Asparaginase Enzyme Activity Levels and Toxicity in Childhood Acute Lymphoblastic Leukemia: a NOPHO ALL2008 study

Asparaginase treatment is a mainstay in contemporary treatment of acute lymphoblastic leukemia (ALL), but substantial asparaginase-related toxicity may lead to jeopardized protocol compliance and compromises survival. We investigated the association between risk of asparaginase-associated toxicities (AspTox) and asparaginase enzyme activity (AEA) levels in 1,155 children aged 1.0-17.9 years, diagnosed with ALL between July 2008 and March 2016 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. Patients with ≥2 blood samples for AEA measurement drawn 14 ± 2 days after asparaginase administration were included (6,944 trough values). AEA was measurable (or above >0 IU/L) in 955 patients while 200 patients (17.3%) had asparaginase inactivation and few AspTox recorded. A time-dependent multiple Cox model of time to any first asparaginase-associated toxicity adjusted for sex and age was used. For patients with measurable AEA, we found a hazard ratio (HR) of 1.17 per 100 IU/L increase in median AEA (95% CI, 0.98-1.41; p=0.09). For pancreatitis, thromboembolism, and osteonecrosis, the HRs were 1.40 (95% CI, 1.12-1.75; p=0.002), 0.99 (95% CI, 0.70-1.40; p = 0.96), and 1.36 (95% CI, 1.04-1.77; p=0.02) per 100 IU/L increase in median AEA, respectively. No significant decrease in the risk of leukemic relapse was found: HR 0.88 per 100 IU/L increase in AEA (95% CI, 0.66-1.16; p=0.35). In conclusion, these results emphasize that overall AspTox and relapse are not associated with AEA levels, yet the risk of pancreatitis and osteonecrosis increases with increasing AEA levels.

Determinants of Compliance With The Implementation of The Covid-19 Health Protocol In The Community of Kediri City

Background: The implementation of the Covid-19 disease prevention health protocol is still a problem in some areas. Many police officers found violations of the Covid-19 prevention health protocol. There are indications that the behavior of the Indonesian people is not ready to face the covid-19 outbreak, which is characterized by four types of behavior, one of which shows non-compliance.Purpose: This study aimed to examine what are the most dominant determinants of knowledge, anxiety, age, gender, and personality type in influencing compliance in implementing the COVID-19 health protocol.Methods: The population in this study is the entire community in the city of Kediri. By using accidental sampling method with a cross-sectional approach. And the sample obtained as many as 114 respondents.Results: The results of the research that have been carried out and analyzed show that the variables of knowledge, personality and anxiety affect health protocol compliance by 57.4% and the rest are influenced by other variables that have not been studied, and the most influencing variable in the study is the knowledge variable in the partial test.Conclusion: Compliance and awareness in the implementation of the covid 19 protocol, there is a need for cooperation from the government to the community so that the spread of covid 19 in Indonesia can be prevented

TP9.2.17Developing Novel Referral Pathways in Emergency Surgery

Introduction In line with the principles of GIRFT and recognising the demand on the Emergency Department (ED) the Acute Surgical Unit (ASU) developed a direct admission pathway entitled ‘ASU Direct’ (ASUD). Nurse led ED triage with adherence to a referral proforma allows direct admission of suitable surgical patients eliminating medical ED review or discussion with the on-call Registrar. Aim Investigate the usefulness of the ASUD pathway and adherence to admission criteria. Method Two retrospective audits of ASUD referrals were completed and compared with concurrent traditional registrar referrals. Inter-departmental discussions occurred between audit cycles. Results Audit 1: 13 days, 150 cases (8 excluded). 75 (53%) referred via ASUD, 67 (47%) via surgical registrar. Sixteen ASUD cases (22%) breached pathway protocols including 3 young women referred without pregnancy tests. Seventeen (25%) cases referred via the Registrar fulfilled ASUD criteria. Documentation complete in 56% of ASUD cases. Audit 2: (3 weeks after feedback) - 10 days, 120 patients (25 excluded). Fifty one ASUD cases (54%) and 44 (46%) registrar referrals. 24% cases breached ASUD criteria, 7 registrar referrals (15%) appropriate for ASUD. ASUD documentation completed in 60% with 100% pregnancy status recorded. Conclusions Proportion of ASUD / registrar referrals remained constant but there were fewer missed opportunities for ASUD. Inappropriate ASUD admissions remained similar. While ASUD worked well for visible pathology, less-so for protocol-driven abdominal pain. Senior ‘front-door’ triage in ED might improve protocol compliance, helping to develop such pathways, observing GIRFT and avoid unnecessary transfer of patients (especially during the COVID pandemic).

Experimental Study to Improves Covid-19 Health Protocol Compliance with High Threat and High Efficacy Poster

