either the payer or the CAR-T center. The payer-specific challenges included slow approval process by payers (27%) and high rates of denials by payers (15%). The challenges specific to the CAR-T center included a slow intake process (23%) and a lack of a CAR-T center in geographic vicinity (13%). Other challenges reported by the participants included deterioration of the patient prior to CAR-T administration (64%) and the lack of communication from the CAR-T center during the process, including lack of instructions to the primary oncologist (14%) and the patient (6%). Conclusions: Overall, the probability of referral for CAR-T therapies in R/R LBCL among cH/O increased over the study period. The proportion of patients unable to receive CAR-T product has remained relatively constant at almost one-third of patients referred. Among physicians who were polled at two timepoints, there does not seem to be increased adoption of CAR-T therapy, though this may arise from the relative rarity of the appropriate patients. High cost and toxicity continue to be potential deterrents to CAR-T consideration and appear to be increasing in significance. These findings can assist manufacturers, payers, and CAR-T centers to focus on modifiable process improvements in patient referral, payer-authorization, and improved intake to facilitate timely access to a potentially curative therapy for patients with R/R LBCL. Disclosures Gajra: Cardinal Health: Current Employment. Hime:Cardinal Health: Current Employment. Jeune-Smith:Cardinal Health: Current Employment. Feinberg:Cardinal Health: Current Employment.

Integrated Primary Specialty Care Access for Adults with Sickle Cell Disease in Delaware

INTRODUCTION A major gap in US care for Sickle Cell Disease (SCD) is a dearth of healthcare providers with expertise in adult SCD management. In 2014 TOVA Community Health launched a community-based primary specialty care clinic in Delaware (DE). The Delaware Department of Health and Social Services found that 96 individual adults in DE with Sickle Cell Disease (SCD) utilized hospital services 99.5% of the time for sickle cell crisis (Anderson et al., 2014). The majority of those adults lived in New Castle County, DE. The dearth of sickle cell hematologist/oncologists for adults in this county may drive them to seek recurrent care through the hospital system. Recognizing this as a nationwide public health crisis, the Delaware Department of Health and Social Services (DHSS) partnered with TOVA Community Health in 2014 to establish an adult primary specialty care clinic medical home in New Castle County, DE. This report describes the progress/impact of an integrated primary specialty clinic for adults with SCD METHODS Prospective/ Retrospective tracking of best practices for SCD are featured in the NIH 2014 guidelines. The staff included a hematologist with expertise in SCD, a primary care provider, an advanced practice nurse, a Social Worker (MSW), a nurse care coordinator, and a community health worker, were funded by Sickle Cell Disease Association of America (SCDAA) and Health Resources and Services Administration (HRSA). From 2014 to 2018, integrated primary specialty care services were provided for 33 discrete patients. RESULTS This first cohort of patients was notable for health complications that may be attributed to the lack of coordinated primary specialty sickle cell care access. Therapeutic counseling, support groups and preventive health maintenance services were measured by: outpatient visits to the clinic, access to disease modifying therapies (hydroxyurea therapy or chronic transfusion therapy), immunizations (Pneumococcal), Depression Screens and Personalized Sickle Care Plans (Table). 21 % percent of the patients had no sickle cell provider and/or hematologist/oncologist other than ED or inpatient care for the 12 months preceding their first visit to our clinic. 48% of the patients received a pneumococcal vaccine (Pneumovax 23 val - n=16/33 and Prevnar 13 - n=7/33) and three (n=3/33) received both Pneumococcal vaccines. 30% percent of the patients (n=10/33 patients) seen were offered access to HU but were not on the drug and 42% (n=14) were prescribed HU. All patients did not have a Personalized Sickle Cell Care Plan prior to receiving services at the Primary Specialty Care clinic. 12% (n=4/33) patients had a diagnosis of Substance Abuse Disorder, 15% (n=5/33) had a diagnosis of Opioid Use Disorder and 3% (n=1/33) had both Substance Abuse and Opioid Use Disorder. 70% (n= 7/10) were male and 30% (n-3/10) were female with a diagnosis of Substance Abuse and/or Opioid Use Disorder. 45% (n=15/33) had a Pain Management Agreement established within the time period at the primary specialty clinic. CONCLUSION The creation of an integrated practice primary specialty care clinic for adults with SCD in New Castle County, Wilmington, DE demonstrates the successful leverage of regional networks that engages an academic institution for telehealth consultation, public health, and community-based organizations to develop an adult SCD primary specialty care model. This safety net clinic provides team based primary specialty care to adults whose only option previously was the hospital and/or emergency room. Unique challenges in managing adult SCD acute and chronic pain were addressed. Overall, this is one model for access to integrated primary specialty care and behavioral health services for persons with SCD across their lifespan. Figure 1. Disclosures No relevant conflicts of interest to declare.

Clinical informatics subspecialists: characterizing a novel evolving workforce

Background The growing complexity of data systems in health care has precipitated increasing demand for clinical informatics subspecialists. The first board certification exam for the clinical informatics subspecialty was offered in 2013. Characterizing trends in this novel workforce is important to inform its development. Methods We conducted an exploratory analysis of American Board of Medical Specialties data on individuals certified in clinical informatics from 2013 to 2019 to review trends and demographic characteristics of current subspecialists. Results 2018 physicians were certified in clinical informatics from 2013 to 2019. The annual number of awarded certifications declined after 2016. The majority of primary certifications held by clinical informaticians were in broad-based medical specialties relative to primarily procedural specialties. Conclusions Disparities may exist within the clinical informatics physician workforce with respect to primary specialty certifications and geographic distribution. There remains a need for the creation of fellowship programs to sustain the growth of this workforce.