This study examines the health campaign of Covid-19 using the extended parallel process model (EPPM) theory. The objective and gap that was successfully filled by this research are to examine the effect of the poster with high threat and high efficacy to obedience to implement Covid-19 health protocol in Indonesia context. In contrast, obedience is divided into aspects of attitude and second aspects of behaviour according to Blass's concept of obedience. This study uses a quantitative approach with an experimental method by grouping respondents into two groups. The first is the treatment group that received a poster. The second is a control group that did not receive any posters. The total number of respondents of this research was 95, representing proportionally by categories of sex and categories of age. This research has met the scientific principles required. This study found that poster with high threat and high efficacy has a significant effect of improving the attitude aspects of obedience to implement Covid-19 health protocol because when respondents saw a poster with high threat and high efficacy, respondents felt that the threat posed by covid-19 was so high that could turn into death, another reason is a poster with high threat, and high efficacy evokes the memory of respondents to remember their relatives, close person or family who have been confirmed positive with Covid-19 virus. This study also found that poster with high threat and high efficacy does not affect behavioural aspects. This means that posters with high threat and high efficacy proved to make changes with the attitude aspects to improve people obedience to implement Covid-19 health protocol but, it has not been proven to change the behavioural aspects.Riset ini meneliti kampanye kesehatan Covid-19 menggunakan pisau analisa teori extended parallel process model (EPPM). Tujuan dan celah yang berhasil diisi dari penelitian ini dibandingkan penelitian terdahulu adalah menguji pengaruh pemberian poster ancaman tinggi dan efikasi tinggi terhadap kepatuhan protokol kesehatan Covid-19 dalam konteks Indonesia, adapun kepatuhan dibagi ke dalam dua aspek yakni aspek sikap dan aspek perilaku sesuai konsep kepatuhan Blass. Penelitian ini menggunakan pendekatan kuantitatif yakni metode eksperimen dengan membagi responden ke dalam dua kelompok yang pertama adalah kelompok perlakuan/treatment yang mendapat poster dan kedua adalah kelompok kontrol yang tidak mendapat poster, jumlah responden sebanyak 95 yang mewakili masing-masing kategori jenis kelamin dan kategori usia secara proporsional. Riset ini telah dilaksanakan mengacu pada kaidah-kaidah ilmiah. Hasil penelitian menemukan bahwa pemberian poster ancaman tinggi dan efikasi tinggi berpengaruh signifikan meningkatkan aspek sikap kepatuhan protokol kesehatan Covid-19 karena saat melihat poster ancaman tinggi dan efikasi tinggi responden merasa ancaman yang ditimbulkan oleh Covid-19 amat besar hingga dapat menimbulkan kematian, alasan lain yakni poster ancaman tinggi dan efikasi tinggi membangkitkan memori responden yang teringat orang dekat, kerabat maupun keluarga yang pernah terkonfirmasi positif virus Covid-19. Penelitian ini juga menemukan bahwa poster ancaman tinggi dan efikasi tinggi tidak berpengaruh terhadap aspek perilaku. Artinya pemberian poster ancaman tinggi dan efikasi tinggi terbukti mengubah aspek sikap untuk lebih mematuhi protokol kesehatan Covid-19 tetapi, tidak terbukti mengubah aspek perilaku.

Application of a composite measure of product adherence, protocol compliance, and semen exposure to a phase III microbicide HIV prevention trial

Background Strict adherence to antiretroviral-based microbicide use is important for effective HIV prevention. We previously developed a composite measure of product adherence, protocol compliance, and semen exposure for determining vaginal use of tenofovir (TFV) 1% gel applicators through biomarkers and residual drug analyses. In this study, we tested the ability of the composite measure in vaginally used TFV gel applicators from a Phase III HIV prevention clinical trial. Methods Used vaginal gel applicators from the FACTS 001 study were swabbed for detection of vaginal bacterial markers (vaginal insertion), semen DNA markers (semen exposure), and residual TFV gel (product use). Results Of 1,098 evaluable TFV and placebo applicators, 80% had detectable vaginal insertion biomarkers and 52% had semen biomarkers. Ninety-nine percent of vaginally inserted applicators TFV applicators had detectable residual TFV as measured by liquid chromatography with tandem mass spectroscopy (LC–MS/MS). Residual TFV levels were also successfully detected using Fourier Transform Infrared (FTIR)-based spectroscopy. Conclusions Vaginal insertion and semen exposure biomarkers were detectable on used TFV 1% gel applicators. Residual TFV on these gel applicators was detectable by LC–MS/MS and FTIR-based spectroscopy, which has potential to be a more convenient and quicker method for detecting drug use. With continual improvements, this composite measure of product adherence, protocol compliance, and semen exposure has potential to assess use of not only TFV gel but also other topical microbicides or products.

773 The Impact of Introducing an Enhanced Recovery Nurse Practitioner on Colorectal ERP Protocol Compliance and Surgical Outcome: A Single-Unit Experience

Introduction The enhanced recovery programme (ERP) is a validated perioperative care plan that has consistently shown to reduce morbidity and improve patient outcomes. Our trust introduced ERP for major elective colorectal procedures in 2007. However, it had been noted that compliance to protocol was variable. This audit was conducted to see if introduction of an enhanced recovery nurse (ERN) improved compliance. Method This was a single-centre, retrospective, closed-loop audit; each cycle consists of resectional cases over a 1-year period. Perioperative data were collected from preoperative assessment documents, anaesthetic charts, operation notes and post-operative patient records. Compliance to 20elements of the agreed ERP protocol and length of stay (LOS) were assessed. First-cycle results were presented locally, leading to protocol revision and introduction of a dedicated ERN. Two years following ERN introduction, data were re-audited and compliance assessed. Statistical analyses were performed using Chi-squared test or independent t-test as appropriate. Results Among 101 procedures analysed in the first-cycle, compliance to ERP elements ranged between 30-95%. Following intervention, among 113 cases, compliance improved to 46-99%. Statistically significant improvements were observed in post-operative ERP elements. Compliance to early cessation of intravenous fluids increased from 44% to 61% (p = 0.02), and early urinary catheter removal increased two-fold, from 30% to 62% (p < 0.01). Patients resumed light diet earlier and mobilised out of bed sooner. LOS improved from median of 7(1-48) to 6(2-50) days (p = 0.03). Conclusions This study demonstrates that the introduction of a dedicated ERN is associated with significantly improved protocol compliance and reduced LOS following major colorectal resection.